Aim: Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intra-articular calcaneal fractures. Materials and Methods: In a period of 5 years (2004–2008), 26 patients with 29 intra-articular fractures of calcaneus (eighteen type III and eleven type IV according to Sanders classification) were treated with the Ilizarov fixator. Twenty-one patients were male and five female. The average age was 45 years (range 22 – 67 years). Five fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fixator. Arthrodiatasis and ligamentotaxis, and closed reduction of the subtalar joint were performed in 24 cases. In 5 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients. Results: The mean follow-up period was 2,1 years (range 1 – 4 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 77,4 (range 70–90). Seven patients had limited degenerative radiological findings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. Two of the patients complained of heel pad pain. Nine patients had grade II pin tract infections and were detected from a total of 258 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done. Conclusion: Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fixator is a viable surgical alternative for intra-articular calcaneal fractures

Objectives: Evaluating the efficacy of the Ilizarov fine-wire distraction/compression technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft. Design: A retrospective review of 15 consecutive patients in one centre. Patients and Methods: 15 patients; 14 males, with a mean SNU duration of 13.9 months. Following frame application the treatment consisted of three stages: stage one – the frame was distracted 1mm per day until radiographs showed a 2–3mm opening at the SNU site (mean 10 days); the SNU site was then compressed for 5 days, until the fragments were in contact., the third stage involved immobilization with the Ilizarov fixator for 6 weeks. Results: Radiographic and clinical bony union was achieved in all 15 patients after a mean of 89 days (70–130 days). Mean modified Mayo wrist scores improved from 21 to 86 at a mean follow-up of 37 months (24 –72 months), with good/excellent results in 12 patients. All patients returned to their pre-injury occupations and levels of activity at a mean of 117 days. Three patients suffered superficial K-wire infections, which resolved with oral antibiotics. Conclusions: In these study group with this technique we achieved bony union without the need to open the SNU site and without the use of bone graft

Aim: To study a staged technique for the removal of the Ilizarov fixator following bony union. Method: A prospective case series of all fractures treated by the senior author between May 2005 and May 2007 were reviewed. When patients were able to weight bear pain free with radiological evidence of healing, the frames were dynamised initially by loosening the rods across the fracture site, then by removing all rods across the fracture site and finally the frame was removed under general anaesthetic. Patients were followed up for 6 months clinically and radiologically. Results: Of 39 fractures (38 patients) 37 underwent staged dynamisation. No patients required further, casting, bracing or walking aids after frame removal. There were no incidences of re-fracture, non-union or late mal-union at 6 months follow up. Conclusion: The proposed method of staged dynamisation is a safe and useful technique for confirming fracture union and guiding frame removal

Introduction: Recurrent clubfoot deformity continues to present a problem in pediatric orthopedic practice. Because of the complexity of feet deformation, the correction represents a significant challenge even for orthopedists having experience in work with the Ilizarov device. Materials and Methods: We apply the Ilizarov fixator consisting of a base from two rings on a shin, an anterior support on the foot – the half ring perpendicular to metatarsal bones and a posterior support from the extended half ring attached to the heel. Anterior and posterior supports are attached to the base by standard details of the Ilizarov apparatus and remain unconnected between them. Such a frame design allows independent and simultaneous correction of forefoot and hind-foot deformities. From 1999–2006, 9 patients aged 3–30, 13 feet with recurrent clubfoot were treated with this technique. Three patients were females and 6 were males. Closed correction was perform in 5 cases, mid-foot osteotomy 4 cases triple arthrodesis 4 cases. The average deformity was: forefoot (supination – 30° FFA – 30°) hind foot (supination 35° equinus 40°). Results: The correction commenced on fourth-seventh day after surgery. Corrections of deformity were achieved in all cases. The average correction period was 8 weeks. Fixation after complete correction was 6–8 weeks. Complications included pin-tract infection 16%, flexion contracture of toes – 87.5%, and severe pain during deformity correction 33%. On mean follow-up of 40 months all patients had good functional outcome. Conclusion: Our frame variant is easy to compose, requires only standard components and allows good correction of all foot deformities

A case is reported of an 18-year-old man with a post-traumatic radial shortening of about 10 cm with 40° of radial deviation as a consequence of an epiphyseal arrest that occurred when the patient was 8 years old. In the past the patient and his parents had refused all corrective treatment which would result in a permanent shortening; then a treatment by the Ilizarov external fixator was proposed. The forearm assembly was made by two fixed rings (one proximal and one medial) and one hinged distal ring. A closed corticotomy was performed parallel to the distal ring, whose fulcrum was at the ulnar styloid. Correction and lengthening were obtained by elongating two opposite threaded bars about 0.5 mm per day. Minor revisions were made on an out-patient basis. Time of correction and lengthening was 113 days, followed by 70 days in the fixator and a further 44 days of plaster cast after fixator removal. The complete correction of deformity and concurrent lengthening showed that Ilizarov‘s method is a definite but very demanding option in the treatment of severe deformities of the upper limb

Introduction. The objective of this study is to report the first cases of femoral lengthening in children using Ilizarov fixator. Materials and Methods. We carried out a retrospective study about the cases of femoral lengthening done in 2010 to 2020 in our BARI-ILIZAROV Orthopaedic centre Dhaka. Results. 48 lengthening were done during this period using Ilizarov fixator. The procedure was done incongenital bone diseases in 20 cases and after a distal femoral epiphysiodesis in 10 cases. The mean age at surgery was 12.8 years. Lengthening was required in all patients and an axis correction was required in 16 of 26 cases. The mean lengthening was 5.9 cm. The healing index was 45.5 day/cm (25.5–62). We noticed 8 knee stiffness and 5 broken wires. Knee Stiffness were corrected by Judet'squadricepsplasty and 6 broken wires were replaced by new wires. The goal of lengthening was reached in all cases. The goal of axis correction was reached in 98.5% of cases. Conclusions. Ilizarov technique allows to do accurate lengthening and axis correction and it is a unique reliable external fixator for femoral lengthening in children

Introduction and Objective

Management of gap non-union of the tibia, the major weight bearing bone of the leg remains controversial. The different internal fixation techniques are often weighed down by relatively high complication rates that include fractures which fail to heal (non-union). Minimally invasive techniques with ring fixators and bone transport (distraction osteogenesis) have come into picture as an alternative allowing alignment and stabilization, avoiding a graduated approach. This study was focused on fractures that result in a gap non-union of > 6 cm. Ilizarov technique was employed for management of such non-unions in this case series. The Ilizarov apparatus consists of rings, rods and kirschner wires that encloses the limb as a cylinder and uses kirschner wires to create tension allowing early weight bearing and stimulating bone growth. Ilizarov technique works on the principle of distraction osteogenesis, that is, pulling apart of bone to stimulate new bone growth. Usually, 4–5 rings are used in the setup depending on fracture site and pattern for stable fixation. In this study, we demonstrate effective bone transport and formation of gap non-union more than 6 cm in 10 patients using only 3 rings construct Ilizarov apparatus.

Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intraarticular calcaneal fractures. In a period of 3 years, 16 patients with 18 intraarticular fractures of calcaneus (eleven type III and seven type IV according to Sanders classification) were treated with the Ilizarov fixator. Twelve patients were male and four female. The average age was 42 years (range 25 – 63 years). Three fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fixator. Arthrodiatasis and ligamento-taxis, and closed reduction of the subtalar joint were performed in 14 cases. In 4 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients. The mean follow-up period was 1,5 years (range 1 – 3 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 79,8 (range 72 – 90). Six patients had limited degenerative radiological findings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. One of the patients complained of heel pad pain. Nine (6.25%) grade II pin tract infections were detected from a total of 144 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done. Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fixator is a viable surgical alternative for intraarticular calcaneal fractures

Background: The Ilizarov external fixator has theoretical advantages over conventional revision surgery for the treatment of recurrent clubfoot deformity where scarred tissue planes, abnormal anatomy and impairment of local blood supply are common. Objective: To assess the outcome of treatment of recurrent club-foot deformity using this device. Patients/Methods: The study evaluated Ilizarov external fixator correction of 40 feet in 31 patients. Deformity was idiopathic in 29 patients, associated with constriction bands in 6 patients and was syndromic or associated with a defined neuromuscular disorder in 6 patients. Patients were reviewed clinically and completed questionnaires documenting pain, function and satisfaction before and after treatment at a mean follow-up of 44 months (range 14–131). All patient’s notes and radiographs were examined. Results: Pain and function scores after treatment improved in 67% and 72% of cases respectively. A subjective increase in stiffness was noted in 46%. Patient satisfaction with outcome was 61%, correlating with improved pain and function scores. Pain and function scores were not significantly different in stiff versus non-stiff feet. The overall recurrence rate was 44%, and was highest in the idiopathic group (59%) compared with the constriction band group (17%) and the neuromuscular/syndromic group (0%). Feet with recurrent deformity had been treated with the Ilizarov fixator at a younger mean age (7.8 years) than those feet which did not recur (mean age 12.6 years). 71% of recurrences experienced significant pain post treatment, compared with only 36% of those feet where deformity did not recur. Functional ability was, however, similar in the two groups. Further surgical treatment has been necessary in 6 patients, including 4 further Ilizarov frames. Complications included almost universal minor pin-site infections, flexion contractures of the toes in 5 feet and skin ulceration in 2 feet, 1 requiring a muscle flap. Conclusions: Treatment of relapsed clubfoot with the Ilizarov fixator can improve the appearance of the foot, correlating with improvement in pain, function and patient satisfaction. This must be balanced however against a high recurrence rate, particularly in young idiopathic feet, an increase in stiffness of the ankle, which has implications for future surgery, and the risk of complications inherent in the technique

Purpose: We assess the results of the surgical treatment of intra-articular fractures of the calcaneus using the Ilizarov external fixator. Materials and Methods: During the period of January 2004 to June 2009 we treated 72 intra-articular calcaneus fractures in 68 patients, 51 male and 17 female with a mean age of 34 (range 18–56). The mean follow –up period was 2 years and 10 months (range 3 months to 4 years). All patients received preoperative CT-scan to facilitate classification and pre-operative planning. Of the 72 fractures, 37 (51.4%) were Sanders type II, 30 (41.6%) were type III and 5 (7%) were type IV. The Ilizarov fixator used consisted of 2 rings positioned above the ankle joint and a foot plate. 1.5 and 1.8 mm wires were used, as well as 1.8 mm wires with an olive for the reduction of displaced fragments. Under image intensification and distraction the fracture was reduced and the articular surface was restored as close as possible. Results: The clinical outcome was excellent in 29 patients (40.4%), good in 32 (44.4%), moderate in 7 (9.7%) and poor in 4 (5.5%). As far as the complications are concerned, we had 17 cases of pin track infection treated with the removal of the pins, ankle joint stiffness in 12 patients treated with physiotherapy, 2 patients developed reflex sympathetic algodystrophy, 2 malunion, 8 developed post-traumatic osteoarthritis and 1 of them underwent subtalar arthrodesis. Conclusion: The use of the Ilizarov external fixator for the treatment of intra-articular calcanear fractures has proved itself to be an alternative method to O.R.I.F with similarly good results. Given the fact that the learning curve is relatively steep, it has proven, from our experience, to be a safe and valuable tool for the treatment of these challenging fractures

Vascularized bone grafts (VFG) have brought great benefits in the field of reconstruction of the lower extremity. However, complications such as fracture of the grafted fibula and delayed union are sometimes seen. Not only to prevent these complications but also for stability after fracture of the grafted fibula, the Ilizarov external fixator is a very useful option. We report here the clinical results of cases treated by VFG combined with Ilizarov external fixator for reconstruction of the lower extremity. We have performed 53 vascularized fibula transfers to reconstruct lower extremities. An Ilizarov external fixator was used for the initial immobilization in 7 (2 femur, 5 tibia) and for delayed union or fracture of the grafted fibula in 2 cases of congenital pseudoarthrosis of the tibia. All patients achieved good bone reconstruction. All are able to walk without a brace except for one congenital case. The average period to achieve bony fusion was 13 months in femur cases, 6 months in adult tibia cases and 2 months in congenital cases. The average periods to walk without a brace were 14 months, 8 months and 10 months respectively. However, it took 9 months and 28 months to achieve bony union in the cases with delayed union or fracture of the grafted fibula. In the reconstruction of the lower extremities using VFG, the determining factor in method selection is whether sufficient mechanical support is available. An Ilizarov external fixator for immobilization permits the patient to walk as soon as possible. Dynamization from this semi-rigid external fixator causes bone hypertrophy and improved incorporation of the graft

To determine the effectiveness of Ilizarov external fixator in the treatment of complex fractures of the tibial plateau. From July 2006 to April 2009, we treated 10 patients with the Ilizarov fixator. Six men and four women ranging in age from 31 to 70 (mean age 56.3 years) were evaluated. All patients were preoperatively evaluated with Computed Tomography scans for better preoperative planning. Eight cases had fractures type VI according to Schatzker Classification and 2 cases type V. In all patients fixation included pushing olive wires or simple wires and 2 to 4 frames. In 4 patients minimal invasive open reduction was performed with use of bone allograft. In 2 fractures, we combined the treatment with minimal internal fixation. There was no major complication trans- or postoperatively. The mean follow-up was 16 months (4–30). The mean hospitalization was 8 days and there were no cases of blood transfusion. Mobilization with no weight-bearing was immediately allowed, with partial weight bearing after 2 months and full weight bearing after 3 months. Three patients had minor pin tract complications. The average duration of external fixation was 120 days. All the fractures united and patients achieved full extension with more than 110 degrees of flexion. Ilizarov circular fixation is an alternative method of treatment for these fractures when internal fixation is contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution

Purpose: The vast majority of forefoot infectious in neuropathy patients are plantar ulcers in diabetics. When conservative treatment is unsuccessful, radical treatment may be indicated, but correct choice of the amputation level is essential. The purpose of this work was to evaluate outcome after tibiocalcaneal arthrodesis achieved with an Ilizarof fixator.

Material and methods: The procedure was performed in nine patients between 1991 and 2002. Male gender predominated (seven men). Mean age was 65 years. Eight patients had diabetes and seven of them had complicated mal perforant. Two patients had bilateral involvement so a total of eleven arthrodeses were performed. The procedure began with de-articulation of the Chopard space and talectomy. After high section of the lateral maleolus, the tibia was cut flush with the joint. The calcaneal cut was vertical passing just behind the tarsal sinus. After verticalising the calcaneum, the two cut surfaces were joined. Arthrodesis was maintained with a circular Ilizarof fixator using two rings on the tibia and one on the calcaneum.

Results: At mean 20 months, we reviewed ten arthrodeses. Good results were obtained for seven and failure was observed in three (necrosis = 2 and severe suppuration = 1). All these problems resolved and fusion was achieved at five months on average. The type of diabetes, renal failure, duration of the infection, presence of severe contralateral lesions, and type of germ involved appeared to affect outcome.

Discussion: Alternatives to the Pirogoff procedure include Chopard amputation, with or without subtalar arthrodesis, and Syme amputation. The technique used in this cohort offers several advantages. The circular external fixator avoids the classic cross screwing in an infectious setting. The mechanical properties of the Ilizarof fixator favour healing and bone fusion. Finally, vericalisation of the calcaneum produces a longer stump so excessively anterior cicatrisation, which can be bothersome for the orthesis, is avoided

Conclusion: This surgical technique provides a radical treatment for proximal osteoarticular infections of the forefoot, often observed in diabetics. Indications are exceptional and should be reserved for lesions which are inaccessible to transmetatarsal amputation. The arthrodesis cannot be achieved without healthy talar stock. The procedure produces a long stable stump which is painless and easy to fit.

Osteomyelitis is an inflammatory condition accompanied by the destruction of bone and caused by an infecting microorganism. Open contaminated fractures can lead to the development of osteomyelitis of the fractured bone in 3-25% of cases, depending on fracture type, degree of soft-tissue injury, degree of microbial contamination, and whether systemic and/or local antimicrobial therapies have been administered. Untreated, infection will ultimately lead to non-union, chronic osteomyelitis, or amputation. We report a case series of 10 patients that presented with post-operative infected non-union of the distal femur with or without prior surgery. The cases were performed at Padmashree Dr. D. Y. Patil Hospital, Nerul, Navi Mumbai, India. All the patients’ consents were taken for the study which was carried out in accordance with the Helsinki Declaration. The methodology involved patients undergoing a two-stage procedure in case of no prior implant or a three-stage procedure in case of a previous implant. Firstly, debridement and implant removal were done. The second was a definitive procedure in form of knee arthrodesis with ring fixator and finally followed by limb lengthening surgery. Arthrodesis was planned in view of infection, non-union, severe arthritic, subluxated knee, stiff knee, non-salvage knee joint, and financial constraints. After all the patients demonstrated wound healing in 3 months along with good radiographic osteogenesis at the knee arthrodesis site, limb lengthening surgeries by tibial osteotomy were done to overcome the limb length discrepancy. Distraction was started and followed up for 5 months. All 10 patients showed results with sound knee arthrodesis and good osteogenesis at the osteotomy site followed by achieving the limb length just 1-inch short from the normal side to achieve ground clearance while walking. Our case series is unique and distinctive as it shows that when patients with infected nonunion of distal femur come with the stiff and non-salvage knee with severe arthritic changes and financial constraints, we should consider knee arthrodesis with Ilizarov ring fixator followed by limb lengthening surgery

Purpose: We report our experience with ankle arthrodesis using Ilizarov External fixator in 18 patients with extensive damage of the ankle joint, mainly with post traumatic osteoarthrosis, during the last 7 years. Materials and Methods: The mean age of the patients was 36 years (range 21–54 years). 14 Pts had posttraumatic arthrosis following complicated intraarticular fractures, 3 Pts had extensive osteochondritis dissecance and 1 had failure of union after RAF arthrodesis of ankle. No cases of osteomyelitis of ankle were included in this seria. All procedures were done with open arthrotomy, 6 through lateral approach and 12 through anterior approach. Bone grafting was used in 3 cases due to extensive damage of talar bone. Temporary fixation by Steinman pin was done in all cases after open alignment of ankle joint, and then Ilizarov external fixator was applied, followed by removal of the temporary fixation. Full weight bearing was allowed from the 3. rd. or 4th postoperative day. Time in fixator ranged from 6 to 14 weeks (average 9,5 weeks). Results: Solid arthrodesis was achieved in all cases. 15 patients were free of pain, 2 patients continued to complain of pain due to degenerative changes in subtalar joint which presented before surgery. 1 patient developed RSD and was treated successfully by analgesics and physiotherapy. 5 cases of superficial pin tract infection were observed and treated with antibiotics. There were no cases of deep wound infection in this series. Conclusions: This method has been proven useful for primary arthrodesis of ankle joint, mainly for complicated cases after multiple surgeries, or in patients with advanced post-taumatic changes

This paper describes the outcome of type III pilon fractures of the distal tibia treated primarily with an Ilizarov ring fixator. Only patients with an intra-articular fracture of the tibial plafond on plainradiographs that corresponded to type III pattern with the system of Rfiedi andAllgower were included. There were thirteen patients with a mean age of 45 (range 29–65), twelve males and one female. The mechanism of injury in all the patients was high-speed road traffic accident. Operative fixation consisted of fracture reduction and stabilisation using the llizarov circular frame external fixator and olive tipped wires. Further insult to the already damaged soft tissues was avoided. Bony union was achieved in all cases. Treatment in the frame lasted between 3 and 10 months (average 6. 3 months). Neither deep infection nor soft tissue complications occurred. Outcome measurements included the Olerud ankle score, modified Ovadia and Beals radiological criteria, and the SF-36 Health Questionnaire. Wound and deep infections were successfully avoided and bony union was achieved in all our patients. This compares well with other fixation techniques. The use of the llizarov circular frame external fixator without any additional internal reduction or fixation procedures is a definite option for the treatment of these high-energy injuries

We reviewed in retrospect the preliminary results of ilizarov type fixator for the treatment of severely comminuted calcaneal fractures. Between February 2006 and December 2008 we dealt with six severely comminuted calcaneal fractures in six patients. Two of which were open type Gustillo IIIa. Mean age was 43 years old(28–56 years old) two of which were female and four male. Preoperatively all fractures were checked by x-ray and computed tomography and were all rated as Sanders type IV. The open fractures were treated within 6 hours and the closed ones the following day. After the positioning of the ilizarov tibial and foot frame, an indirect reduction was achieved using the Ilizarov olive wires. Mean follow up was 20 months (9 to 36 months). Results were rated as very good in two patients (33%), good in three patients (50%) and fair in one (17%). So far no re-operation has been required and four of the patients are back to work. We conclude that the ilizarov system, even with indirect reduction can give very promising results in severely comminuted and complex calcaneal fractures whereas internal fixation has questionable success and many complications

Introduction The purpose of this study was to compare the time to union following acute shortening and subsequent lengthening versus Bone Transport using the Ilizarov external fixator. Methods Eighteen patients with tibial non-unions (age range 26 to 63 years) were recruited between March 1995 and September 2001. Three subgroups of six patients each, were formed. Group 1 underwent Acute Shortening and subsequent Lengthening, whereas Group 2 underwent Bone Transport. Group 3 patients had defects < 1 cms but were still high energy injuries, therefore underwent application of a frame. This group was used as a comparison group. A proximal corticotomy was used for distraction osteogenesis. Bone grafting at the fracture or regenerate site was used if required to aid healing. All patients were followed-up to union. All three groups were similar for age, pre-injury health status including cigarette smoking. Ten infected non-unions were present. Most patients had at least two conventional operative interventions prior to referral to us for Ilizarov surgery. The mean bone resection in the Acute Shortening group (Group 1) was 4.6 cms and in the Bone Transport group (Group 2) was 5.9 cms. Patients in Group 2 had more procedures done before union was achieved. This included adjustment of frame/ reinsertion of wires to align transport segment for optimal docking and bone grafting at the docking/regenerate site. Four patients in Group 2 required bone grafting at the docking site compared to none in Group 1. Results Eradication of infection and union was achieved in all patients with average time in frame being 12.1 months in the Acute Shortening group, 17.2 months in the Bone Transport group and 8.0 months in the Frame stabilisation group. Using Paley’s bone result evaluation system, an excellent result was achieved in all patients of all groups. However, patients in the Acute Shortening group had a shorter time to union and needed fewer procedures. Conclusions We recommended that where feasible, acute shortening and lengthening is preferable to bone transport due to shorter union time and fewer procedures undertaken to achieve union. If this is not possible due to large defects, then a combination of acute shortening with transport to bridge the gap should be considered

Introduction: The accepted treatment for unstable displaced tibial shaft fractures in adults is primary closed reduction and intramedullary nailing. However, this method poses a problem when treating young adolescents whose epiphyseal plates have not yet closed. We used the Ilizarov external fixation as an alternative method of treatment for these patients.

Patients and Methods: 13 patients with displaced unstable tibial shaft fractures (11 boys, 2 girls; age 13 to 16 yrs), of which 5 were open (Gustilo I–II), were treated by this method from 1995–2000. The Ilizarov frame was applied to 3 patients within the first 2 days of injury, a further 6 during the 1st week and 4 on the 2nd week or later.

All patients were allowed to weight bear from the first postoperative week. Physiotherapy was started immediately after operation and continued until normal knee and ankle function was regained. Dynamization was done in all cases 2 weeks before removal of frame. Following removal, the patients were advised to use crutches for an additional two weeks.

Results: A good or excellent alignment with full ROM in the ankle and knee joints was obtained in all patients. There were no cases of delayed or non-union. No cases of contractures or nerve injuries were reported. Superficial pin tract infection was seen in 6 patients, treated by antibiotics and local care. No cases of osteomyelitis or deep infection occurred. Length of fixation was 8–15 weeks (mean 11 weeks).

Conclusions: This method permits fixation without danger of injury to the epiphysis in growing adolescents. The stability of the fixator allows early weight bearing and leaves the adjacent joints mobile. There is no necessity for POP after removal of frame. Due to early weight bearing and an unrestricted joint movement less muscle wasting occurs. The healing time is relatively shorter than in other methods of the treatment and the complications rate was low in the presented series.

Aims: To evaluate the clinical outcome of the treatment of severe high-energy war injuries to limbs using circular external þxation frames. Metods: 43 patients after war injuries with 57 high-energy fractures were treated. According to Gustilo and Anderson all fractures were open grade 3B and 3C. There was other major organ trauma in 52,8% of patients. On admission, the fractured bones were stabilized with an AO tubular external þxation frame followed by thorough extensive soft tissue debridement, vascular reconstruction if needed. After 5 to 7 days the tubular þxator is exchanged for a circular frame that allows receiving stability, sufþcient for full weight bearing by minimal invasive þxation and freeing the previously bridged joints, in order to preserve their range of movement. Closed reduction of fractures was performed in most patients by successful implementation of ligamentotaxis and use thin wires with olives. In patients with high-energy Ç ßoating joint È injuries the circular devices were connected by hinges to permit early initiation of joint motions and functional treatment. In patients with upper limb injuries a separate bone þxation was used to allow early ßexion/ extension and pronation/supination motions. Results: In all patients the circular external þxation was the deþnitive treatment. Bone grafting was not necessary in any patient because of compression-distraction possibility. Fracture union was achieved at median time of 8 months (range 3 60). Throughout the period of fracture healing the patients were ambulatory, living at home. Conclusion: The circular þxation frame allows perform successful skeletal stabilization and functional restoration of limbs in patients with extensive bone and soft tissue loss, even in limbs of the risk.