We report on the use of the Ilizarov method to treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and five AO 42B3 fractures) in adults. There were 28 men and 12 women with a mean age of 43 years (19 to 81). The series included 19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21 closed injuries. The mean time from injury to application of definitive Ilizarov frame was eight days (0 to 35) with 36 fractures successfully uniting without the need for any bone-stimulating procedure. The four remaining patients with nonunion healed with a second frame. There were no amputations and no deep infections. None required intervention for malunion. The total time to healing was calculated from date of injury to removal of the frame, with a median of 166 days (mean 187, (87 to 370)). Minor complications included snapped wires in two patients and minor pin-site infections treated with oral antibiotics in nine patients (23%). Clinical scores were available for 32 of the 40 patients at a median of 55 months (mean 62, (26 to 99)) post-injury, with ‘good’ Olerud and Molander ankle scores (median 80, mean 75, (10 to 100)), ‘excellent’ Lysholm knee scores (median 97, mean 88, (29 to 100)), a median Tegner activity score of 4 (mean 4, (0 to 9)) (comparable to ‘moderately heavy labour / cycling and jogging’) and Short Form-12 scores that exceeded the mean of the population as a whole (median physical component score 55 (mean 51, (20 to 64)), median mental component score 57 (mean 53, (21 to 62)). In conclusion, the Ilizarov method is a safe and reliable way of treating complex tibial shaft fractures with a high rate of primary union

This study aimed to determine the long-term functional, clinical and radiological outcomes in patients with Schatzker IV to VI fractures of the tibial plateau treated with an Ilizarov frame. Clinical, functional and radiological assessment was carried out at a minimum of one year post-operatively. A cohort of 105 patients (62 men, 43 women) with a mean age of 49 years (15 to 87) and a mean follow-up of 7.8 years (1 to 19) were reviewed. There were 18 type IV, 10 type V and 77 type VI fractures. All fractures united with a mean time to union of 20.1 weeks (10.6 to 42.3). No patient developed a deep infection. The median range of movement (ROM) of the knee was 110. o. and the median Iowa score was 85. . Our study demonstrates good long-term functional outcome with no deep infection; spanning the knee had no detrimental effect on the ROM or functional outcome. . High-energy fractures of the tibial plateau may be treated effectively with a fine wire Ilizarov fixator. Cite this article: Bone Joint J 2015;97-B:1693–7

Aims. Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. Methods. We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. Results. The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. Conclusion. We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470–477

Introduction. Traditionally, radiological union of fractures treated with an Ilizarov frame is confirmed by a period of dynamization - destabilisation of the frame for a period prior to removal. Reduced clinic availability during the COVID-19 pandemic caused a shift to selective dynamisation in our department, whereby lower risk patients had their frames removed on the same day as destabilisation. This study investigates the effects of this change in practice on outcomes and complication rates. Materials & Methods. Adult patients treated with circular frames between April 2020 and February 2022 were identified from our Ilizarov database. Patients were divided into 2 groups: - “dynamised” if their frame was destabilised for a period to confirm union prior to removal; or “not dynamised” if the decision was taken to remove the frame without a period of dynamisation, other than a short period in the clinic. A retrospective review of clinical notes was conducted to determine outcome. Results. 175 patients were included in the final analysis, 70 in the dynamised and 103 in the not dynamised groups, median follow-up was 33 months. 3 patients in the dynamised group failed dynamisation and had their period of fixation extended, subsequently having their frames removed without complication. Two patients suffered a refracture or non-union after frame removal in the dynamised group and none in the not dynamised group, this difference was not statistically significant. Conclusions. In our practice, selective frame removal without a period of dynamisation appears safe. This has the potential to shorten frame time and reduce the number of clinic appointments and radiographic investigations for these patients. Some patients find the period of dynamisation uncomfortable and associated with pin site infection, which can be avoided. We plan to continue this practice and collect further data to confirm these findings in a larger dataset

Introduction. The aim of the study is to evaluate the results of using Ilizarov technique for correcting the post traumatic lower limb deformities. Materials and Methods. This prospective study included 25 femurs (Group A) and 65 tibias (Group B) underwent correction with Ilizarov technique and frame. Both groups had moderate and complex deformed segments. Outcomes were Ilizarov correction time, distraction index (DI), consolidation index (CI), Ilizarov index (II) and complications. Results. Within group A, mean correction of frontal plane deformity was 15°, sagittal plane was 10° rotational deformity was 20°. In group B, mean correction of frontal plane deformity was 19°, sagittal plane was 12° and rotational deformity was 10°. Conclusions. Ilizarov provided easy, accurate and excellent lower limb deformity correction and lengthening

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. Pilon fractures are complex, high-energy, intra-articular fractures of the distal tibia. Achieving good outcomes is challenging due to fracture complexity and extensive soft tissue damage. The purpose of this study was to determine the long-term functional and clinical outcomes of definitive management with fine wire Ilizarov fixation for closed pilon fractures. Materials and Methods. 185 patients treated over a 14-year period (2004–2018) were included. All patients had Ilizarov frames applied to restore mechanical axis and fine wires to control periarticular fragments. CT scans were performed post operatively to confirm satisfactory restoration of the articular surface. All frames were dynamized prior to removal. Patients' functional outcome was assessed using the validated Chertsey Outcome Score for Trauma (“COST”). Review of clinical notes and imaging was used to determine complications and time to union. Results. The mean functional outcome in the studied cohort was determined to be “average” on the “COST” score. Poorer functional outcomes were associated with younger age at time of injury and multi-fragment fracture patterns. Mean time in frame was 170 days. Complication rates were low. There were no deep infections, no amputations and only 8 patients went on to have ankle fusions. Conclusions. Good functional results and low complication rates can be achieved by managing pilon fractures with fine wire Ilizarov fixation. Nonetheless, at time of injury patients should be counselled as to the severity of the injury and impact on their functional status

Background. It is an accepted fact that Ilizarov frames are difficult to live with. Professionals advise patients that things get easier over time, but, there is little evidence to support this. This study examined the course of patient's self-reported anxiety and depression during treatment with an Ilizarov frame. Method. Over 12 months, 66 trauma and elective patients were prospectively recruited to the study. Patients completed validated questionnaires measuring anxiety and depression (GAD-7 and PHQ-9) at set time points through their treatment ranging from before the frame was fitted through to after it was removed. Results. Complete data sets were collected for sixty patients. Two patients were unable to be included and four have yet to complete treatment. There is a trend towards decreasing anxiety and depression throughout the period evaluated. However, of seven patients who scored within the ‘severe’ range (PHQ/GAD = 15+) before the Ilizarov frame was applied, four remained in the ‘severe’ range at the treatment end. Conclusion. We have shown that psychological screening can be easily incorporated into standard practise, and found that early screening of psychological distress can identify the small but significant group of patients who go on to have prolonged adverse psychological reactions

Aims. Ilizarov described four methods of treating non-unions but gave little information on the specific indications for each technique. He claimed, ‘infection burns in the fire of regeneration’ and suggested distraction osteogenesis could effectively treat infected non-unions. This study investigated a treatment algorithm for described Ilizarov methods in managing infected tibial non-union, using non-union mobility and segmental defect size to govern treatment choice. Primary outcome measures were infection eradication, bone union and ASAMI bone and function scores. Patients and Methods. A consecutive series of 79 patients with confirmed, infected tibial non-union, were treated with one of four Ilizarov protocols, consisting of; monofocal distraction (26 cases), monofocal compression (19), bifocal compression/distraction (16) and bone transport (18). Median non-union duration was 10 months (range 2–168). All patients had undergone at least one previous operation (mean 2.2; range 1–5), 38 had associated limb deformity and 49 had non-viable non-unions. Twenty-six cases (33%) had a new simultaneous muscle flap reconstruction at the time of Ilizarov surgery and 25 had pre-existing flaps reused. Treatment algorithm based on assessment of bone gap and non-union stiffness, measured after resection of non-viable bone. Results. The treatment algorithm was easy to apply, being based on easily assessable criteria. Infection was eradicated in 76 cases (96.2%) at a mean follow-up of 40.8 months (range 6–131). All three cases of infection recurrence occurred in the monofocal compression group. They required repeat excision and Ilizarov distraction in two cases and below-knee amputation in one. Union was achieved in 68 cases (86.1%) with the initial Ilizarov methods alone. Union was highest amongst the monofocal distraction and bifocal compression/distraction groups, 96.2% and 93.8% respectively. Mean external fixator time was 7.5 months (range 3–17). Monofocal compression was successful in only 73.7% of mobile non-unions, with significantly lower ASAMI scores and a 26.3% re-fracture rate. Bone transport secured union in 77.8% (14/18) but with a 44.4% unplanned reoperation rate. However, after further treatment, infection-free union following bone transport was 100%. Conclusion. We cannot recommend Ilizarov monofocal compression in the treatment of infected, mobile non-unions. Distraction (monofocal or bifocal) was effective and is associated with higher rates of union and infection clearance

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. Materials and Methods. This case study was conducted at Dr. D. Y. Patil Medical Hospital, Navi Mumbai, Maharashtra, India. The study involved 10 patients with a non-union or gap > 6 cm after tibial fracture. 3 rings were used in the setup for the treatment of all the patients. Wires were passed percutaneously through the bone using a drill and the projecting ends of the wires were attached to the metal rings and tensioned to increase stability. The outcome of the study was measured using the Oxford Knee scoring system, Functional Mobility Scale, the American Foot and Ankle Score and Visual Analog Scale. Further, follow up of patients was done upto 2 years. Results. All the patients demonstrated good fixation as was assessed clinically and radiologically. 9 patients had a clinical score of > 65 which implied fair to excellent clinical rating. The patients showed good range of motion and were highly satisfied with the treatment as measured by different scoring parameters. Conclusions. In this case study, we demonstrate that the Ilizarov technique using 3 rings is equally effective in treating non-unions > 6 cm as when using 4–5 rings. Obtaining good clinical outcome and low complication rate in all 10 patients shows that this modified technique can be employed for patients with such difficulties in the future

Cubitus varus and valgus are the most common complications of supracondylar and lateral condylar fractures. Various combinations of osteotomy and fixation have been described to correct these deformities but each is associated with significant complications. In this study, we used distraction osteogenesis and Ilizarov frame fixation to treat 24 elbows in 23 patients with cubitus varus or valgus. Their clinical outcome was evaluated using the protocol of Bellemore et al. The mean time to follow-up was 18.3 months (10 to 36) and the mean time to frame removal was 13.5 weeks (8 to 20). The mean carrying angle was corrected from −18.7° (−10° to −30°) to 6.1° (2° to 10°) in patients with cubitus varus and from 36.5° (25° to 45°) to 9.4° (4° to 15°) in patients with cubitus valgus. There were 18 excellent and six good results. The Ilizarov method with gradual distraction is a safe, stable, adjustable and versatile method of treating deformities at the elbow without the problems of an unsightly scar or limited range of movement, and gives a good clinical and radiological outcome. Tardy ulnar nerve palsy should be treated first by anterior transposition

The purpose of this study was to assess the impact of Ilizarov frame fixation and total contact casting on the complications of Charcot arthropathy. The diabetic charcot foot or ankle is a potentially limb threatening disorder. This progressive disorder is characterised by osteopenia, bone fragmentation and joint subluxation. The risk of significant deformity and osteomyelitis lead to high rates of amputation in these patients. We analysed patients with acute charcot arthropathy attending the Rowley Bristow Unit between 2008 and 2012. We assessed 48 patients with a mean age of 59 years. Mean follow up was 24 months. 12 patients were managed with Ilizarov frame fixation and 36 using total contact casting. The duration of management was determined using serial infrared temperature monitoring to ensure the temperature of the limb normalised before patients were deemed safe to remove their immobilisation. The mean duration of Iliazarov frame fixation was 6.2 months and 5.3 months duration for total contact casting. In the Ilizarov group pin site infections were common and treated with a short course of antibiotics. In total one patient required below knee amputation following Ilizarov frame fixation. No patients suffered with osteomyelitis. We feel that prompt management of acute charcot arthropathy with either total contact casting where appropriate or Ilizarov frame fixation can reduce serious complications of this disorder

Introduction: Ilizarov frames are widely used as an external fixation system. Whether applied for trauma, bone transport or deformity-correction they are usually applied for a minimum of three months and can be used for over a year. The psychological and lifestyle impact of frames has been shown to be significant. Purpose: We examined the informational needs of patients with Ilizarov frames pre and post-operatively. We then assessed how these needs are met by the provision of a nurse-led support group. Methods: All patients with Ilizarov frames applied at Hope Hospital, Manchester were contacted by postal questionnaire. Questions were asked about preparation before surgery, changes to lifestyle and information received. Specific questions were asked about attendance at the nurse-led Ilizarov support group. Results: Thirty-seven patients replied. Twenty-two had frames on and fifteen had recently had them removed. Most patients reported feeling well prepared before surgery regarding the likely impact on their lives. Two-thirds (twenty-five) felt they had received adequate information. Three-quarters (twenty-six) patients had attended the Ilizarov support group and most (twenty-one) had attended the group pre¬operatively. Over three-quarters of patients agreed they would attend the group with a “frame problem” before attending their own GP. All patients found the group supportive and felt comfortable discussing their problems. Conclusion: The Ilizarov Support Group is a useful resource for people with frames. The group atmosphere is supportive to patients and it is a valuable problem-solving environment. It helps patients prepare for their surgery and reduces attendance to primary care providers for frame related problems. We suggest other Ilizarov units may benefit from the provision of such a service

The present study was conducted to evaluate the cost of physiotherapy both for inpatient and outpatient services. Significant physiotherapy resources are required to rehabilitate patients with an Ilizarov or Taylor Spatial Frame (TSF). Within Hull and East Yorkshire Hospitals NHS Trust Physiotherapy department the average number of outpatient treatment sessions per routine patient is 6. In comparison, the average number of treatment sessions required for a patient with an ilizarov (or TSF) is 24 for a trauma patient and 33 for a patient undergoing an elective procedure. Seventy three (73) patients received physiotherapy treatment with an Ilizarov frame or a Taylor spatial frame between April 2008 and April 2010. Physiotherapy input was recorded (in minutes) for the patients identified. This included treatment received as an inpatient as well as an outpatient (if the patient received their treatment within Hull and East Yorkshire NHS trust). Data collection was divided into either trauma or elective procedure for analytical purposes. The average cost of physiotherapy treatment to Hull and East Yorkshire Hospitals NHS Trust for an inpatient with an ilizarov frame is £121.82 per case (trauma) and £133.15 per case (elective). The average cost of physiotherapy treatment to Hull and East Yorkshire Hospitals NHS Trust for an outpatient for a trauma case was calculated as £404.65 and £521.41for an average elective case. This is in comparison to a routine patient costing the service £60.29 (when treated by a Band 7 physiotherapist). The present study gives valuable data for future business planning and assistance with the setting of local or national tariffs for the treatment of this patient group

Aims. To investigate a treatment algorithm of various Ilizarov methods in managing infected tibial non-union. Patients and Methods. A consecutive series of 76 patients with infected tibial non-union were treated with one of four Ilizarov protocols, consisting of; monofocal distraction (25 cases), monofocal compression (18), bifocal compression/distraction (16) and bone transport (17). Median duration of non-union was 10.5 months (range 2–546 months). All patients underwent at least one previous operation, 36 had associated limb deformity and 49 had non-viable non-unions. Twenty-six cases had a new muscle flap at the time of Ilizarov surgery and 24 others had pre-existing flaps. Results. Infection was eradicated in 74 cases (96.1%) at a mean follow-up of 42 months (range 8–131). Both infection recurrences were in the monofocal compression group. Union was achieved in 66 cases (86.8%) with the initial Ilizarov method alone. Union was highest amongst the monofocal distraction and bifocal compression/distraction groups, 96% and 93.8% respectively. Monofocal compression was successful in only 77.8% of mobile non-unions. Bone transport secured initial union in 76.5% with a 47% unplanned reoperation rate. However, following further treatment union was 100% in the bone transport group compared to 88.9% in the monofocal compression group. Six cases sustained a refracture, with 5/6 occurring in the monofocal compression group, representing a 27.7% refracture rate. ASAMI scores were also significantly lower for the monofocal compression group. Conclusion. We do not recommend monofocal compression in the treatment of infected, mobile non-unions. Distraction (monofocal or bifocal) was more effective achieving higher rates of infection clearance, lower refracture rates and better ASAMI scores

Aim. Simultaneous use of Ilizarov techniques with transfer of free muscle flaps is not current standard practice. This may be due to concerns about duration of surgery, clearance of infection, potential flap failure or coordination of surgical teams. We investigated this combined technique in a consecutive series of complex tibial infections. Method. A single centre, consecutive series of 45 patients (mean age 48 years; range 19–85) were treated with a single stage operation to apply an Ilizarov frame for bone reconstruction and a free muscle flap for soft-tissue cover. All patients had a segmental bone defect in the tibia, after excision of infected bone and soft-tissue defects which could not be closed directly or with local flaps. We recorded comorbidities, Cierny-Mader and Weber-Cech classification, the Ilizarov method used, flap type, follow-up duration, time to union and complications. Results. 26 patients had osteomyelitis and 19 had infected non-union. Staphylococci were cultured in 25 cases and 17 had polymicrobial infections. Ilizarov monofocal compression was used in 14, monofocal distraction in 15, bifocal compression/distraction in 8, and bone transport in 8. 8/45 had an additional ankle fusion, 7/45 had an angular deformity corrected at the same time and 24 also had local antibiotic carriers inserted. Median time in frame was 5 months (3–14). 38 gracilis, 7 latissimus dorsi and 1 rectus abdominus flaps were used. One flap failed within 48 hours and was revised (flap failure rate 2.17%). There were no later flap complications. Flaps were not affected by distraction or bone transport. Mean follow-up was 23 months (10–89). 44/45 (97.8%) achieved bony union. Recurrence of infection occurred in 3 patients (6.7%). Secondary surgery was required to secure union with good alignment in 8 patients (17.8%; docking site surgery in 6, IM nailing in 2) and in 3 patients for infection recurrence. All were infection free at final follow-up. Conclusions. Simultaneous Ilizarov reconstruction with free muscle flap transfer is safe and effective in treating segmental infected tibial defects, and is not associated with an increased flap failure rate. It shortens overall time spent in treatment, with fewer operations per patient. However, initial theatre time is long and a committed multidisciplinary team is required to achieve good results

Purpose: End results analysis of surgical treatment of posttraumatic bone defects in the lower extremity by Ilizarov method and intramedullary nailing augmentation during consolidation. Materials and method: Between 1990–2000,83 patients with posttraumatic bone defect (femur 26, tibia 57) with an average age of 38 years (11–65y.) were surgically treated. Open fracture was the cause of bone defect in 50 patients (60%). In the rest 33 (40%) patients, the bone defect was the result of a surgical removal of a nonviable bone due to osteomyelitis or infected non-union. The average length of bone defect was 8,5 cm. (4–20 cm.). In all cases corticotomy and application of Ilizarov device was necessary to initiate bone transport. In 26 patients the Ilizarov device was removed during consolidation and interlocking intramedullary nailing was performed. Selection criteria for changing method were: 1) delayed union at the docking site (13 pt.), 2) Intolerance of the Ilizarov device (6 pt.), 3) Angular deformity > 10 degrees (7 pt.). Radiological and clinical assessment was performed periodically. Functional recovery and bone healing were evaluated according to A.S.A.M.I criteria. Results: Forty-eight patients (58%) presented delayed union at the docking site. In 35 patients compression- distraction was necessary to promote union. The rest 13 patients were healed using an interlocking intramedullary nailing. Three refractures needed reapplication of the Ilizarov device. Angular deformity of more than 10 degrees was found in 13 patients. Seven of them needed an osteotomy and intramedullary nailing. All bone defects were finally covered and solid bone formation resulted. Conclusions: The Ilizarov method offers unique advantages in treatment of bone defects. The use of an interlocking intramedullary nail during consolidation, is a treatment option for delayed docking site union and prolonged treatment time

Open reduction and internal fixation of high-energy pilon fractures are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. A total of 17 consecutive patients with pilon fractures of AO/OTA type 43-B3 (n = 1), type C2 (n = 12) and type C3 (n = 4) were treated by indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov fixator. The calcaneal ring was removed at a mean of 3.7 weeks (3 to 6). A total of 16 patients were available for follow-up at a mean of 29 months (23 to 43). The mean time to healing was 15.8 weeks (13 to 23). Nine patients had pin-track infections but none had deep infection or osteomyelitis. Four patients (25%) had malunion. Fair, good or excellent ankle scores were found in 14 patients. External fixation with a ring fixator achieves stable reduction of the fractured fragments without additional trauma to soft tissues. With minimum complications and good healing results, the Ilizarov apparatus is particularly useful for high-energy pilon fractures

Aims. We wished to examine the effectiveness of tibial lengthening using a two ring Ilizarov frame in skeletally immature patients. This is a potentially biomechanically unstable construct which risks the loss of axial control. Patients and Methods. We retrospectively reviewed a consecutive series of 24 boys and 26 girls, with a mean age of 8.6 years (4 to 14), who underwent 52 tibial lengthening procedures with a mean follow-up of 4.3 years (4.0 to 16.9). Tibial alignment was measured before and after treatment using joint orientation lines from the knee and a calculation of the oblique plane axis. Results. The mean percentage length gain was 20% (13 to 31) with a mean bone-healing index (BHI) of 34 days per centimetre (20 to 54). Age at surgery and location of the osteotomy site showed a strong relationship as the location of the osteotomy migrated more proximally with age. However, no significant correlation was found between BHI and the position of the osteotomy. The coronal and sagittal joint orientation of the lengthened tibias were within the normal range in 67% and 92% of cases, respectively. The oblique plane angulation calculation revealed a statistically significant change pre- to post-operatively in both magnitude (p < 0.05) and direction (p < 0.01), but without clinical consequence. The majority of complications were minor (n = 40 in 27 patients; 1.48 complications per segment lengthened) with no residual disability reported. Conclusion. Two-ring tibial lengthening is effective in maintaining segmental alignment, efficient in callous production and relatively comfortable for the patient with few significant complications. Cite this article: Bone Joint J 2016;98-B:1276–82

Background:. Developing a successful outpatient service for Ilizarov frame removal provides both patient and cost benefits. Misinformation and patient trepidation can be detrimental to recovery and influence choices. Education may play an important role in tailoring an efficacious service. Objective:. Review Belfast Regional Limb Reconstruction frame removal practice, introduce changes aimed at improving care and evaluate effects. Methods:. 1 year retrospective review of Ilizarov frame removal. Evaluation of service prior to and following provision of a new patient information leaflet, alongside a test wire removal technique. Subsequent service evaluation supplemented via patient reported feedback questionnaire. Results:. Retrospectively 85% Ilizarov frames removed in clinic, 54% required Entonox. Annual cost £19000. 46% patients unaware of process, gathering information from unprofessional sources. General anaesthetic and analgesic requirements related to psychosocial influences; no correlation between fracture configuration, elective reconstructive cases and operative techniques. Prospectively 96% patients found information leaflet educational and beneficial. 87% Ilizarov frames removed in clinic. 100% patients who had outpatient removal recommend this method. Entonox use reduced to 15% with average pain score 4.6/10 without analgesia. Patients felt happier. Projected annual cost savings £3000. 100% rated service excellent. Discussion:. Professional education and a standardised outpatient removal process for Ilizarov frames, delivered by a dedicated specialist team, reduces morbidity and positively impacts service provision