Infected tibial nonunion in children: Is radical debridement mandatory?

Nonunion is a devastating complication of tibial fractures with a debilitating effect. Several studies reporting tibial nonunions in adults are available; however, the reports on infected nonunions in children are scarce. The purpose of this study was to evaluate the results of treating paediatric infected tibial nonunion using Ilizarov fixator without radical resection.

Management of complex long bone nonunions using limb reconstruction system

Background:

Management of complex nonunions is difficult due to the presence of infection, deformities, shortening and multiple surgeries in the past. Complex nonunions are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 30 long bone complex nonunions treated by the limb reconstruction system (LRS).

Materials and Methods:

Between April 2009 and September 2012, we treated 30 cases of complex nonunion of long bone with the LRS. 28 were male and 2 females. Average shortening was 5.06 cm and 14 cases presented with infected implants. Initially we managed with implant removal, radical debridement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 9.68 months. We compressed the fracture site at the rate of 0.25 mm per day for 1-2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved.

Result:

The union occurred in 89.28% cases and eradication of infection in 91.66% cases. Average lengthening done was 4.57 cm. We had 79% excellent, 11% good and 10% poor bony result and fnctional result was excellent in 40% cases, good in 50% and failure in 10% cases using ASAMI scoring system.

Conclusion:

LRS is an alternative to the Ilizarov fixation in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly.     

The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method

The purpose of this study was to demonstrate the effectiveness of the Ilizarov method and circular external fixator in order to eradicate the infection and restore bone union, limb anatomy and functionality in cases with infected nonunion of the tibia following intramedullary nailing.During 7 years nine patients suffering from infected nonunion of the tibia after intramedullary nailing were treated in our department. The series comprised seven men and two women with an average age of 39.7 years (range 21-75 years). The patients had previously undergone an average of 4.8 operations (range 3-6 operations). Active purulent bone infection occurred in all nine patients. Bone defect was present in all patients with a mean size of 5 cm (range 2-12 cm). In three cases with bone defect less than 2 cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2 cm, bifocal consecutive distraction-compression osteosynthesis technique was applied. Three patients required a local gastrocnemius flap. The mean follow-up period was 26.6 months (range 13-42 months). Results were evaluated using Paley's functional and radiological scoring system.Bone union was achieved in all nine patients without recurrence of infection during the follow-up period. Bone results were graded as excellent in five cases and good in the rest four cases. Functional results were graded as excellent in three cases, good in four and fare in two cases. Mean external fixation time was 187.4 days (range 89-412 days) and mean lengthening index was 32 days/cm (range 27-39 days/cm). Complications observed included eight grade II pin tract infections, axial deformity at the lengthening site in two cases and at the nonunion site in another two cases. Ankle joint stiffness was detected in five cases.The Ilizarov method may be an effective method in infected nonunions of the tibia following intramedullary nailing.     

Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合伴骨缺损

目的 探讨Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合的疗效.方法 2000年9月至2006年6月共收治胫骨感染性骨折不愈合伴骨缺损患者14例,男11例,女3例;年龄19～49岁,平均31.9岁;胫骨近端3例,中段8例,远端3例.原始损伤:5例为开放骨折钢板内固定,3例为开放骨折髓内钉内固定,4例为开放骨折外固定架固定,2例为闭合骨折钢板内固定术后所致.患者自受伤至此次治疗时间为2～24个月,平均7.54个月;手术次数平均6次(3～14次).根据Jain骨缺损和感染程度分型:A2型5例,B1型2例,B2型7例.窦道形成10例,骨外露4例;骨外露面积最大7 cm×5 cm,最小2 cm×1 cm;清创后骨缺损长度3～12 cm,平均6.71 cm.14例患者均采用清创联合Ilizarov技术自体骨段延长治疗.结果 14例患者均获8个月～6年(平均20个月)随访,均获稳定骨折愈合.住院时间1～7个月,平均3个月;骨折愈合时间6～12个月,平均7.79个月;骨外固定时间8～14个月,平均9.64个月.并发症:针道感染1例,皮肤过敏1例,骨折畸形愈合再截骨1例,提前矿化再截骨1例,断针1例,无深部感染、骨折不愈合和膝关节僵直发生.根据Paley骨折愈合评分标准:优13例,良1例.结论 Ilizarov骨段延长是治疗胫骨感染性骨折不愈合伴大段骨缺损的一种有效方法.     

Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

Background:

Resection arthroplasty or hip arthrodesis after total hip replacement (THR) can be used to salvage the limb in case with deep infection and severe bone loss. The Ilizarov fixator provides stability, axial correction, weight-bearing and good fusion rates.

Materials and Methods:

We retrospectively assessed the outcomes of 37 patients with severe periprosthetic infection after THR treated between 1999 and 2011. The treatment included implant removal, debridement and a modified Girdestone arthroplasty (29 cases) or hip arthrodesis (seven cases) using the Ilizarov fixator. The Ilizarov fixation continued from 45 to 50 days in the modified arthroplasty group and 90 days in the arthrodesis group. One case was treated using the conventional resection arthroplasty bilaterally.

Results:

Eighteen months after treatment, infection control was seen in 97.3% cases. Six hips were fused as one patient died in this group. Limb length discrepancy (LLD) averaged 5.5 cm. The Harris hip score ranged from 35 to 92 points. Hip joint motion ranged from 10° to 30° in the modified arthroplasty group. All subjects could walk independently or using support aids. No subluxation or LLD progression was observed.

Conclusion:

The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.     

Epidemiology and treatment outcome of congenital pseudarthrosis of the tibia

Purpose

Congenital pseudarthrosis of the tibia (CPT) is a rare disease. Epidemiological data are limited, and treatment of the condition is challenging. The purpose of our study was to gain epidemiological data on the incidence of CPT in Norway and to evaluate the treatment outcome of the disease.

Methods

During the period 1987–2006 22 patients with CPT were born in Norway (11 boys, 11 girls; mean age 15 years, age range 8–24 years) and are included in this study. During the same time period 1,183,380 live-births were registered by the Norwegian Birth Register. Primary surgical treatment was the Ilizarov method in 15 patients, intramedullary nailing in three patients, and plate osteosynthesis in two patients; two patients never developed a fracture and were treated with an orthosis.

Results

The incidence of CPT based on this period was 1:53,000. The rate of primary healing was 66 % for the Ilizarov group. Primary healing occurred in three patients treated with intramedullary nailing and in none of the patients treated with plate osteosynthesis. However, almost all patients required additional surgery due to refracture or deformity correction. Currently, all 12 skeletally mature patients are considered to be healed, whereas two of the skeletally immature patients are still under treatment.

Conclusion

The incidence of CPT in Norway seems to be notably higher than that based on epidemiological data from other studies. Primary healing rates are satisfactory when treated either with an Ilizarov device or intramedullary nailing. Refractures must be avoided, and alignment of the leg must be maintained. Healing is usually achieved before skeletal maturity. However, residual deformities are common.     

Bone Transport for Reconstruction in Benign Bone Tumors

Background

The aim of this study was to assess the results of using the Ilizarov apparatus to transport bones in the treatment of benign bone tumors.

Methods

Seven patients (six males and one female) with benign bone tumors were treated by bone transport with an Ilizarov apparatus at our institution. Their mean age at surgery was 14.4 years (range, 4.8 to 36.9 years). The histological diagnoses were osteofibrous dysplasia (4), giant-cell tumor (1), intraosseous cavernous hemangioma (1), and aneurysmal bone cyst (1). Three radiological indices were used for evaluating the results: an external fixation index, a distraction index, and a maturation index. The bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov classification.

Results

Five patients had bone union at the reconstructed site, one patient had a local recurrence, and the other had a nonunion at the docking site. The mean length of distraction was 7.3 cm (range, 5.1 to 12.1 cm). The mean external fixation index was 26.0 day/cm (range, 19.8 to 32.5 day/cm), the distraction index was 9.6 day/cm (range, 6.8 to 12.0 day/cm), and the maturation index was 14.9 day/cm (range, 8.0 to 22.5 day/cm). Ultimately, the bone and the functional results were rated excellent in six cases and good in one case.

Conclusions

Bone transport using the Ilizarov apparatus is a good treatment option in patients with bone defects after the resection of an active or aggressive benign bone tumor.     

Ilizarov外固定器结合病灶清除及植骨术在治疗感染性骨不连及慢性骨髓炎的应用

【摘要】〓目的〓探讨应用Ilizarov外固定器治疗骨感染和骨不连的技术和经验。方法〓2012年~2013年,对18例骨感染和骨不连病人接受治疗,其中感染性骨不连12例,骨髓炎6例。根据感染的部位和范围预先在患肢安装Ilizarov外固定器,将感染波及的骨干彻底整段切除后,再在缺损段的远或(和)近侧干骺端行一期截骨延长。结果〓16例患者一期伤口痊愈且无破溃,骨愈合良好,随访10个月无骨髓炎复发的表现。2例患者术后1个月再次伤口破溃流脓,提示感染复发,按上述方法重新治疗后愈合。随访12~18个月,所有患者均达到骨性愈合,肢体外观和功能效果令人满意。结论〓应用Ilizarov技术,采用大段病骨切除同时截骨延长的方法是治疗外伤后感染性骨不连与骨髓炎的有效方法,并同时恢复肢体长度和矫正马蹄足畸形。     

Outcome of rail fixator system in reconstructing bone gap

Background:

Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps.

Materials and Methods:

20 patients (17 males and 3 females with mean age 30.5 years) who suffered bone loss due to open fracture and chronic osteomyelitis leading to infected gap nonunion. Ten patients suffered an open fracture (Gustilo type II and type III) and 10 patients suffered bone gap following excision of necrotic bone after infected nonunion. There were 19 cases of tibia and one case of humerus. All patients were treated with debridement and stabilization of fracture with a rail fixator. Further treatment involved reconstructing bone defect by corticotomy at an appropriate level and distraction by rail fixator.

Result:

We achieved union in all cases. The average bone gap reconstructed was 7.72 cm (range 3.5-15.5 cm) in 9 months (range 6-14 months). Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.

Conclusion:

All patients well tolerated rail fixator with good functional results and gap reconstruction. Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.     

Appraisal of the role of external skeletal fixation in the management of sequelae of open tibial fractures

Background:

Severe open tibial fractures are more apt to be followed by complications even with the universally accepted lines of treatment. The present study investigated the role of external skeletal fixation, based on Ilizarov techniques, in the management of the sequelae of open tibial fractures with modifications to meet the requirements of each case.

Materials and Methods:

We reviewed the results of treatment of 148 cases of late presentation with complicated open tibial fractures. Their ages ranged from 12 to 74 years (average, 34 years). Active infection was present in 40 cases. We performed acute shortening and relengthening in 60 cases; excision of nonunion, acute deformity correction, and lengthening for nonunion with deformity in 30 cases; segmental excision and bone transport in 20 cases; gradual deformity correction after osteotomy in 15 cases; and distraction and gradual deformity correction for hypertrophic nonunion with deformity in 23 cases. Ilizarov external fixator was used in 96 (65%) cases, and monolateral fixator was used in 52 (35%) cases. The mean follow-up was 35 months (range 24 to 118 months).

Results:

Fracture union was achieved in all cases (100%). Evaluation of results were based on both objective (clinical and radiological) and subjective criteria and patients'' satisfaction. The results were satisfactory in 139 cases (94%) and unsatisfactory in nine (6%) cases because of residual leg length discrepancy, joint stiffness, and persistent pain.

Conclusions:

The use of external fixation, based on Ilizarov techniques, is invaluable in the management of difficult open tibia fractures. However, the technique should be tailored to the requirements of each case. The functional outcome is predetermined by the soft tissue status before treatment.     

Reconstruction of infected nonunion of the distal humerus by Ilizarov external fixator

BackgroundInfected nonunion of the distal humerus represents a true challenge as the fragment is usually small and difficult for fixation. The aim of the present study is to assess the results of Ilizarov external fixator in management of infected nonunion of the distal third humerus.Material and methodsTwenty-three patients with infected nonunion of the distal humerus were included in this study. The ages ranged from 19 to 58 years with an average of 35 years. Seventeen cases were males and 6 were females. All patients were treated by radical debridement and application of Ilizarov external fixator in one stage surgery.ResultsBony union was achieved in all cases. Bone graft was required in 12 patients with hypotrophic nonunion. The external fixation time ranged from 4 to 9 months with an average of 5.6 months. Infection was controlled in all cases without recurrence during the period of follow up. The complications included pin tract infection in 7 cases, radial nerve injury in one case, elbow stiffness in 4 cases and refracture after frame removal in one case.ConclusionIlizarov external fixator is effective in management of infected nonunion of the distal humerus. The thin tensioned wires produce good grip in the small or osteoporotic bone fragments.     

Ilizarov external fixator: acute shortening and lengthening versus bone transport in the management of tibial non-unions

Eighteen patients with tibial shaft non-unions were treated by the Ilizarov method between March 1995 and September 2001 by the senior author. Three subgroups of six patients each were treated by either acute shortening and lengthening, bone transport or simple stabilisation with a frame. All aspects of non-union, infection, shortening, deformity and bone loss were addressed by using Ilizarov principles. There were 10 cases of infected non-unions in the entire series. Bone resection in the shortening group was between 3 and 6 cm (median 4.6) compared to 3-7.5 cm (median 5.9) in the bone transport group. Union was achieved in all the patients with the average time to union at 12.1 months, 17.2 months and 8.0 months, respectively. The bone transport group required additional bone grafting in five patients (83.3%) prior to union compared to one (16.7%) in the acute shortening group.     

Management of infected nonunion of the femur in adults using the Ilizarov technique

Background

Infected nonunion encompasses a series of complex problems including osteomyelitis, bone and soft tissue loss, osteopenia, adjacent joint stiffness, complex deformities, limb length discrepancies, and multidrug resistant multibacterial infections. Several surgical techniques were proposed for management of this major complication including intramedullary devices, free tissue transfer and in situ reconstruction, and the Ilizarov technique.

Aim of the study

The aim of this study was to revaluate the results of management of infected non-united fractures of the femur in adults using the Ilizarov frame.

Patients and methods

There were 20 patients with infected femoral nonunion, whom were managed using Ilizarov technique. The mean age of the studied patients was 37.45 years. There was only one female. Of the included patients, ten had diaphyseal fractures, two suffered from proximal metaphyseal fractures, and eight presented with distal metaphyseal nonunion. No patient was able to bear weight on the infected limb. All the patients had had previous surgeries, with a mean of 1.95 (SD 1.050 and range 1–5 previous surgeries). Debridement of the infected bone and soft tissues was performed in all the studied cases. Techniques adopted were acute compression in 5 patients, acute shortening in 13, and acute shortening and distant corticotomy in 2 patients: one proximal and one distal corticotomies. Periodic regular clinical, as well as radiographic, evaluation was performed. A minimum follow-up period of 2 years was an inclusion criterion in this study.

Results

The bone, (radiological) results, functional results, and complications were evaluated. The mean time between injury and the application of the frame was 10.15 (SD 8.798, range 3–35 months). The mean follow-up period was 36.65 (SD 15.849, range 25–82 months). The mean external fixation time was 8.03 (SD 2.774, range 5–15 months). The mean limb length discrepancy was 1.45 (SD 1.134, range 0–3 cm). Bony union was achieved in all except two patients. One patient had refractured 1 month after frame removal and union was managed by reapplication of the frame. Bone grafting was not performed in this study. Infection was controlled in all but one patient, in which the fracture did not unite. The radiological results were excellent in ten patients (50 %), good in six (30 %), fair in one (5 %), and poor in three patients (15 %). The functional results were excellent in 4 patients (20 %), good in 13 (65 %), and poor in 3 patients (15 %) and no fair results. In the studied 20 patients, there were 63 complications in total, (25 problems, 6 obstacles, and 32 true complications). From the encountered 32 true complications, 4 were defined as minor and 28 were considered as major complications.

Conclusion

Despite the high rate of complications, the Ilizarov technique was found to be effective in the treatment of infected femoral nonunion as it allowed simultaneous treatment of bone loss, nonunion, infection, shortening, and deformity.     

Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects

IntroductionThis study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10 cm in length.MethodsIn a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10 cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates.ResultsThe mean size of the bone defect was 7 cm in Group A, and 5.8 cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P = 0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P = 0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P = 0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P = 0.28).ConclusionsWhile both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures.Level of evidence: Level III; Retrospective comparative study     

Ilizarov技术矫正足踝畸形的器械研究与临床应用

[目的]根据Ilizarov技术的基本原理,研究、探讨矫正不同类别足踝畸形的器械构型、适应证扩展、手术方法与临床应用的效果。[方法]根据中国患者马蹄足、高弓足、跟行足和前足内收或外翻畸形足的病理改变特点与矫形要求,在Ilizarov环形外固定器构型的基础上,设计完成了标准的矫正马蹄足、高弓足、跟行足和前足内收或外翻的4种外固定矫形器构型,并进行了力学测试。创新的扩展了Ilizarov矫正瘢痕性马蹄足、类风湿性关节炎和先天性腓骨缺如所致的重度足外翻畸形。[结果]新设计的4种足踝外固定器,经过临床应用,证实了器械结构合理,安装与调节方便,牵张应力根据需要能进行适度调整,临床治疗105例足踝畸形患者,均获得满意的畸形矫正与功能恢复,无1例出现较严重的并发症。[结论]新设计的4种足踝矫形器构型,结构简便、实用,性能优良、能够满足Ilizarov技术的矫形需求。Ilizarov技术对严重足、踝畸形的矫正,具有其它技术不能替代的满意疗效。     

Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study

Background:

Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20–50 years were treated with the Ilizarov method.

Materials and Methods:

Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases.

Results:

Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5–2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4–6 weeks.

Conclusion:

The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.     

Management of distal tibial intra-articular fractures with circular external fixation

The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures.     

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.     

Outcome analysis of ilizarov and monorail fixators in the treatment of nonunion of long bones: A systematic review and proportion meta-analysis

IntroductionNonunion of long bones is a major complication following fractures that requires a substantial amount of investment both monetary and time from patients and surgeons. The need to comprehensively understand the complications, outcomes and distraction capability is profound, which necessitates a review of current evidence on special fixators used for distraction. The current systematic review aims to study the available literature on distraction osteogenesis using special fixators (Ilizarov and Limb Reconstruction System) in the management of nonunion (infected and non-infected).MethodsCochrane Library, PubMed, Scopus were searched until January 2022. The review included all original studies which used Ilizarov or Monorail Fixators/LRS in the treatment of nonunion of long bones. The quality of studies was assessed using the Modified Coleman Methodology Score.ResultsA total of 35 original studies with Ilizarov (n = 29) and LRS (n = 8) were selected including two comparative studies. The pooled data meta-analysis and the subgroup analysis of these studies found both Ilizarov and LRS fixator yield similar functional outcomes for the treatment of long bones nonunion.ConclusionThe review was conducted to understand the scenario of nonunion in long bones. Pin tract infection is found to be the most common complication followed by adjacent joint stiffness and deformity. In our review we observed that both external fixator time and index were lower in LRS compared to Ilizarov group. Further RCT are required comparing Ilizarov and LRS fixators to effectively comment upon the superiority of the implants.     

Die infizierte Osteosynthese am oberen Sprunggelenk

Background

Should osteosynthesis infection occur after ankle fractures in patients with microangiopathy, the infection needs to be cured quickly and safely to protect implants, bone, and tendons. Vacuum therapy (TNP) provides a perfect treatment plan that keeps the inpatient time low whilst ensuring high patient comfort.

Methods and patients

Four angiopathic patients with deep wound infection after ankle osteosynthesis were treated. At admission, loss of stability and spread of the infection were the immeadiate risks. To prevent this, we treated the patients with vacuum therapy after initial debridement until skin cover was achieved.

Results

In all cases stability was secured and after 2 dressing changes, the swabs were sterile. The inpatient time was 13 days; overall vacuum therapy time was 59 days. Patient satisfaction was high.

Discussion

Vacuum therapy is a perfect strategy after surgical debridement and before secondary mesh grafting. It protects the stability of the bone and open-lying delicate structures in patients with infected osteosynthesis of the ankle and angiopathy and offers an easy, safe, and successful treatment path with a short inpatient time.