Journal of Musculoskeletal Trauma

Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator: Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee; J Korean Fract Soc 2007;20(4):323-329. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.323

Abstract PDF: PURPOSE
We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern.
MATERIALS AND METHODS
We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern.
RESULTS
Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%).
CONCLUSION
The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

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Treatment of Tibial Condylar Fractures Using the Ilizarov External Fixator: Dong Wha Lee, Kyoo Seog Shin, Jong Soon Kim, Yong Whee Kim, Jin Ho Seok; J Korean Soc Fract 2001;14(3):404-411. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.404

Abstract PDF: PURPOSE
The aim of this study is to report results of treatment of tibial condylar fracture using the Ilizarov external fixator. MATERIALS & METHOD: 21 Cases of tibial condylar fracture, which were operatively treated with Ilizarov external fixator were evaluated clinically & radiographically. All patients were followed for at least 1 years.
RESULTS
Primary bony union was achieved in 15 cases(71.4%) and bony union after secondary operative procedure was obtained in 6 cases(28.6%). The fracture was united within 6 months except 2 cases. As complications, pin irritation was observed in 6 cases and Joint stiffness in 1 case, delayed union in 1 cases, nonunion in 1case CONCLUSION: We could obtain satisfactory clinical results with using of Ilizarov external fixator in treating of tibial condylar fractures. The good indications for the use of Ilizarov external fixator seems to be high energy tibial condylar fracture difficult to fixation with other method. In cases of bony defect or severe comminuted fractures, we shall obtain better outcome when bone graft is performed.

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Treatment of Infected Nonunion of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Keun Ho Yang, Byung Yun Hwang; J Korean Soc Fract 2000;13(4):921-927. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.921

Abstract PDF: PURPOSE
To analyze the clinical results and complications of the Ilizarov technique in the treatment of the tibial nonunion.
MATERIALS AND METHODS
Twenty-seven patients who had infected nonunion of the tibia were managed with Ilizarov external fixator form January 1992 to January 1997. Types of nonunion were classified according to Paley and status of infection were divided into AO classification. We evaluated clinical outcomes and complications which were assessed with rating system of Paley.
RESULTS
All cases obtained bony union. The mean time to union was 11.5 months. On average, healing index was 51.4 days/cm(range 28-72 days/cm) and percentage of increment was 18.5 %(range, 13-31.5 %). According to Paley criteria, bone results were good to excellent in 22 cases(81.5 %), and functional results were good to excellent in 24 cases(88.9 %). Total thirty five complications were occurred, which were classified by Paley criteria, problems in 15 cases, obstacles in 17 cases, and complication in 3 case.
CONCLUSION
Ilizarov technique is a useful method in management of the tibial nonunion, but we have to consider the complications and endeavor to reduce them.

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Treatment of Humerus Fracture using Ilizarov External Fixator: Suk Myun Ko, Myung Gu Kim, Ryuh Sup Kim, In Suk Oh, Joung Yoon Lee, Hyeok Chae Jeong; J Korean Soc Fract 2000;13(1):30-37. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.30

Abstract PDF

PURPOSE
Recently, the incidence of humerus fracture not allowing open reduction and internal fixation has been increased with increment of traffic accident and industrial accident. But, there have been a few reports in the use of Ilizarov external fixator. The purpose of this study is to report the authors'experience with Ilizarov external fixation for the treatment of the patients with fractures of the humerus.
MATERIALS AND METHODS
From June 1996 to July 1998, we reviewed sixteen patients with humeral fracture who were treated by the Ilizarov external fixator. Three fractures were in the middle third of the shaft; two, in the proximal third; two, in the distal third; seven, in the proximalmiddle; two, in the middle-distal. The fractures that were located within the joint of the shoulder or the elbow were excluded. Five fractures had been open and six had been associated with multiple trauma. Two had been initially treated by open reduction and internal fixation but failed : one, because of infection; the other, because of loss of fixation. We performed the Ilizarov external fixator procedure in the case of soft tissue trauma so severe that internal fixation was impossible, and in the case of the comminution too extensive and severe for internal fixation.
RESULTS
The average time to radiologic union was 12.7 weeks. According to Stewart and Hundley's functional assessment system, excellent or good results were obtained in 14 cases. There was no poor result.
CONCLUSION
Although the Ilizarov external fixator was a technically demanding procedure, it was a good method comparing with any other operative methods for the treatment of fractures of the humerus not allowing the open reduction and internal fixation.

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Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Tae-Soo Park, Joon-Hwan Lee, Tai-Seung Kim, Kwang-Hyun Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2008; 21(4): 292. CrossRef

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Treatment of Comminuted Fractures of Femur & Tibia with Ilizarov Apparatus: Soo Bong Hahn, Hong Jun Park, Hui Wan Park, Sung Hun Kim; J Korean Soc Fract 2000;13(1):20-29. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.20

Abstract PDF: PURPOSE
To evaluate the effectiveness of Ilizarov external fixator for the treatment of unstable closed or open comminuted femoral and tibial fractures, especially those with severe soft tissue injury by clinical and radiological analysis.
MATERIALS AND METHODS
Fifty six consecutive femoral or tibial fractures were treated using Ilizarov external fixator between May 1991 and August 1998 and followed up for minimum 12 months upto 36 months with the average of 16 months. All of them consisted of comminuted or segmental fractures. And thirty five cases of them were open fractures. There were nine Type I, seventeen Type II, five Type IIIA, and four Type IIIB fractures. Primary closure was performed for Type I and II fractures. Split-thickness skin graft (5 cases) and free vascularized flap (3 cases) were used for severe soft tissue defects.
RESULTS
All fractures healed within the average of 7.7 months (from minimum 3 months to maximum 24 months). Bone grafts were performed in 39 cases. Bony union was obtained in all the cases with Ilizarov method. The most common complication, the adjacent joint contracture was developed in 21 cases (37.5%). Pin site infection in 12 cases (21.4%), delayed union in 3 cases (5.4%), angulation deformity in 2 cases (3.6%) were developed.
CONCLUSION
The Ilizarov external fixation technique is one of the effective methods in the management of unstable closed or open comminuted femoral or tibial fractures.

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Treatment of Tibial Fractures with the Ilizarov External Fixator: Suk Myun Ko, Myung Ku Kim, Jung Yoon Lee, In Suk Oh, Sang Eun Kim; J Korean Soc Fract 1998;11(4):833-840. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.833

Abstract PDF: Between June 1996 and July 1997, 29 tibial fracture patients were treated using the Ilizarov method and apparatus. The mean follow-up petiod was 18 months. Among 29 cases, 11 were closed fractures with comminution and 18 were open fractures. There were 2 Gustilo-Anderson type I, 5 type II, and 11 type III open tibial fractures. Complications included 4 pin tract average time from application of the device to complete fracture healing was 26.3 weeks. According to Tucker's functional criteria, the results were 14 excellent, 9 good, 4 fair, 2 poor. No practical contraindications to the use of the Ilizarov device in the management of tibial fractures were encountered. We concluded that Ilizarov method is indeed a useful adjunct for the treatment of either open or closed tibial fractures.

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Treatment of Open Fractures of the Tibial Shaft by Sequential Compression technique in Ilizarov device: Suk Ku Han, In Ju Lee, Nam Yong Choi, Sung Jin Park, Gyeol Yoo, Hyo Seng Ahn; J Korean Soc Fract 1998;11(4):817-824. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.817

Abstract PDF: External skeletal fixation is used widely in the management of open or closed tibial fractures, but delayed healing is common. There is concern that this might be due not only due to the severity of injury but also to the mechanical conditions imposed at the fracture site by the fixator. Since fractures treated by external skeletal fixation can rarely be reduced to perception nor held with absolute stability, union occurs by indirect healing, which is acutely sensitive to both the charactericstics and timing of mechanical stimulation. So, the achivevment of the optimum mechanical environment is particularly important where delay in bone healing is likely. Ilizarov external fixator is useful in treating open fractures of the tibial shaft because it permits axial micromotion which enhances bridging callus formation with stable fixation as well as its complications such as infected nonunion or limb length discrepancy. The impared healing with external fixation is often caused by wrong surgical technique, such as distraction of fracture fragments by fixation device. Sequential compression at fracture site may overcome any fracture gap in external skeletal fixation and also enhance endosteal bone formation. We applied sequential compression forces at the fracture site in 18 open fractures of the tibial shaft, trated by Ilizarov external fixator with or without autogenous bone grafting. Sequential compression technique is composed of initial compression with 1 mm/wk for 4 weeks and then compression 1 mm/10 days until adequate apposition of cortex and callus formation in radiograph. We acquired successful bony union in all cases except one which had additional bone grafting in open fractures of the tibial shaft by sequential compression technique using Ilizarov device.

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Treatment of Commiuted Fractures of the Proximal Tibia Using Ilizarov External Fixator: Jae Ik Lee, Myung Hwan Son, Jae Hong Park, Kang Hoon Kim; J Korean Soc Fract 1998;11(1):198-204. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.198

Abstract PDF: Twenty one comminuted fractures of the proximal tibia in 21 patients were treated with Ilizarov external fixator from May 1990 to May 1996 in Pusan City Medical Center. The average duration of external fixation was 17weeks, and all of the fractures healed without bone graft. The mean time to union was 18weeks in closed comminuted fractures, and 21 weeks in Gustilo type I, II open fractures. The complications with this technique were pin tract infection 3 cases, pin loosening 6 cases, septic arthritis 1 case, post-traumatic osteoathritis 1 case, and joint ankylosis 1 case. The average duration of follow up was 18 months. The range of knee motion of 19 cases of the the 21 patients was at least 115-degrees arc. Post-operative immediate exercise was possible, and partial weight bearing with crutch was also possible after post-operative 4 weeks. We concluded that Ilizarov external fixation is a satisfactory technique for the treatment of selected comminuted fractures of the proximal tibia.

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Management of open Supracondylar Fractures of Femur using the Ilizarov Method: Bum Ku Lee, Do Hyun Moon, Jin Hong Ko, Soo Chan Lee, Ki Dong Kang, Jong Seob Park; J Korean Soc Fract 1996;9(3):567-573. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.567

Abstract PDF: It is extremely difficult to treat to the comminuted open fractures of supracondyle of femur Internal fixation with plates and screw or intramedullary nailing of open fracture is high risk of infection and circulatory compromising at the fracture site. External fixation reduces the risk of infection and permits easy access for wound care, early mobilizatioll of joints and weight bearing. We reviewed nine cases of open supracondylar fractures of femur treated with Ilizarov method from February 1993 to December 1995 and obtained the following results. 1. The average time of bony union was 2 weeks. According to AO classification, the average time of bony union was 22.7 weeks in type A and 29.3 weeks in type C. According to classification of Gustilo and Anderson, the average time of bony union was 21 weeks in type II,27.3 weeks in type Illa and 30 weeks in type IIIb. 2. The Neers criteria was based on the final functional and anatomical rating for supracondylar fracture of femur. According to this criteria, excellent was 1 case, satisfactory in 7 cases and unsatisfactory in 1 case. 3. The complications were divided into problem, obstacle and complication;Problem in 9 cases, bstacle in 5 cases and complication in 3 cases. We conculded the Ilizarov technique is a useful method in management of the severe comminuted fractures and extensive soft tissue injury of the supracondylar fractures of femur.

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Treatment of Nonunion of the Tibia Fracture: Dong Heon Kim, Kyu Cheol Shin, Hee Cheol Park, Ju Yong Shin; J Korean Soc Fract 1996;9(1):112-118. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.112

Abstract PDF: Nonunion after tibia fracture is a relatively common problem. The cases of nonunion have been known open and comunited fracture, extensive soft tissue injury, interposition of the soft tissue, distarbance of the blood supply and inadequate fixation. A number of methods stimulating union have born described. These include fibular osteotomy followed by weight-bearing in a cast, autogenous boone graft with or without additional stabilization, internal or external fixation with compression, open or closed IM nailing and even electromagetic stimulation. In this paper we carried out retrospective study of the 24 nonunion of the tibia fracture which were treated at the Department of Orthopeadic Surgery, Kon-Kuk University Hospital from March 1990 to March 1995. The results were as follows: 1. Among 24 cases of monunions, 16cases(66.6%) were communited fractures and 18cases(75%) were open fractures. 2. Hypervascular nonunion were 12cases and avascular nonunion were 12cases. Previous methods of treatinent were conservative treatment in 6cases of closed fracture and were treated with Ender nailing, multiple K-wire fixation, Ilizarolr external fixation, monofixator external fixation in 1 Bcases of open fractures. 3. The average duration from injury to dignosis of nonunion was 7 months tweets.(Range 5 months to 24months) 4. Tibial nonunion were treated with plate and screw with bone graft(Bcases), Interlocking IM nail ing(14cases), and nizarov external fixation with bone graft(teases). 5. The average time of union was 23weeks in all patients: 24 weeks in the case of plate and screw with bone graft. 20 weeks in the case of interlocking IM nailing. 28 weeks in the case Ilizarov external fixation with bone graft. 6. The main complications were joint stiffness due to long-term cast irnrnobiliBation in the case of plate and screw with bone graft, LROM of joint contracture and external pin site in the case of Ilizarov external fixation with bone graft, deep infection Icase and knee joint pain teases due to proximal nail protrusion in the case of Interlocking IM nailing.

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Extensively Comminuted Type III Open Fracture of Tibial Shaft: 4 Case Treated by Ilizarov External Fixator: Ju Hai Chang; J Korean Soc Fract 1994;7(2):480-489. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.480

Abstract PDF: It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing. Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection. Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis. At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.

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The Treatment in Infected Nonunion of Distal Femoral Fracture: Report of two cases: Jong Oh Kim, Yon Sik Yoo, Suk Ha Lee, Sung Jong Lee, Taek Sun Kim, Jae Ik Sim; J Korean Soc Fract 1994;7(1):161-166. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.161

Abstract PDF: It is reported that infected pathological fracture of distal femur has a difficulty in treatment The difficulties lie in; choosing a internal fixator, adequate sequestrectomy of infected lesion, limb shortening, long duration of immobilizatlon. We uses the external fixator in treatment of distal femoral fracture because it needs less devices in fracture site than the internal fixator, and it could get a rigid fixation. we uses the Ilizarov apparatus. The merits of Ilizarov are, early weight bearing; limb lengthening and easy compression and distraction. The one case in which limb length discrepancy is occured, is peformed by limb lengthening. In this study, we are going to argue about the two cases, of infected non-unlon of distal femoral fixation comparing with one another.

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Application of the Ilizarow technique to the complications of tibial open fracture report of two cases: Eun Kyoo Song, Ju Chull Jeung, Sung Man Rowe, Hyung Soon Kim; J Korean Soc Fract 1991;4(2):332-339. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.332

Abstract PDF: No abstract available.

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