Journal of Musculoskeletal Trauma

Ilizarov Treatment of Nonunions with Bone Defect in the Tibia: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(1):13-19. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.13

Abstract PDF: PURPOSE
To analyze the clinical results and complications of internal transport by Ilizarov for defect nonunion of tibia MATERIALS AND METHODS: We performed a retrospective review of 24 patients undertaken internal transport by Ilizarov for defect nonunion of tibia from January 1991 to December 1997. There were 21 males and 3 females with a mean age of 33.4 years(range, 17-64 years). On average, the size of bone defect measured 7.9 cm(range, 2-17 cm). Bone defects were gradually closed by progressive internal transport. After internal transport, bone grafts on 14 docking sites were performed because of delayed union. Soft tissue defects were treated with secondary closures(6 cases), skin grafts(4 cases), and flaps(4 cases).
RESULTS
According to Paley and Catagni's classification, bone results were excellent in 19 cases, good in 4 cases, and poor in 1 case. Functional results were excellent in 2 cases, good in 21 cases, and poor in 1 case. According to Paley's classification, the complications were developed as follows; Problems were pin site infections(12 cases), joint contractures(9 cases), and distraction gap delayed consolidations(3 cases). Obstacle was absent. Complication was refracture(1 case). The average distraction consolidation index was 39.4 days/cm. The average percentage transport was 139.7 %.
CONCLUSION
The application of Ilizarov to defect nonunion of the tibia is effective, but correct technique and careful follow-up is required.

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Treatment of comminuted supracondylar fractures of the femur using Ilizarov method: Myung Chul Yoo, Yoon Je Cho, Ki Tack Kim, Young Soo Chun, Na Sil Pyo, Sung Gun Kim; J Korean Soc Fract 1999;12(3):529-537. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.529

Abstract PDF: PURPOSE
To evaluate the effectiveness of the Ilizarov method as a treatment of open or comminuted supracondylar fractures which are uncommon, and difficult to manage because of the wide range of potential complications.
MATERIALS and METHODS
Between 1992 and 1999, we treated open or comminuted supracondylar fractures of the femur by Ilizarov method in whole period or conversion to OR/IF with or without bone graft after transient Ilizarov fixation. There were 13 cases in 11 patients. Open comminuted fractures were seven cases and closed comminuted fracutres were six cases. We compared Ilizarov method in all procedures and temporary mode followed by internal fixation for definite care.
RESULTS
According to Schatzker and Lamberts assessment the results were good or excellent in ten cases(77%). And the results were rated as good or excellent in 67% of case of Ilizarov method in all procedures, and 86% of cases changed to OR/IF.
CONCLUSION
Ilizarov technique is an useful method in cases of open and/or comminuted supracondylar fractures of the femur. And after initial stabilization of fracture, conversion to OR/IF is advisable to prevent pin site infection and allow ROM excercise of the knee joint.

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Treatment of Pilon Fracture, limited ORIF with External Fixation by Ilizarov Method: Bu Hwan Kim, Jong In Im, Yong Kyun Yim, Deog Jeong Kang, Uk Nam; J Korean Soc Fract 1998;11(4):798-805. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.798

Abstract PDF: The authors retrospectively reviewed 22 pilon fractures in 22 patients treated with limited ORIF with external fixation by Ilizarov method. Clinical follow up averaged 28 months (range, 16-45 months). Interfragmental screw fixation of key fragments were done in fifteen cases and bone-grafting was done in thirteen cases. The average duration of external fixation was fourteen weeks. All of the fractures healed (one after delayed bone-grafting). The subjective and objective results were classified according to Ovadia and Beals. Sixteen patients (72%) had good and excellent results at final follow up. On the basis of these early results, the prevalence of complications asociated with pilon fractures and their treatments can be decreased by external fixation of Ilizarov method and limited internal fixation. We conclude that this method is good treatment modality on tibial pilon frature.

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Treatment of Unstable Open Tibial Fractures with Ilizarov System: Won Sik Choy, Kwang Won Lee, Ha Yong Kim, In Sung Hwang; J Korean Soc Fract 1998;11(3):567-575. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.567

Abstract PDF: The treatment of open comminuted tibial shaft fractures have a high incidence of complications and often result in poor outcomes. General principles of treatment are accepted throughout most surgeons, which include aggressive debricdement, antibiotics, early stabilization, early soft tissue coverage, and prophylactic bone graft. But, recently there is a controversy on the bony stabilization methods; one group of authors favors external fixator, and the other group favors unreamed interlocking intramedullary nail. In this paper, we carried out retrospective study of the 42 cases of open comminuted tibial shaft fractrues managed with Ilizarov external fixator (minimum follow up of one year(average: 2.8 years)). The purpose of this study is to evaluate the results of treatment with an Ilizarov method for the patients with open comminuted tibia fractures (open type III-A and more by Gustilo and Anderson classification and, type B and more by AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification. 2. Forty eight additional operations were needed for 27 patients; 24 bone grafts for 19 atients, 1 case of bone marrow injection, 4 cases of corticotomy and bone transport, 4 cases of sequestrectomy, 3 cases of internal fixation with plate, 2 cases of IM nailings, and 2 cases of Ilizarov correction in operating room. 3. Following complications were resulted in; delayed union 14 cases, nonunion 1 case, superficial infection 2 cases, deep infection 8 cases, chronic osteomyelitis 3 cases, refracture 2 cases, knee stiffness 6 cases, ankle stiffness 5 cases, subtalar stiffness 8 cases, lateral angulation 4 cases, anteroposterior angulation 4 cases, and leg length discrepancy 5 cases. 4. Twenty patients, at the final follow-up, could walk without limping and live their life with no activity limitation. 5. At the final follow-up, 19 patients complained intermittent pain on fracture sites, knees or feet and ankles. We could conclude that the Ilizarov external fixator can be a stabilizer of choice for the open comminuted (Gustilo type III and more than AO type B) tibial shaft fractures of which fracture line extended over the proximal or distal metaphysis.

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Use of the Ilizarov Technique for Treatment of Infected Non-Union: Sung Taek Jung, eun Kyoo song, Bong suk Bae; J Korean Soc Fract 1998;11(2):398-404. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.398

Abstract PDF: We reviewed infected non-union of tibia and femur which had been treated by radical resection of the necrotic bone and Ilizarov method in thirty-nine patients. All patients had either one-segment or two segment lengthening of bone with a technique of bone transport. The size of the bone defect that was bridged averaged 5.7cm (range, 2 to 16cm). All cases attained bone union and the infection was eradicated in all pattints before the fixator was removed. The mean duration of external fixator was 14 months(range, 4-28months). The mean external fixation index was 1.6 months/cm and the mean distraction index was 23.2 days/cm. The functional results were exellent in 3 patients, good in 19, fair in 9, poor in 8. The bone results were excellent in 5 patients, good in 20, fair in 10, poor in 4. Complication were pin tract infection in 15 patients, equinus contracture of ankle in 2, knee flexion contracture in 1, transient sensory change in 1, axial deviation in 2, premature consolidation in 2, delayed union in 2, and leg length discrepancy in 2, and refracture in 1. In conclusion, the Ilizarov method is very effective for treatment of infected non-union with bone loss, limb shortening and soft tissue defect.

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Treatment of Chronic Uncontrolled Infected Nonunion of Femur and Knee with the Ilizarov Instrument: 3 cases reports: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suck Ha Lee, Hyung Gon Jee; J Korean Soc Fract 1997;10(4):801-811. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.801

Abstract PDF: We analysed three cases, repectively. The first case was chronic uncontrolled infected nonunion of femur due to open type III fracture which had been operated unsuccessfully at least 5 times. The second case was a infected nonunion and shortening of leg due to infecton of soft tissue surgery and then after knee arthrodesis. The third case was result from the total knee arthroplasty failure and then after knee arthrodesis. Ilizarov instrument was applied to this case for the knee joint arthrodesis. All cases showed bony union after average 14.6 months. The exact bony lengthening in the two cases after treatment was 11cm and 13cm and the healing index was 49.Odays/cm and 50.8days/cm The complications included the pin tract infection in all three cases and pin breakage in 2 of the cases. We achieved bony lengthening and bony union with relief of infection in 3 cases of chronic uncontrolled infected nonunion of femur treated with extensive saucerizaton and fixation using the Ilizarov instrument. These are the results of our treatment of chroic uncontrolled infected nonunion of femur using the Ilizarov instrument.

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Ilizarov Method for Treatment of Large Bone Defect: Hae Ryong Song, Young June Park, Ji Yeon Kim; J Korean Soc Fract 1996;9(3):794-800. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.794

Abstract PDF: Twenty eight long bone defects were treated with internal bone transport using Ilizarov method. The causes of defect were open fracture (ten cases), infected non-union(nine cases), and osteomyelitis(nine cases). The mean bone defect was 8.5cm ranging from 2.5cm to 22cm in open fracture and 5.8cm ranging from 1.8cm to 17cm in an infected nonunion, and 7.2cm ranging from 3.4cm to 12cm in osteomyelitis. Internal bone transport was performed with transverse ring system. Free latissimus dorsi muscle flap was done in three cases and rotational muscle flap in seven cases. Single level lengthening was done in 26 cases and double level lengthening in two cases. Fibular transport was done in five cases. All cases obtained bone union. The radiologic consolidation index was 89 day/cm in tibia, 71d ay/cm in femer, and 42.5 day/cm in humerus. External fixation index was 96 day/cm in tibia, 86 day/cm in femur, and 48.5 day/cm in humerus. Complications were pin tract infection(25 cases), equinus contracture of ankle(7 cases), knee flexion contracture(4 cases), delayed union(11 cases), premature consolidation(2 cases) and refracture(1 case). Ilizarov method is a useful treatment for large bone defect inopen fracture and infected nonunion. To obtain better result, careful postoperative management and intensive physiotherapy are recommended.

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The Treatment of Infected Nonunions of the Tibia by the Methods of Ilizarov: Chil Soo Kwon, Yong Uck Kim, Byung Hyun Jung, Kyung Seog Shin; J Korean Soc Fract 1995;8(2):347-353. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.347

Abstract PDF

Chronic infection of the shaft of tibia is one of the most perplexing dilemmas in orthopedic surgery. Difficult or resistant infection usually require more radical debridement of the septic bone and soft tissue in addition to application of stable fixation to enhance soft-tissue healing and bony union. The application of Ilizarov is possible to correct deformities, regenerate new bone tissue without the use of bone grafts, progressirely lengthen the extremity and allow weight bearing during the treatment period. Application of Ilizarov were preformed on eigtheen patients with infected nonunion of tibia between November 1989 February 1993. The result were as follows; 1. There were 16 males and 2 females with an average age of 39 years. 2. Fifteen of 18 patients had infected tibial nonunion associated with bone loss. 3. Two of 15 patients had infected nonunions associated with hemicircumferential bone loss. These tibiae were treated by hemicircumferential corticotomy and partial bone transport. 4. Twelve of 15 patients had an average 6.6cm of segmental bone loss. These were treated by coitictomy and internal bone transport. 5. The mean duration of treatment was 10.3 months. 6. The application of Ilizarov technique to diaphyseal infected nonunion and segmental defect is very encouraging. It may prove to be an excellent technique for further management of resisitant diaphyseal infection of bone.

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Bone Transport Over the Intramedullary Nail for Defects of Long Bone
Jae-Young Roh, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Byung-Chul Park, Woo-Kie Min, Joon-Woo Kim, Chang-Hyun Cho
Journal of the Korean Fracture Society.2008; 21(1): 37. CrossRef

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