1: Int Orthop. 1998;22(5):298-302.
The treatment of infected non-union of the tibia by compression-distraction
techniques using the Ilizarov external fixator.
Hosny G, Shawky MS.
Department of Orthopaedic Surgery, Benha Faculty of Medicine, Tanta El Gharbia,
Egypt.
Circular external fixation using the Ilizarov apparatus combined with
compression-distraction techniques was used to treat 11 patients with infected
non-union and segmental bone loss of the tibia. The series comprised 8 males and
3 females, with an average age of 27 years (range 17-51 years). The average
number of previous failed surgical attempts at union was 2 per patient (range 1
to 4). Three infected non-unions without shortening were treated with complete
resection of the site and conversion of the diaphysis into a segmental defect.
The functional results were excellent in 5, good in 3, fair in 2 and poor in one
patient. No additional procedures were used in any of the patients.
PMID: 9914932 [PubMed - indexed for MEDLINE]
2: Clin Orthop Relat Res. 1992 Jul;(280):143-52.
The treatment of infected nonunions and segmental defects of the tibia by the
methods of Ilizarov.
Cattaneo R, Catagni M, Johnson EE.
Department of Orthopaedics and Traumatology, Hospital of Lecco, Italy.
Circular external fixation using the Ilizarov apparatus combined with internal
bone transport or compression-distraction techniques were used to treat 28
patients with infected nonunions or segmental bone loss of the tibia. There were
22 males and six females with an average age of 34 years (range, 17-58 years).
Six of 28 patients had infected tibial nonunions associated with
hemicircumferential bone loss. These tibiae were treated by anterior
hemicircumferential corticotomy and partial bone fragment internal transport.
Fifteen of the remaining 22 patients had an average of 4 cm of segmental bone
loss (range, 2-7 cm). Seven patients without shortening or defect had infected
nonunions associated with extensive diaphyseal sequestrae. These nonunions were
treated by en bloc resection of the diaphyseal shaft and internal bone
transport. All patients healed their infected extremities without the addition
of cancellous bone graft, microvascular fibular, or soft-tissue grafting.
Preoperative shortening was present in 13 of 28 patients. Regenerate new bone
formation averaged 6 cm (range, 1.5-22 cm). Postoperative antibiotics were not
administered in 21 of 28 patients. In seven patients, antibiotics were given for
ten days after en bloc resection of the diaphyseal sequestrae. Equal limb length
was maintained in 21 extremities, within 1 cm in five tibiae and less than 3 cm
in two tibiae. Functional results were good to excellent in 21, fair in six, and
poor in one. The application of Ilizarov techniques to diaphyseal infected
nonunions and segmental defects is very encouraging. It may prove to be an
excellent technique for future management of resistant diaphyseal infections of
bone.
PMID: 1611734 [PubMed - indexed for MEDLINE]
3: Int Orthop. 1998;22(5):293-7.
Tibial bone defects treated by internal bone transport using the Ilizarov
method.
Song HR, Cho SH, Koo KH, Jeong ST, Park YJ, Ko JH.
Department of Orthopaedic Surgery, School of Medicine, Gyeong-Sang National
University, Chinju, Republic of Korea.
We reviewed 27 cases of tibial bone defects treated by internal bone transport
using the Ilizarov method. The causes of the bone defects were open fractures in
14 segments and infected non-unions in 13. The average length of the defects was
8.3 cm (range, 3-20 cm). There were 21 one-level tibial transports, 3 two-level
tibial transports, 1 one-level tibial transport with fibular transport, and 2
fibular transports. At the docking site, 25 segments underwent bone grafting.
Eleven of the 25 were Papineau-type open cancellous bone grafts. Acute
shortening or docking was performed in 10 segments. Bone union was obtained in
every instance. The average time of external fixation was 8 months and the
average time to union was 7.1 months. Bone grafting at the docking site is
recommended in order to shorten the duration of treatment and to prevent
refracture and non-union.
PMID: 9914931 [PubMed - indexed for MEDLINE]
4: J Bone Joint Surg Am. 1995 Jun;77(6):835-46.
Use of the Ilizarov technique for treatment of non-union of the tibia associated
with infection.
Dendrinos GK, Kontos S, Lyritsis E.
First Orthopaedic Department, Athens General Hospital, Greece.
Non-union of the tibia associated with infection was treated with radical
resection of the necrotic bone and distraction osteogenesis in twenty-eight
patients who were eighteen to seventy-four years old. Non-union, infection,
shortening, deformity, and osteoporosis were all addressed simultaneously. All
patients had either one-segment or two-segment lengthening of bone with a
technique of bone transport in which a bone fragment is moved toward the site of
non-union, leaving a defect that is bridged by distraction osteogenesis. The
size of the bone defect that was bridged averaged six centimeters (range, two to
thirteen centimeters). The infection was eradicated in all patients before the
fixator was removed. The mean duration of treatment was ten months. The mean
time to union, calculated from the day that the intercalary segment came into
contact with the target segment, was six months. The mean duration of follow-up
was thirty-nine months. The deformity and the inequality of the lengths of the
legs were corrected successfully--to less than 7 degrees and to less than 2.5
centimeters, respectively--in fourteen of the twenty-eight patients. In these
fourteen patients, the bone result--determined according to the criteria of
union, healing of the infection, status of the deformity, and amount of residual
shortening--was considered excellent. Of the fourteen remaining patients, eight
had a good bone result; one, a fair result; and five, a poor result. The
functional result was excellent in seven patients, good in eleven, fair in four,
and poor in five. One patient had an amputation. Three patients (11 per cent)
had a problem with union that was treated with augmentation with a bone graft.
One patient, who had sustained a refracture, had an amputation. Twenty-five
patients (89 per cent) had a total of seventy-one minor or major complications,
a rate of 2.5 complications per patient.
PMID: 7782356 [PubMed - indexed for MEDLINE]
5: J Orthop Trauma. 2002 Aug;16(7):491-7.
Augmentative Ilizarov external fixation after failure of diaphyseal union with
intramedullary nailing.
Menon DK, Dougall TW, Pool RD, Simonis RB.
St. Peter's Hospital, Chertsey, Surrey, United Kingdom.
OBJECTIVE: To investigate the use of the Ilizarov circular fixator and nail
retention in treating diaphyseal nonunion following previous intramedullary
nailing. DESIGN: Retrospectively reviewed, consecutive series. Mean duration of
follow-up after achieving bone union: 19.2 months (range 6 to 33 months).
SETTING: A tertiary referral center for nonunion surgery. PATIENTS: Nine
patients (two femoral, three tibial, and four humeral nonunions) were included
in the study. All patients were referred from other centers after failure to
achieve union with intramedullary nailing. Patients who had nonunion with other
fixation devices in situ, those with active infection and nonunion following
nonoperative treatment, were excluded from the study. The patients had undergone
an average of 2.4 operations (range 1 to 5 operations) before application of the
Ilizarov fixator. All patients completed the study. INTERVENTION: The circular
fixator was used to compress the nonunion site from without, retaining the
intramedullary nail in each case. We excluded a patient who had his nonunion
site explored followed by bone excision and transport. The mean duration of
fixator treatment was 6.2 months (3 to 11 months). MAIN OUTCOME MEASUREMENTS:
Clinical and x-ray evidence of bone union, infection, residual deformity,
shortening, and assessment of functional outcome. RESULTS: Bone union was
achieved in all nine patients using the circular fixator over the nail. The bone
results were graded as six excellent, one good, and two fair. All patients
reported a reduction in pain and satisfaction with their final outcome.
CONCLUSIONS: There is a role for the use of the Ilizarov fixator with nail
retention in resistant long bone diaphyseal nonunion in carefully selected
patients. This method can achieve high union rates where other treatment methods
have failed.
PMID: 12172279 [PubMed - indexed for MEDLINE]
6: Clin Orthop Relat Res. 1989 Apr;(241):146-65.
Ilizarov treatment of tibial nonunions with bone loss.
Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R.
Division of Orthopaedic Surgery, University of Maryland Hospital, Baltimore,
Maryland 21201.
Twenty-five patients aged 19-62 years were treated for tibial nonunions (22
atrophic, three hypertrophic) with bone loss (1-23 cm, mean 6.2 cm) by the
Ilizarov technique and fixator. Thirteen had chronic osteomyelitis, 19 had a
limb-length discrepancy (2-11 cm), 12 had a bony defect (1-16 cm), and 13 had a
deformity. Six had a bone defect with no shortening, 13 had shortening with no
defect, and six had both a bone defect and shortening. Nonunion, bone defects,
limb shortening, and deformity can all be addressed simultaneously with the
Ilizarov apparatus. Bone defects were closed from within without bone grafts by
the Ilizarov bone transport technique of sliding a bone fragment internally,
producing distraction osteogenesis behind it until the defect is bridged
(internal lengthening). Length was reestablished by distraction of a
percutaneous corticotomy or through compression and subsequent distraction of
the pseudarthrosis site (external lengthening). Distraction osteogenesis
resulting from both processes obviated the need for a bone graft in every case.
Deformity was corrected by means of hinges on the apparatus. Infection was
treated by radical resection of the necrotic bone and internal lengthening to
regenerate the excised bone. Union was achieved in all cases. The mean time to
union was 13.6 months, but it was only 10.6 months if the time taken for
unsuccessful compression-distraction of the nonunion is eliminated from the
calculation. The bone results were excellent in 18 cases, good in five, and fair
in two based on union in all cases, persistent infection in three, deformity in
four, and limb shortening in one. The functional results were excellent in 16
cases, good in seven, fair in one, and poor in one based on return to work and
daily activities in all cases, limp in four cases, equinus deformity in five
cases, dystrophy in four cases, pain in four cases, and voluntary amputation for
neurogenic pain in one case.
PMID: 2924458 [PubMed - indexed for MEDLINE]
7: Acta Orthop Belg. 2000 Jun;66(3):279-85.
Ilizarov treatment of tibial nonunions results in 16 cases.
Laursen MB, Lass P, Christensen KS.
Department of Orthopedic Surgery, Aalborg Hospital, Denmark.
Treatment with the Ilizarov technique was performed in 16 patients with complex
tibial nonunions. Two years post treatment the functional stage and patient
satisfaction were recorded. There were 4 hypertrophic, 3 atrophic and 9 infected
nonunions. Eleven patients had segmental bone loss. Fifteen nonunions united,
and limb length discrepancy was reduced within 1.5 cm of the contralateral leg.
Average time in the frame was 182 days. Fifteen of the 16 patients were
satisfied with the treatment. One patient demanded an amputation after 3 months
of treatment, despite good signs of healing. There were no refractures or
recurrent infections. In conclusion the Ilizarov technique for complex nonunions
has a high rate of success in achieving union and eradicating infection, bone
loss and malalignment. The treatment is demanding both to the surgeon and to the
patient, but we strongly recommend the Ilizarov treatment for tibial nonunion,
especially in cases with chronic infection and severe bone loss.
Publication Types:
Evaluation Studies
PMID: 11033919 [PubMed - indexed for MEDLINE]
8: J Trauma. 1995 Jan;38(1):111-7.
The treatment of tibial nonunion with angular deformity using an Ilizarov
device.
Ebraheim NA, Skie MC, Jackson WT.
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43699-0008,
USA.
Nine patients with nonunion of the tibia associated with angular deformity were
treated using the Ilizarov device. Eight of these went on to heal the nonunion
and had acceptable correction of the angular deformity. One patient with an
atrophic nonunion and severe bone loss received a below knee amputation. The
authors recommend the use of circular ring fixation as an alternative in the
treatment of selected cases of stiff nonunion of the tibia combined with angular
deformity, particularly if there is active infection, prior use of an external
fixator, or poor soft tissue coverage.
PMID: 7745640 [PubMed - indexed for MEDLINE]
9: Acta Orthop Traumatol Turc. 2003;37(1):9-18.
[Results of the Ilizarov method in the treatment of pseudoarthrosis of the lower
extremities]
[Article in Turkish]
Ozturkmen Y, Dogrul C, Karli M.
SSK Istanbul Egitim Hastanesi 1. Ortopedi ve Travmatoloji Klinigi, Istanbul.
OBJECTIVES: We evaluated the results of the Ilizarov method in the treatment of
pseudoarthrosis of the lower extremities. METHODS: Forty-six patients (34 men,
12 women; mean age 38.6 years; range 28 to 69 years) were treated by the
Ilizarov method for femoral (n=8, 17%) and tibial (n=38, 83%) pseudoarthrosis.
The mean duration of the disease was 1.6 years (range 6 months to 4.8 years).
Pseudoarthrosis was hypertrophic in seven patients (16%) and atrophic in 39
patients (84%). The mean number of previous operations was 1.4 (range 0 to 4);
the mean bone loss was 7.4 cm (range 3 to 12 cm); the mean shortening was 6.8 cm
(range 0 to 12 cm); the mean size of the defect was 5.2 cm (range 3 to 12 cm).
Applications were monofocal in 30 patients (66%) and bifocal in 16 patients
(34%). The mean follow-up was 22.6 months (range 9 to 54 months). RESULTS: Union
occurred in all patients (92%) but four (2 monofocal, 2 bifocal). The fixator
was applied for a mean of 208 days (range 93 to 750 days), which was 162 days
(range 98 to 296 days) for monofocal, and 286 days (range 140 to 496 days) for
bifocal applications. According to the Paley's criteria, the results for bone
healing and function were excellent in 26 and 25 patients, good in 12 and 14
patients, fair in four and three patients, and poor in four patients,
respectively. Pin tract infections developed in 28 patients, and reflex
sympathetic dystrophy in three patients. Refracture occurred after the removal
of the frame in three patients who received bifocal treatment. One patient
developed transient peroneal nerve palsy with drop foot. Equinus rigidity of the
ankle was seen in four patients. Cancellous bone grafting was performed in four
patients (25%) in whom delayed healing was observed at the target site following
segmental bone transport. Three patients had union with a residual deformity of
more than 7 degrees. In the monofocal group, none of the patients had a residual
shortening of more than 1 cm. Following bifocal applications, no bone defects
were observed; the mean residual length discrepancy was 1. 5 cm (range 0 to 4
cm), and the healing index was 52 days/cm. CONCLUSION: The Ilizarov technique
may simultaneously be successful in the treatment of joint contractures,
angular, rotational, and translational deformities, shortening, and bone
defects.
Publication Types:
Evaluation Studies
PMID: 12655190 [PubMed - indexed for MEDLINE]
10: Arch Orthop Trauma Surg. 2001;121(1-2):79-82.
Adaptation of Ilizarov ring fixator to the economic situation of developing
countries.
Pulate A, Olivier LC, Agashe S, Rallan R, Kamal V, Nast-Kolb D.
Department of Orthopedic and Traumatology, Pravara Rural Hospital and Rural
Medical College, Maharashtra, India.
Especially in countries with low per capita income, poor patients with open
fractures and non-unions are unable to purchase modern, commercially produced
surgical implants. To alleviate this situation, we initiated the production of a
locally made ring fixator. The rings were cut from tubes cast from scrap
aluminium. It was applied in 40 patients to test its utility for the typical
indications for the Ilizarov technique. The fixator was tolerated well. All
fractures united except in one case where there was refracture of the
consolidate due to too early removal of the fixator. Two arthrodeses were
successful. Bone transport showed adequate regeneration. A single radial
non-union united successfully. Loosening occurred in 11 wires and breakage in 6.
The subacute infections in 11 (27.5%) patients were not due to the fixator
itself but to low standards of hygiene and the delay of treatment in the
prehospital phase. Reusing the fixator at least three times reduces the cost for
the individual patient to US$ 13.60. A locally made fixator is cost-effective
and can be recommended for surgical treatment under similar economic situations.
PMID: 11195126 [PubMed - indexed for MEDLINE]
11: Injury. 2000 Sep;31(7):509-17.
The Ilizarov method in infected nonunion of fractures.
Maini L, Chadha M, Vishwanath J, Kapoor S, Mehtani A, Dhaon BK.
Department of Orthopaedics, Maulana Azad Medical College, New Delhi 110002,
India.
Thirty patients with infected non-union of long bones were treated with radical
resection of the necrotic bone and bone transport or compression/distraction
osteosynthesis. Non-union, infection, deformity, bone gap and shortening were
all addressed simultaneously using the Ilizarov principles. There were 15 cases
with bone loss ranging from 4 to 12 cm (median bone gap of 7 cm), 10 cases of
stiff non-union (six of which had an associated deformity) and five cases of
mobile non-union. The median time in the Ilizarov frame was 150 days. Median
follow up time after frame removal was 23.5 months. Bone grafting at the docking
site was only required in three cases (10%). There were three cases of
refracture (10%) and three cases of recurrence of infection (10%). The bone
result was excellent in 21 patients (70%), good in three (10%), fair in none
(0%) and poor in six (20%). The functional results were excellent in eight
patients (26.7%), good in 12 (40.0%), fair in three (10%) and poor in seven
(23.3%). It is difficult to precisely define the indications for preservation
and reconstruction of severe injuries. The surgical team has to take into
account the length, disability, complications and cost of treatment. Patients
must be aware of the limitations of functional results and the possible
difficulty of return to work despite the reconstructive attempt.
PMID: 10908744 [PubMed - indexed for MEDLINE]
12: J Reconstr Microsurg. 2001 Jan;17(1):17-25.
Free vascularized fibular graft vs. Ilizarov method for post-traumatic tibial
bone defect.
Yokoyama K, Itoman M, Nakamura K, Tsukamoto T, Saita Y, Aoki S.
Dept of Orthopedic Surgery, School of Medicine, Kitasato University, Sagamihara,
Kanagawa, Japan.
From 1991 to 1996, four free vascularized fibular grafts (FVFG) and four callus
distraction (CD) techniques were performed for post-traumatic tibial defects at
the authors' institute. They attempted to discern any differences of results
between FVFGs and CDs for post-traumatic tibial defects. The mean defect length
of the FVFG and CD groups were 7.3 cm and 4.6 cm, respectively (p < 0.05). They
selected as contributing factors: external fixation time, complication rate,
hospital charge, union rate, and functional score (Puno's criteria), in order to
compare the treatment of FVFG with that of CD. The external fixation times of
the FVFG and CD groups were 176 days and 261 days, respectively. One septic
non-union after refracture of the grafted fibula occurred in the FVFG group. Two
non-unions (50 percent) at the docking site occurred in the CD group. The mean
total costs of the FVFG and CD groups were 7,398,536 yen (US $68,505) and
11,798,153 yen(US $109,242), respectively. The union rates of both groups were
75 percent and 100 percent, respectively. The mean functional scores of both
groups were 69.5 and 88.8 points, respectively. The functional results of the
FVFG group were as follows: one patient showed good results; one, fair; and two,
poor. The functional results of the CD group were as follows: two patients
showed excellent results; one, good; and one, fair. Both the costs and the
functional outcomes between the two groups did not significantly differ. No
clear differences between the two treatment groups could be determined. However,
many more cases are needed to establish statistically significant differences
between both methods.
PMID: 11316280 [PubMed - indexed for MEDLINE]
13: Clin Orthop Relat Res. 1994 Apr;(301):159-63.
Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using
the Ilizarov apparatus.
Catagni MA, Guerreschi F, Holman JA, Cattaneo R.
Department of Orthopaedics, Lecco General Hospital, Italy.
The principle of treating stiff hypertrophic nonunions of long bones with
distraction using the Ilizarov method permits simultaneous correction of axial
deformity, angular deformity, translational deformity, shortening, and, in most
instances, infection. Twenty-one hypertrophic nonunions in 19 patients were
treated using the Ilizarov apparatus in distraction. Six of these patients had
associated chronic osteomyelitis. Ilizarov treatment ranged from four to 12
months (mean, 6.5 months). Follow-up time ranged from three to 11 years. Stable
union was achieved in all patients. Angular, axial, and translational
deformities were corrected in all patients; length discrepancies were corrected
in 18 of 21 patients (86%). Infection resolved in five of the six cases (83%)
with chronic osteomyelitis. The sole complication was axial collapse of
regenerate bone (in one patient with subsequent loss of 2 cm of lengthening)
after premature removal of the Ilizarov fixator. Distraction osteogenesis in the
treatment of stiff hypertrophic nonunions offers the most complete method of
providing optimal limb function. The process allows the patient to maintain
extremity mobility and weight bearing while undergoing treatment.
PMID: 8156667 [PubMed - indexed for MEDLINE]
14: Orthop Rev. 1989 May;18(5):609-13.
The Ilizarov technique in the treatment of infected tibial nonunions.
Pearson RL, Perry CR.
Department of Surgery, Washington University School of Medicine, St. Louis,
Missouri.
Five patients with infected tibial nonunions and segmental defects were treated
with the method of Ilizarov: application of circular small-wire fixator,
corticotomy and bone transport to fill the segmental defect. Four of the five
patients developed regenerate bone at the corticotomy distraction site. The one
failure was related to a previous surgery--reamed locked nailing of the tibia.
Three of the four patients with regenerate bone required open reduction and
internal fixation at the nonunion site following bone transport. Superficial pin
tract infections, broken wires and psychological intolerance of the frame were
frequent but minor problems.
Publication Types:
Case Reports
PMID: 2657597 [PubMed - indexed for MEDLINE]
15: Ugeskr Laeger. 1996 Apr 15;158(16):2237-40.
[Tibial pseudoarthrosis. Treatment using the Ilizarov technique]
[Article in Danish]
Andersen LR, Johannsen HG, Ernst C, Weeth ER.
Ortopaedkirurgisk afdeling, Odense Universitetshospital.
In the period from the 1.1.1991 to the 31.5.1993 17 patients with a tibial
pseudoarthrosis were treated by the Ilizarov method. The mean age was 35 years
(13-88 years). Mean time from fracture to operation for pseudoarthrosis was 14.6
months (3-39 months). There were two hypertrophic, 14 atrophic and one defect
pseudoarthrosis. Six of the pseudoarthroses were infected. After stable external
fixation the treatment was compression over the pseudoarthrosis in four cases
and alternating distraction and compression in eight cases. In five cases the
treatment was supplemented by bone transport for the defects between 15 and 50
mm. Mean time of treatment with the external fixator was 5.2 months (2-11.5
months). The overall treatment time was 9.8 months (3-19 months). At the
follow-up 14 pseudoarthroses were fully consolidated, one patient was still
using an orthosis, and three patients were in need of reoperation with bone
transplantation. During the period of fixation thirteen patients were
hospitalized for short periods, and some of them several times. The treatments
were for correction of the distraction, replacement of fixation of pintrack
infection or treatment of pain. The Ilizarov method of treatment of
pseudoarthrosis show a good stimulation of healing, but experience with the
fixator system and aggressive treatment of various minor complications are
essential for a successful outcome.
PMID: 8650795 [PubMed - indexed for MEDLINE]
16: Mil Med. 2004 Sep;169(9):728-34.
Treatment of infected tibial nonunions with debridement, antibiotic beads, and
the Ilizarov method.
McHale KA, Ross AE.
Department of Orthopedic Surgery and Rehabilitation, Walter Reed Army Medical
Center, Washington, DC 20307-5001, USA.
This study of 10 patients presents the early results of a protocol of
debridement, antibiotic bead placement, and use of the Ilizarov method with a
circular external fixator for treatment of infected nonunions of the tibia in a
military population. The nonunions resulted from high-energy fractures in nine
cases and an osteotomy in one. The Ilizarov techniques used were transport (five
cases), shortening and secondary lengthening (two cases), minimal resection with
compression (one case), and resection with bone grafting (two cases). Flap
coverage was required for five patients. There were two recurrences of infection
(20%) among patients with the most compromised soft tissue. Only 50% of patients
were able to perform limited duties while wearing the external fixator. Only
four patients returned to active duty; however, three patients from special
operations units were able to return to jump status. Six patients underwent
medical retirement because of insufficient function, resulting from decreased
ankle or knee range of motion and arthrosis or muscle weakness.
Publication Types:
Case Reports
PMID: 15495730 [PubMed - indexed for MEDLINE]
17: J Orthop Trauma. 2000 Feb;14(2):76-85.
Ilizarov bone transport treatment for tibial defects.
Paley D, Maar DC.
Department of Orthopaedic Surgery, University of Maryland Medical School,
Baltimore, USA.
OBJECTIVES: To evaluate the results and complications of Ilizarov bone transport
in the treatment of tibial bone defects. DESIGN: Retrospectively reviewed
consecutive series. METHODS: Nineteen patients with tibial bone defects were
treated by the Ilizarov bone transport method. The mean bone defect was ten
centimeters, and there were eight soft-tissue defects. The mean external
fixation time was sixteen months. Ten patients required debridement of the bone
ends and/or bone grafting of the docking site at the end of transport. RESULTS:
Union was achieved in all cases. One refracture of the docking site required
retreatment with the Ilizarov apparatus to achieve union. There was one residual
leg length discrepancy greater than 2.5 centimeters and two angular deformities
greater than 5 degrees. There were no recurrent or residual infections. Seven of
the eight soft-tissue defects were closed by soft-tissue transport; the eighth
required a free-vascularized flap. The bone results were graded as fifteen
excellent, three good, and one fair. The functional results were graded as
twelve excellent, six good, and one poor. There were twenty-two minor
complications, sixteen major complications without residual sequelae, and three
major complications with residual sequelae. To treat the bone defect and the
complications, a mean of 2.9 operations per patient was required. CONCLUSIONS:
Our results compare favorably with those for other methods of bone grafting as
well as with those from other published accounts of the Ilizarov method,
especially considering the large defect size in this series. The main
disadvantage of the Ilizarov method is the lengthy external fixation time.
Publication Types:
Clinical Trial
PMID: 10716377 [PubMed - indexed for MEDLINE]
18: Bull Hosp Jt Dis. 2003;61(3-4):101-7.
Ten year experience with use of Ilizarov bone transport for tibial defects.
Bobroff GD, Gold S, Zinar D.
Harbor-UCLA Medical Center, Department of Orthopaedic Surgery, 1000 West Carson
Street, Box 422, Torrance, California 90509, USA.
Tibial defects greater than 4 cm and secondary to high-energy trauma or
debridement for infected nonunion pose a significant challenge to the treating
orthopaedic surgeon. Twelve patients who had been treated with Ilizarov bone
transport for tibial defects over the past ten years were retrospectively
reviewed. All patients were male with an average age of thirty-two. Ten of the
twelve limbs were categorized as Grade IIIB fractures initially. The average
tibial defect at initiation of bone transport was 9.45 cm (range 4 to 20 cm).
The mean external fixator time (EFT) was 16.7 months with a mean external
fixator index (EFI) of 2.0 months per centimeter. There were a total of 36
complications. Twenty were minor, fourteen were major without sequelae and two
were major with sequelae. Overall bone results were good or excellent in nine
patients. Overall functional results were good or excellent in eight patients.
Ten patients achieved union after Ilizarov bone transport. Use of Ilizarov bone
transport can be an effective tool for treating large tibial defects. However,
the treatment time is lengthy with a considerable risk of complications.
PMID: 15156806 [PubMed - indexed for MEDLINE]
19: Am J Orthop. 2004 Sep;33(9):461-7.
Ilizarov external fixation salvage of failed intramedullary fixation of tibia
with nail retention.
Taylor KF, McHale KA.
Orthopaedic Surgery Resident, Department of Orthopaedic Surgery and
Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
kenneth.taylor@na.amedd.army.mil
Failure of intramedullary fixation of the tibia presents a unique problem, as
improving fracture alignment is often difficult after nail placement. The
purpose of this study was to demonstrate the effectiveness of the Ilizarov
technique in obtaining anatomic union after failed intramedullary fixation of
the tibia. We reviewed medical records and plain radiographs of 4 men who, at a
tertiary-care facility, presented with failed intramedullary fixation of the
tibia. Mean age was 28 years (range, 23-36 years). All 4 patients underwent
reduction and external fixation by the llizarov technique with retention of the
intramedullary nail. Anatomic union was attained in each case. Thin-wire
circular-frame external fixation by the Ilizarov technique was a viable salvage
option for failed intramedullary fixation of the tibia.
Publication Types:
Case Reports
PMID: 15509112 [PubMed - indexed for MEDLINE]
20: Orthopedics. 1989 Apr;12(4):497-508.
Infected tibial pseudarthrosis. A 2-year follow up on patients treated by the
Ilizarov technique.
Morandi M, Zembo MM, Ciotti M.
Louisiana State University Medical Center, New Orleans.
The Ilizarov technique with a circular external fixator was used in the
treatment of infected tibial nonunions. This is a report on 13 patients with a
2-year follow up after removal of the external fixation. There was no
debridement of the site of nonunion performed. Union was obtained in all cases.
There was no recurrence of infection at follow up. The Ilizarov technique
provides the orthopedic surgeon with another alternative in the treatment of
complicated tibial nonunions and their associated problems.
Publication Types:
Case Reports
PMID: 2710712 [PubMed - indexed for MEDLINE]
21: Rev Chir Orthop Reparatrice Appar Mot. 1999 Jun;85(3):231-7.
[Use of Ilizarov fixator in the treatment of post-osteomyelitis pseudoarthroses
in children]
[Article in French]
Zehi K, Karray S, Fathallah M, Bouguira A, Zouari O, Litaiem T, Douik M, Sliman
N.
Institut National d'Orthopedie MT Kassab, La Manouba, Tunisie.
PURPOSE OF THE STUDY: The aim of this study was to emphasize the importance of
the distraction osteogenesis technique in the treatment of post-osteomyelitis
nonunion. We report 12 cases. PATIENTS AND METHODS: Mean patient age was 9.5
years. There were 7 cases of nonunion of the femur and 5 involving the tibia.
Nonunion was associated with 5.9 cm shortening in 10 cases, 8.4 cm
circumferential bone defect in 1 case, shortening and bone defects in 6 cases,
and shortening and joint deformities in 2 cases. RESULTS: Consolidation was
obtained in 11 cases with an average delay of 11.6 months. Infection was
eradicated in 75 per cent of the cases. Average residual shortening was 0.4 cm.
Joint deformities and axial deviations were corrected at the same time in all
cases. DISCUSSION: The advantages of the Ilizarov technique are well known for
the treatment of such deformities and musculoskeletal system disorders
subsequent to osteomyelitis: nonunion, infection, shortening, joint deformities
and malunion.
PMID: 10422128 [PubMed - indexed for MEDLINE]
22: J Trauma. 1994 Oct;37(4):629-34.
The Ilizarov method for complex fracture nonunions.
DiPasquale D, Ochsner MG, Kelly AM, Maloney DM.
Department of Orthopaedic Surgery, Washington Hospital Center, Washington, DC
20010.
INTRODUCTION: Nonunion of complex fractures continues to challenge orthopedic
trauma surgeons. Although traditional management results in a successful outcome
in 50% to 80% of cases, the Ilizarov method has been reported to be more
effective. We evaluated the efficacy of the Ilizarov method for treatment of
nonunions. METHODS: Patients were selected based on the presence of nonunion
associated with osteomyelitis, treatment failure, or extensive segmental bone
loss. Treatment principles include surgical debridement, stabilization, and bone
regeneration for correction of defects. Patients were given maximum mobility and
were required to function as normally as possible during the course of
treatment. RESULTS: Seventeen patients were treated for complex nonunions with
the Ilizarov method during a 33-month period. Seven patients were facing the
alternative of amputation. Causes of nonunion were osteomyelitis (65%), failure
of conventional treatment (23%), and segmental bone loss (12%). Fractures
involved the lower (82%) and upper (18%) extremities. Using the Ilizarov method,
union was achieved in 94% (16 of 17) of patients over an average time of 6
months. CONCLUSION: Our results indicate that the Ilizarov method is superior to
traditional techniques of managing complex nonunions.
PMID: 7932895 [PubMed - indexed for MEDLINE]
23: J Orthop Sci. 2000;5(2):108-13.
The Ilizarov fixator in trauma: a 10-year experience.
Pavolini B, Maritato M, Turelli L, D'Arienzo M.
Second Orthopaedic and Traumatology Unit, University of Florence, c/o C.T.O.,
L.go Palagi, 1, 50139 Florence, Italy.
We reviewed the clinical results of 332 fractures treated with the Ilizarov
external fixator between 1984 and 1993. The locations of the involved bones
were: tibia, 247 (including 28 with tibial pylons); femur, 47; humerus, 21;
forearm, 12 and calcaneus, 5. The clinical outcomes of this series were
retrospectively evaluated by radiological and clinical rating systems. In the
tibial fractures, results in 71.1% were categorized as excellent or good,
without deep infection; 63.3% of the tibial pylon fractures, mostly open, also
showed excellent or good results. In the femoral fractures, which were mostly
localized at the metaphysis or distal epiphysis, 72% showed excellent or good
results, but the patients com-monly complained of knee stiffness. Limitations of
range of movement (ROM) in the elbow and the wrist were common in patients with
forearm fracture, but ROM was regained after physical therapy. According to the
clinical results of the present study, we believed that Ilizarov external
fixation was best indicated for tibial fractures, because of its advantage of
allowing early weight-bearing. Ilizarov external fixation was also best
indicated for: (1) open fractures, (2) comminuted fractures, (3) intra-articular
fractures, and (4) fractures with bony defect.
PMID: 10982644 [PubMed - indexed for MEDLINE]
24: Am J Orthop. 1995 May;Suppl:16-21.
Posttraumatic nonunion of the distal tibial metaphysis. Treatment using the
Ilizarov circular external fixator.
Lonner JH, Koval KJ, Golyakhovsky V, Frankel VH.
Department of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic
Institute, New York, New York, USA.
Ten nonunions of the distal tibial metaphysis were treated by using the Ilizarov
circular external fixator. Original fractures were classified in terms of the
Association for the Study of Internal Fixation as AO type A (4 cases), type B (5
cases), and type C (1 case). Six patients had a history of osteomyelitis.
Bifocal compression-distraction lengthening osteosynthesis was performed in all
cases. Proximal metaphyseal corticotomy was combined with resection and
compression of the distal nonunion site in five cases, and compression alone in
three patients. Ankle arthrodesis, in addition to nonunion resection, was
performed in two patients. Follow-up averaged 48 months (range, 26 to 81). Eight
nonunions healed (80%). Limb length was completely corrected in five cases;
angular and rotational alignment was corrected to within 5 degrees in seven
patients (70%). Based on an objective and subjective scale, the results were
considered good-to-excellent in seven cases and poor in three. Despite the high
complication rate and relatively low success rate (70%), the use of the circular
frame with small-diameter, tensioned wires may provide an alternative method for
the treatment of the very difficult problems associated with complex low distal
tibial metaphyseal nonunions.
Publication Types:
Clinical Trial
PMID: 7663956 [PubMed - indexed for MEDLINE]
25: Clin Orthop Relat Res. 1992 Jul;(280):136-42.
Management of segmental defects by the Ilizarov intercalary bone transport
method.
Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J.
Problem Fracture Service, Rancho Los Amigos Medical Center, Downey, California
90242.
Seventeen patients with segmental skeletal defects were managed with the
Ilizarov intercalary bone transport method, whereby an osseous defect is
eliminated by elongating one fragment. On average, the regenerate new bone
length measured 5.14 cm, corresponding to the creation of new osseous tissue
equaling 13.7% of the bone's original length (range, 4.2%-35%). The average time
in fixation was 9.6 months, including 4.8 months to transport the bone fragment
throughout the limb. Numerous complications were encountered, most commonly
wire-site sepsis and fixator instability. No serous nerve or vessel
complications occurred. All but one patient eventually healed, although six
patients required bone grafts, five at the target site and one at the level of
the regenerate. Most of the difficulties encountered were due to a lack of
technical knowledge with the method.
PMID: 1611733 [PubMed - indexed for MEDLINE]
26: Chir Organi Mov. 2001 Jul-Sep;86(3):199-210.
Aseptic nonunion and delay in consolidation in the tibia: treatment by
intramedullary nailing and using the Ilizarov method.
[Article in English, Italian]
Iacobellis C, Cacciato F.
Dipartimento di Specialita Medico-Chirurgiche Clinica ortopedica e
Traumatologica Universita degli Studi, Padova.
The authors present a clinical-radiographic study on two groups of patients
affected with aseptic nonunion and delays in consolidation of the tibia treated
by intramedullary nailing (24 cases) and Ilizarov method (29 cases). Nailing was
locked in 12 cases and associated with resection of the fibula in 15 (in 8
locked nailing). Autoplastic bone grafts were applied in 3 cases of atrophic
nonunion. The Ilizarov method was used with different procedures: standard
assembly in 23 patients, of which 6 with the application of autoplastic grafts
for atrophic nonunion. En bloc resection of the atrophic nonunion was carried
out in 6 patients followed by removal (4 cases) or lengthening (2 cases).
Parafocal osteotomy according to Paltrinieri was reserved for closed
hypertrophic nonunion with severe varus and procurvatum. The data for this study
allow the authors to conclude that intramedullary nailing is preferable in
delays in consolidation and in hypertrophic nonunion without angular defects or
hypometria, while the Ilizarov method is more indicated in atrophic nonunions
and in hypertrophic nonunions with hypometria and angular defects.
PMID: 12025183 [PubMed - indexed for MEDLINE]
27: Arch Orthop Trauma Surg. 2002 Jun;122(5):295-8. Epub 2002 Jan 31.
Distraction of hypertrophic nonunion of tibia with deformity using
Ilizarov/Taylor Spatial Frame. Report of two cases.
Rozbruch SR, Helfet DL, Blyakher A.
Limb Lengthening Service, Orthopaedic Trauma Service, Hospital for Special
Surgery, 535 East 70th Street, New York, NY 10021, USA. RozbruchSR@hss.edu
Two cases of hypertrophic nonunion of the tibia with deformity for which
distraction treatment using an Ilizarov/Taylor Spatial Frame (Smith & Nephew,
Memphis, TN) are presented. This frame utilizes a computer program to help plan
correction of the deformity.
Publication Types:
Case Reports
PMID: 12070651 [PubMed - indexed for MEDLINE]
28: Can J Surg. 2002 Jun;45(3):196-200.
Morbidity resulting from the treatment of tibial nonunion with the Ilizarov
frame.
Sanders DW, Galpin RD, Hosseini M, MacLeod MD.
Division of Orthopedic Surgery, University of Western Ontario, London.
David.Sanders@lhsc.on.ca
OBJECTIVE: To determine the sources and magnitude of residual morbidity after
successful treatment of tibial nonunion using the Ilizarov device and
techniques. DESIGN: A retrospective cohort study. SETTING: A level 1 trauma
centre. PATIENTS: Sixteen patients with healed tibial nonunion. INTERVENTION:
Application of the Ilizarov device and techniques to obtain union of a previous
ununited tibial fracture. MAIN OUTCOME MEASURES: Patient satisfaction and
sources of morbidity through clinical review and a visual analogue scale. Two
disease-specific outcome measurement scales were used to assess ankle
dysfunction. Radiographs were examined to determine the presence of arthrosis.
RESULTS: Residual pain was present in over 90% of patients at a mean follow-up
of 39 months: in 80% the worst pain was in the ankle, less than 10% felt the
worst pain in the knee or at the fracture site. Mean ankle osteoarthritis scores
were 3.4 for pain and 4.0 for disability, compared with 0.76 and 0.90
respectively for age-matched controls. Mean ankle-hindfoot scores were between
64 and 100. CONCLUSION: Ankle pain with disability is the major source of
residual disability after successful use of the Ilizarov device for the
treatment of tibial nonunion.
PMID: 12067172 [PubMed - indexed for MEDLINE]
29: Injury. 2005 May;36(5):662-8.
Ilizarov external fixator: acute shortening and lengthening versus bone
transport in the management of tibial non-unions.
Mahaluxmivala J, Nadarajah R, Allen PW, Hill RA.
Limb Reconstruction Unit, Princess Alexandra Hospital, UK.
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.
PMID: 15826629 [PubMed - in process]
30: Orthopade. 1996 Sep;25(5):405-15.
[Ilizarov procedure in pseudarthrosis]
[Article in German]
Josten C, Kremer M, Muhr G.
Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliche Kliniken
Bergmannsheil, Bochum.
The treatment of nonunions has made an important development through the work of
Ilizarov describing the principles of compression and distraction by using the
ring-fixator. While local compression is sufficient in hypertrophic nonunions,
the treatment of choice for atrophic infected nonunions with bony defects is a
corticotomy followed by a segmental transport, especially in case of an osseous
defect larger than 3 cm. Primary shortening poses a better starting point both
for soft-tissue reconstruction and for early docking. External fixation systems
are the ring-fixator, the unilateral fixator and hybrid systems combining both
fixation methods. The use of a ring-fixator makes a shorter time of osseous
consolidation possible when compared to a unilateral system (25,8 d/cm - 35,8
d/cm). Soft-tissue reconstruction before initiation of transport also shortens
the time of osseous consolidation compared to later soft-tissue coverage. A
docking-region in the metaphyseal area is supported by minimal internal fixation
and cancellous bone graft. Segmental transport is complicated by local
infection, regenerate failure (4.3% and regenerate fracture (2.9%).
PMID: 8966033 [PubMed - indexed for MEDLINE]
31: J Bone Joint Surg Br. 1997 Mar;79(2):273-9.
The Ilizarov method in nonunion, malunion and infection of fractures.
Marsh DR, Shah S, Elliott J, Kurdy N.
Hope Hospital, Salford, England.
We have reviewed a series of 56 consecutive patients treated by the Ilizarov
circular fixator for various combinations of nonunion, malunion and infection of
fractures. We used segmental excision, distraction osteogenesis and gradual
correction of the deformity as appropriate. Treatment was effective in
eliminating 40 out of 46 nonunions and all 22 infections. There were two cases
of refracture some months after removal of the frame, both of which healed
securely in a second frame. Correction of malunion was good in the coronal plane
but there was a tendency to anterior angulation, often occurring in the
regenerate bone rather than at the original fracture site, after removal of the
frame. This was associated with very slow maturation of regenerate bone in some
patients, occurring largely, but not exclusively, in those who smoked heavily.
Patients expressed high levels of satisfaction with the outcome, despite
relatively modest improvements in pain and function, presumably because their
longstanding and intractable nonunion had been treated. None the less, the
degree of satisfaction correlated strongly with the degree of improvement in
pain and function. We emphasise the importance of a multidisciplinary team in
the assessment and support of patients undergoing long and demanding treatment.
The Ilizarov method is valuable, but research is needed to overcome the problems
of delayed maturation of the regenerate and slow or insecure healing of the
docking site.
PMID: 9119856 [PubMed - indexed for MEDLINE]
32: Instr Course Lect. 1990;39:185-97.
Treatment of tibial nonunion and bone loss with the Ilizarov technique.
Paley D.
Publication Types:
Review
Review, Tutorial
PMID: 2186101 [PubMed - indexed for MEDLINE]
33: Unfallchirurg. 1990 Jun;93(6):237-43.
[Ilizarov's distraction osteogenesis using the mono-fixator system and initial
clinical experiences with the injured lower leg]
[Article in German]
Gotzen L, Baumgaertel F.
Klinik fur Unfallchirurgie, Philipps-Universitat Marburg.
Distraction osteogenesis, as developed by Ilizarov, allows the limbs to be
lengthened and intercalary defects to be filled by bone transport without the
use of bone grafts. In five patients with traumatic sequelae (fractures of the
lower leg), unilateral dynamic mono_fixation and a special distraction apparatus
were used for application of the Ilizarov technique. With the distraction
device, gradual distraction of the osteotomy surfaces (1/3 mm in three steps per
day) is easy for the patients to perform. In three cases distraction
osteogenesis was used to correct shortening of the lower leg and in two cases
for bridging a tibial defect due to an infection in the plate osteosynthesis. In
all cases, the course of treatment and bone healing were uneventful. Based on
our first clinical experiences, we believe that mono_fixation provides
appropriate stability and the distraction apparatus permits appropriate bone
transportation for successful distraction osteogenesis in the tibia.
Publication Types:
Case Reports
PMID: 2367859 [PubMed - indexed for MEDLINE]
34: J Orthop Trauma. 2004 Aug;18(7):470-1.
OPINION: ilizarov external fixation and bone transport.
Steinberg EL.
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Publication Types:
Case Reports
PMID: 15289696 [PubMed - indexed for MEDLINE]
35: Chir Organi Mov. 1996 Sep-Dec;81(4):395-400 hl.
The effects of cigarette smoke on the progression of septic pseudarthrosis of
the tibia treated by Ilizarov external fixator.
[Article in English, Italian]
Gualdrini G D, Zati A, Degli Esposti S.
III Div. di Ortopedia e Traumatologia, Istituti Ortopedici Rizzoli, Bologna.
The authors conducted a study to evaluate the effects of cigarette smoke on the
healing of septic pseudarthrosis of the tibia treated by ilizarov external
fixator. A total of 31 patients of both sexes were chosen, and the healing time
in relation to the habit of smoking was examined. The results have shown that
the healing time in non-smokers as compared to smokers was shorter by 33%. The
difference is highly significant. This shows that abstention from smoking during
treatment should be given maximum importance in prevention.
PMID: 9147931 [PubMed - indexed for MEDLINE]
36: Rev Hosp Clin Fac Med Sao Paulo. 1994 May-Jun;49(3):112-5.
[Treatment of pseudarthrosis of the long bones using the Ilizarov method in
children]
[Article in Portuguese]
Guarniero R, Montenegro NB, Guarnieri MV, Luzo CA.
Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, F.M.U.S.P.
In the period 1987-1993, 13 patients were treated for both infected and
non-infected long bone pseudoarthrosis by Ilizarov method. The records and
radiographs of nine boys and four girls, with the age ranging from 7 to 16
years, with an average of 12.3 years, were reviewed. All but one concerned the
tibia. In one case the pseudoarthrosis was localized in the humerus. Ten were
infected. Ten had bone loss, all in the tibia, 2.5 to 8.0 cm in the extension
of. All the results were considered good and the complications observed were few
and not related with the treatment.
PMID: 7817105 [PubMed - indexed for MEDLINE]
37: Clin Orthop Relat Res. 1989 Jun;(243):71-9.
Local bone transportation for treatment of intercalary defects by the Ilizarov
technique. Biomechanical and clinical considerations.
Aronson J, Johnson E, Harp JH.
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences,
Little Rock.
Ilizarov applied revolutionary methods for salvaging limbs with severe
congenital, posttraumatic, or other acquired deformities. His methods, which use
a universal system of ring external fixators with tensioned transosseous wires,
were developed over the past 35 years at his institute in Kurgan, USSR. These
noninvasive techniques have proved successful in over 300,000 patients (adults
and children) treated for bone shortening and intercalary deficiency, angulatory
and rotational malalignment, active infection, ischemia, joint contractures, and
nonunions. Bone transportation involves moving a free segment of living bone to
fill intercalary bone defects with vital bone. The trailing end of the transport
bone segment maintains continuity with the host bone surface by distraction
osteogenesis. The leading end of the transport bone segment fuses to the target
bone surface by transformational osteogenesis. The small diameter of the
transosseous wires contributes to better patient tolerance over the prolonged
treatment times required for gradual distraction at 1 mm per day.
Publication Types:
Review
Review, Tutorial
PMID: 2656035 [PubMed - indexed for MEDLINE]
38: Arch Putti Chir Organi Mov. 1984;34:303-8.
[Treatment of pseudoarthrosis with the external Ilizarov fixator. Initial
experiences]
[Article in Italian]
Confalonieri N, Penna G, Bagnoli G, Landini A, Pietrogrande V.
Publication Types:
Case Reports
PMID: 6544089 [PubMed - indexed for MEDLINE]
39: Chir Narzadow Ruchu Ortop Pol. 1998;63(4):395-8.
[A case of infected tibial pseudoarthrosis treated by Ilizarov method
complicated by supracondylar traumatic fracture of the femur]
[Article in Polish]
Palczewski D, Kordala K.
Oddzial Ortopedyczno-Urazowy, Szpital Wojewodzki w Siedlcach.
A case of 45 years old male with infected pseudoarthrosis of the tibia, 4 cm
shortening of the limb involved, complicated with ipsilateral distal femur
fracture is reported. Ilizarov apparatus was used to address whole pathology. At
8 months follow-up good clinical and radiological result is achieved--the
fracture and pseudoarthrosis united, the leg is lengthened by 4 cm.
Publication Types:
Case Reports
PMID: 9857559 [PubMed - indexed for MEDLINE]
40: Chir Organi Mov. 1995 Jan-Mar;80(1):45-8.
The Ilizarov method for the treatment of infected pseudarthrosis of the tibia:
our experience in cases with severe lesion of the soft tissues.
[Article in English, Italian]
Gualdrini G, Galli G, Rollo G, Ponzo L.
3a Divisione, Istituto Ortopedico Rizzoli, Bologna.
Between 1985 and 1990 a total of 35 cases of infected pseudarthrosis of the
tibia were treated by radical resection of the pseudarthrosis and
corticotomy-distraction-compression. In 5 patients there was severe lesion of
the soft tissues with extensive loss of substance. It is the purpose of the
present study to evaluate the effects of the use of this method on lesions of
the soft tissues in these 5 patients.
PMID: 7641540 [PubMed - indexed for MEDLINE]
41: West J Med. 1995 Dec;163(6):568.
The Ilizarov method.
Rosenfeld SR.
PMID: 8553645 [PubMed - indexed for MEDLINE]