The Use Of The Knee Spanning Ilizarov Method As A Treatment Procedure In Infected Nonunion Of The Distal Femur With Bone Loss

MALLICK S.K.

Abstract


Abstract
Abstract Title
: The Use Of The Knee Spanning Ilizarov Method As A TreatmentProcedure In Infected Nonunion Of The DistalFemur With Bone Loss

 

ABSTRACT:

BACKGROUND-

 infected non union of distal femur is a very difficult entity in treatment point of view ,it grossly affects dalily living and add economical burden to the society. Surgical treatment of which is
difficult and there is no consensus as to which technique leads to the
best out come.

MATERIALS AND METHODS-

 We reviewed 10 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator  from jan2010 to dec 2015.

RESULTS-

The mean follow-up after removal of the frame was 18.6months (14 to 30). No patient was lost to follow-up.The mean external fixator time was 313.9 days (275 to 362) which correlated with the final lengthening achieved .

CONCLUSION-

Distal femoral fracture with non-union is complicated orthopedic entity as it is associated with non-union,infection ,bone loss.shotening,soft tissue scar,contracture,restriction of movement,dis-use osteopenia.ilizarov ex-fix is definitive treatment modality in these cases as it gives stability,allows early wt bearing ,compression/distraction at fracture site helps to wean off infection and help in union,,corticomy helps to regain length.  

REFERENCES-

1. Kretek C, Schandelmaier P, Tscherne H.Distal femoral fractures: transarticularreconstruction, percutaneous plate osteosynthesis and retrograde nailing.Unfallchirurg1996;99:2-10 (in German).

2. Wu CC, Shih CH.Distal femoral non-union treated with interlocking nailing.J Trauma1991;31:1659-62.

3. Ali F, Saleh M.Treatment of distal femoral non-unions by external fixation withsimultaneous length and alignment correction.Injury2002;33:127-34.

4. Bellabarba C, Ricci WM, Bolhofner BR.Indirect reduction and plating of distalfemoral non-unions.J OrthopTraums2002;16:287-96.

5. Johnson KD, Hicken G.Distal femoral fractures.OrthopClin North Am1987;18:115-32.

6. Webb LX.Bone defect non-union of the lower extremity.Tech Orthop

2001;164:387-97.

7. Ilizarov GA.Transosseousosteosynthesis.Theoretical and clinical aspects of theregeneration and growth of tissue. Berlin: Springer-Verlag, 1992.

8. Green SA.Skeletal defects: a comparison of bone grafting and bone transport forsegmental skeletal defects.ClinOrthop1994;301:111-17.

9. Paley D, Catagni MA, Argnani F, et al.Ilizarov treatment of tibial non-unions withbone loss.ClinOrthop1989;241:146-65.

10. Gustilo RB, Anderson JT.Prevention of infection in the treatment of one thousandand twenty five open fractures of long bones: retrospective and prospective analyses.J Bone Joint Surg [Am]1976;58-A:453-8.

11. Song HR, Cho SH, Koo KH, et al.Tibial bone defects treated by internal bone transportusing the Ilizarov method.IntOrthop1998;22:293-7.

12. Arazi M, Memik R, Ogun TC, Yel M.Ilizarov external fixation for severely comminutedsupracondylar and intercondylar fractures of the distal femur.J Bone Joint Surg[Br]2001;83-B:663-7.

13. Wang JW, Weng LH.Treatment of distal femoral non-union with internal fixation,cortical allograft struts, and autogenous bone-grafting.J Bone Joint Surg [Am]2003;85-A:436-40.

14. Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N.Femoral exchange nailingfor aseptic non-union: not the end to all problems.Injury2003;34:349-56.

15. Paley D, Maar DC.Ilizarov bone transport treatment for tibial defects.

J OrthopTrauma2000;14:76-85.

16. Paley D.Problems, obstacles and complications of limb lengthening by the Ilizarovtechnique.ClinOrthop1990;250:81-104.

17. Bolhofner BR, Carmen B, Clifford P.The result of open reduction and internal fixationof distal femur fractures using a biologic (indirect) reduction technique.J OrthopTrauma1996;10:372-7.

18. Aronson J.Limb-lengthening, skeletal reconstruction, and bone transport with theIlizarov method.J Bone Joint Surg [Am]1997;79-A:1243-58.

19. Hutson JJ Jr, Zych GA.Treatment of comminuted intraarticular distal femur fractureswith limited internal and external tensioned wire fixation.J Orthop Trauma2000;14:405-13.

20. Ramesh LJ, Rajkumar SA, Rajendra R, et al.Ilizarov ring fixation and fibular strutgrafting for C3 distal femoral fractures.J OrthopSurg (Hong Kong)2004;12:91-5.

21. Marsh DR, Shah S, Elliot J, Kurdy N.The Ilizarov method in non-union, malunionand infection of fractures.J Bone Joint Surg [Br]1997;79-B:273-9.

22. A. Saridis, E. Panagiotopoulos, M. Tyllianakis, C. Matzaroglou, N. Vandoros, E. LambirisThe use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Joint Surg [Br] 2006;88-B:232-7.

 

 


References References

References

Kretek C, Schandelmaier P, Tscherne H. Distal femoral fractures: transarticular reconstruction, percutaneous plate osteosynthesis and retrograde nailing. Unfallchirurg 1996;99:2-10 (in German).

Wu CC, Shih CH. Distal femoral non-union treated with interlocking nailing. J Trauma 1991;31:1659-62.

Ali F, Saleh M. Treatment of distal femoral non-unions by external fixation with simultaneous length and alignment correction. Injury 2002;33:127-34.

Bellabarba C, Ricci WM, Bolhofner BR. Indirect reduction and plating of distal femoral non-unions. J Orthop Traums 2002;16:287-96.

Johnson KD, Hicken G. Distal femoral fractures. Orthop Clin North Am 1987;18: 115-32.

Webb LX. Bone defect non-union of the lower extremity. Tech Orthop

;164: 387-97.

Ilizarov GA. Transosseous osteosynthesis. Theoretical and clinical aspects of the regeneration and growth of tissue. Berlin: Springer-Verlag, 1992.

Green SA. Skeletal defects: a comparison of bone grafting and bone transport for segmental skeletal defects. Clin Orthop 1994;301:111-17.

Paley D, Catagni MA, Argnani F, et al. Ilizarov treatment of tibial non-unions with bone loss. Clin Orthop 1989;241:146-65.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg [Am] 1976;58-A:453-8.

Song HR, Cho SH, Koo KH, et al. Tibial bone defects treated by internal bone transport using the Ilizarov method. Int Orthop 1998;22:293-7.

Arazi M, Memik R, Ogun TC, Yel M. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Joint Surg [Br] 2001;83-B:663-7.

Wang JW, Weng LH. Treatment of distal femoral non-union with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Joint Surg [Am] 2003;85-A:436-40.

Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N. Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury 2003;34:349-56.

Paley D, Maar DC. Ilizarov bone transport treatment for tibial defects.

J Orthop Trauma 2000;14:76-85.

Paley D. Problems, obstacles and complications of limb lengthening by the Ilizarov technique. Clin Orthop 1990;250:81-104.

Bolhofner BR, Carmen B, Clifford P. The result of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma 1996;10:372-7.

Aronson J. Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg [Am] 1997;79-A:1243-58.

Hutson JJ Jr, Zych GA. Treatment of comminuted intraarticular distal femur fractures with limited internal and external tensioned wire fixation. J Orthop Trauma 2000;14:405-13.

Ramesh LJ, Rajkumar SA, Rajendra R, et al. Ilizarov ring fixation and fibular strut grafting for C3 distal femoral fractures. J Orthop Surg (Hong Kong) 2004;12:91-5.

Marsh DR, Shah S, Elliot J, Kurdy N. The Ilizarov method in non-union, malunion and infection of fractures. J Bone Joint Surg [Br] 1997;79-B:273-9.

A. Saridis, E. Panagiotopoulos, M. Tyllianakis, C. Matzaroglou, N. Vandoros, E. Lambiris The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Joint Surg [Br] 2006;88-B:232-7.


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