[Results of the Ilizarov method in the treatment of pseudoarthrosis of the lower extremities]

Yusuf Oztürkmen, Cemal Doğrul, Mahmut Karli
Acta Orthopaedica et Traumatologica Turcica 2003, 37 (1): 9-18

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.

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