AIM To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODS Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss ...AIM To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODS Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo(range 27-56 mo). RESULTS The infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases. CONCLUSION Distraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.展开更多
The clinical behavior of nonossifying fibroma （NOF） appears to be a benign lesion without recurrence or canceration.[1] Ewing＇s sarcoma （ES） is usually regarded as a differential diagnosis of NOF.[2] There has no...The clinical behavior of nonossifying fibroma （NOF） appears to be a benign lesion without recurrence or canceration.[1] Ewing＇s sarcoma （ES） is usually regarded as a differential diagnosis of NOF.[2] There has not been any report on NOF and ES appearing in the same position simultaneously. Here, we first report a case that the simultaneous onset of two entities was mistaken for the development of NOF into ES. A17-year-old boy referred to hospital in October 2010 for a durative ache in his right knee after an injury during football training. Initial radiographs revealed a low-density area with sclerotic margin on the proximal part of the right tibia. Computed tomography （CT） scan showed a radiolucent, eccentric, and cortically based lesion in the posterolateral metaphysis of the right tibia. Then, the patient underwent magnetic resonance imaging （MRI）, in which a lesion revealed long mixed signs on T1-weighted imaging （T1WI） and short signs on T2WI accompanied with bone contusion around it. These reports suggested that the eccentric area could be an osteoid osteoma or a NOF. A percutaneous biopsy of the right proximal tibia lesion was performed, and then NOF was pathologically confirmed. Hence, curettage and bone grafting were performed.展开更多
BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in...BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.展开更多
The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixa...The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.展开更多
在埃及骨科学会以及下设Ilizarov技术研究与应用学会(ASAMI)的积极推动下,Ilizarov技术和方法在埃及及周边地区迅速推广,已广泛应用于开放性骨折、粉碎性骨折、关节内骨折、陈旧骨折、骨不连、畸形愈合及各种创伤后遗症等,使很多常规方...在埃及骨科学会以及下设Ilizarov技术研究与应用学会(ASAMI)的积极推动下,Ilizarov技术和方法在埃及及周边地区迅速推广,已广泛应用于开放性骨折、粉碎性骨折、关节内骨折、陈旧骨折、骨不连、畸形愈合及各种创伤后遗症等,使很多常规方法需要截肢的重度畸形患者改变了治疗策略。经过近40年的发展,Ilizarov技术在埃及已成为诸多疑难骨科问题的主要解决方法,使发展中国家成千上万贫困患者的生活得以改变。Gamal Ahmed Hosny教授担任国际ASAMI主席期间,埃及ASAMI在开罗承办了第六届世界ASAMI大会,推动了Ilizarov技术领域的国际交流。一年一度的开罗国际肢体畸形矫正大会已被公认为全世界讲授畸形分析和矫正原则最重要的课程之一。2021年,正值Ilizarov教授诞辰100周年,Gamal Ahmed Hosny教授受秦泗河教授邀请,就Ilizarov技术在埃及的应用和发展概况进行介绍。展开更多
Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The ear...Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The earlier treatment outcomes have been poor due to the high rate of infection and avascular necrosis.However,more recent literature advised reimplanting the talus whenever practical,and providing with meticulous cleaning of the talus.In the presence of infection and severe trauma,tibiocalcaneal fusion achieved by the Ilizarov external fixator can be an effective salvage method.展开更多
Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mea...Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n = 4) and curling of toes (n = 4). The bone healing results were excellent in 92% of cases and good in 8% of cases. The functional results were excellent in 84% of cases, good in 12% and fair in 4% of cases. Thus bone transport by Ilizarov’s method manages the bone loss and the associated conditions with good bone healing and functional results.展开更多
文摘AIM To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODS Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo(range 27-56 mo). RESULTS The infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases. CONCLUSION Distraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.
文摘The clinical behavior of nonossifying fibroma （NOF） appears to be a benign lesion without recurrence or canceration.[1] Ewing＇s sarcoma （ES） is usually regarded as a differential diagnosis of NOF.[2] There has not been any report on NOF and ES appearing in the same position simultaneously. Here, we first report a case that the simultaneous onset of two entities was mistaken for the development of NOF into ES. A17-year-old boy referred to hospital in October 2010 for a durative ache in his right knee after an injury during football training. Initial radiographs revealed a low-density area with sclerotic margin on the proximal part of the right tibia. Computed tomography （CT） scan showed a radiolucent, eccentric, and cortically based lesion in the posterolateral metaphysis of the right tibia. Then, the patient underwent magnetic resonance imaging （MRI）, in which a lesion revealed long mixed signs on T1-weighted imaging （T1WI） and short signs on T2WI accompanied with bone contusion around it. These reports suggested that the eccentric area could be an osteoid osteoma or a NOF. A percutaneous biopsy of the right proximal tibia lesion was performed, and then NOF was pathologically confirmed. Hence, curettage and bone grafting were performed.
文摘BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
文摘The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
文摘在埃及骨科学会以及下设Ilizarov技术研究与应用学会(ASAMI)的积极推动下,Ilizarov技术和方法在埃及及周边地区迅速推广,已广泛应用于开放性骨折、粉碎性骨折、关节内骨折、陈旧骨折、骨不连、畸形愈合及各种创伤后遗症等,使很多常规方法需要截肢的重度畸形患者改变了治疗策略。经过近40年的发展,Ilizarov技术在埃及已成为诸多疑难骨科问题的主要解决方法,使发展中国家成千上万贫困患者的生活得以改变。Gamal Ahmed Hosny教授担任国际ASAMI主席期间,埃及ASAMI在开罗承办了第六届世界ASAMI大会,推动了Ilizarov技术领域的国际交流。一年一度的开罗国际肢体畸形矫正大会已被公认为全世界讲授畸形分析和矫正原则最重要的课程之一。2021年,正值Ilizarov教授诞辰100周年,Gamal Ahmed Hosny教授受秦泗河教授邀请,就Ilizarov技术在埃及的应用和发展概况进行介绍。
文摘Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The earlier treatment outcomes have been poor due to the high rate of infection and avascular necrosis.However,more recent literature advised reimplanting the talus whenever practical,and providing with meticulous cleaning of the talus.In the presence of infection and severe trauma,tibiocalcaneal fusion achieved by the Ilizarov external fixator can be an effective salvage method.
文摘Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n = 4) and curling of toes (n = 4). The bone healing results were excellent in 92% of cases and good in 8% of cases. The functional results were excellent in 84% of cases, good in 12% and fair in 4% of cases. Thus bone transport by Ilizarov’s method manages the bone loss and the associated conditions with good bone healing and functional results.
