Ilizarov technique for treatment of a giant aneurysmal bone cyst at the distal femur:A case report

BACKGROUND Aneurysmal bone cyst(ABC)is a benign cystic of unknown etiology,characterized by multiple chambers and a high recurrence rate.Current treatment options include vascular embolization,surgical excision,curettage with cavity filling,sclerosing agent injection into the cavity,radiotherapy,and systemic drug therapy.Among these,surgical excision and curettage are the preferred treatment modalities.However,when the cyst reaches a large size,extensive removal of diseased tissue during surgery can hinder bone healing.In our department,we treated a case of a large ABC at the distal end of the femur in a child using the Ilizarov technique.The tumor was completely excised,and reconstruction was achieved through autologous femoral bone transfer.The follow-up at two years post-surgery indicated good results without tumor recurrence,and the growth and development of the child were essentially unaffected.CASE SUMMARY An 11-year-old boy was presented with an accidental fracture of his right leg.Despite having been examined at other hospitals,he had not received treatment.Given the potential for significant bone defects and the difficulty of the surgery,our doctors opted to use the Ilizarov technique to minimize harm to the patient.Upon admission,the patient underwent a needle biopsy and complete tumor resection-the Ilizarov technique assisted in the transport and reconstruction of the autologous femoral bone.Postoperatively,the patient exhibited regular followups,during which bone transport was gradually performed,and the external fixation frame was removed on time.Follow-up X-rays of the right lower limb displayed no tumor recurrence,with a normal appearance.Bone formation at the cutting site was satisfactory,and the union of the bone ends indicated good healing.After two years of follow-up,the patient had essentially returned to normal.CONCLUSION We successfully applied the Ilizarov technique to treat ABC,reducing the financial burden of patients and the pain of multiple surgeries.In cases where significant bone defects occur,the Ilizarov technique has demonstrated satisfactory therapeutic outcomes.

Lengthening of a below knee amputation stump with Ilizarov technique in a patient with a mangled leg

A below knee amputation(BKA)requires sufficient stump length for the fitting of a modern prosthesis.In cases of trauma where the levels of injury are unpredictable,achieving sufficient stump length can be a challenge.We described a case report of using the Ilizarov technique for bone lengthening at the residual BKA stump for a patient who sustained a mangled limb following a road traffic accident.Using this technique,we have successfully lengthened the tibial stump adequately for a functioning prosthesis.As shown in this case,we believe that this technique could attain an excellent outcome for a selected group of patients with short residual BKA stump.

Treatment of talipes equinovarus after triceps surae intramuscular hemangioma surgery by Ilizarov technology in adults:A case report

BACKGROUND Postoperative complications of triceps surae intramuscular hemangioma surgery with talipes equinovarus have rarely been described,and the evidence for treatment is limited.The purpose of this case study was to report the new application of the Ilizarov technique,which successfully treated talipes equinovarus in adults after triceps surae intramuscular hemangioma.CASE SUMMARY A 29-year-old woman treated with the Ilizarov technique for talipes equinovarus in the right leg after triceps surae intramuscular hemangioma surgery.The equinus deformity was roughly corrected after 2 years of follow-up,without significant secondary sequelae.CONCLUSION Talipes equinovarus caused by postoperative sequelae of intramuscular hemangioma was successfully corrected by the Ilizarov technique.The Ilizarov technique may be used for treating talipes equinovarus caused by various causes.

Severe hand contracture treated by external fixation after proximal row carpectomy and awake tenolysis after general anesthesia: A case report

Wide-awake local anesthesia has many advantages.We describe a new method to use wide-awake local anesthesia with more flexibility.A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis.We performed most of the tenolysis procedure under general anesthesia and the final stage with an intra-operative assessment of active finger movement and dissection under local anesthesia.He regained his grip strength 2.5 years post-injury.General anesthesia is useful to treat a surgical site with extensive hard scars,whereas local anesthesia is useful for adjusting tension in an awake patient.The indication for wide-awake surgery is yet to be established;our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.

Injury and regeneration of intramuscular connective tissue subjected to various regimes of distraction

Objective： To investigate the effect on intramuscular connective tissue and passive range of joint motion by the stress produced in limb lengthening. Methods： An animal model of limb lengthening was established in the tibia of rabbits. Distraction was initiated at a rate of 1 mm/d and 2 mm/d in two steps respectively, and both proceeded until 10% and 20% of the tibia length was achieved. Muscle samples were harvested at the time when distraction ended and at the 4th week of consolidation after the distraction. Scanning electron microscope was applied to observe the morphological changes of the perimysium. The goniometer, which we made for this study, was used to measure the passive range of joint motion. Results： The collagen fibers were partitioned in bundles, crimped and interconnected closely and orderly. In the regime of 1 mm/d distraction with 10% lengthening, no apparent changes of the collagen fiber and passive range of joint motion was demonstrated. When tibia was increased to 20%, the crimped fibers showed a tendency of being straightened while the passive range of joint motion was reduced. The findings remained the same at the 4th week ofconsolidation. In the regime of 2 mm/d distraction with 10% lengthening, the crimped structure of the collagen fibers in the perimysium disappeared and the fibers were almost straightened. Additionally, the interconnection of the collagen fibers became loosened and interstice was presented among the fibers. At the 4th week of consolidation, the restoration to the original crimped structure was not completed. When the lengthening ratio was increased to 20%, the collagen fibers were straightened completely. This condition remained unchanged throughout all 4 weeks. The passive range of joint motion was reduced dramatically in the regime of 2 mm/d distraction. Conclusion： The ultrastructure of perimysium and the passive range of joint motion in the regime of lmm/d lengthening shows the condition closest to the normal ones. The regime of 2 mm/d lengthening may cause an apparent change in the ultrastructure of perimysium and passive range of joint motion.

Application of monorail fixator for femoral gap nonunion

Difficult femoral nonunion takes account of infective nonunion and aseptic gap nonunion.Limb length discrepancy and nonunion need to be tackled simultaneously.Conventionally Ilizarov ring fixator is in vogue but it has some limitations.To overcome these,monorail fixator is an effective alternative.Persistent good results can be obtained if we can get a perfect anatomical alignment and good regeneration.

Cosmetic arm lengthening with monorail fixator

Upper limb length discrepancy is a rare occurrence. Humerus shortening may need specialized treatment to restore the functional and cosmetic status of upper limb. We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up. Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand. The monorail unilateral fixator is more functional and cosmetically acceptable, and thus becomes an effective treatment option.