Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 10 , ISSUE 1 ( April, 2015 ) > List of Articles

Original Article

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan

Konstantinos Tilkeridis, Basavraj Chari, Nusrat Cheema, Marios Tryfonidis, Arshad Khaleel

Keywords : Ilizarov external fixator, Mass casualty setting, Earthquake, Complex tibial fracture, Non-union, Humanitarian mission

Citation Information : Tilkeridis K, Chari B, Cheema N, Tryfonidis M, Khaleel A. The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan. 2015; 10 (1):13-20.

DOI: 10.1007/s11751-015-0213-7

License: CC BY-NC-SA 4.0

Published Online: 30-04-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.

PDF Share
  1. Ilizarov GA (1992) The transosseous Osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue. Springer, New York
  2. Cattaneo R, Catagni M, Johnson EE (1992) The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop 280:143-152
  3. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. JBJS 58-A(4):453-458
  4. Patzakis MJ, Harvey JP Jr, Ivler D (1974) The role of antibiotics in the management of open fractures. J Bone Joint Surg Am 56:532-541
  5. Gosselin RA, Roberts I, Gillespie WJ (2004) Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev 1:CD003764
  6. Olson SA, Finkemeier CG, Moehring ND (2001) Open fractures. In: Bucholz RW, Heckman JD (eds) Rockwood and Greene's fractures in adults, 5th edn. Lippincott, Williams and Wilkins, Philadelphia, pp 285-318
  7. Lerner A, Fodor L, Soundry M, Peled I, Herer D, Ullman Y (2004) Acute shortening: modular treatment modality for severe combined bone and soft tissue loss of the extremities. J Trauma Inj Infect Crit Care 57(3):603-608
  8. Green SA, Jackson JM, Wall DM, Marinow H, Ishkanian J (1992) Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop 280:136-142
  9. Dahners LE, Mullis BH (2004) Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue healing. J Am Acad Orthop Surg 12(3):139-143
  10. Giannoudis PV, MacDonald DA, Matthews SJ, Smith RM, Furlong AJ, De Boer P (2000) Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br 82(5):655-658
  11. Rozbruch SR, Weitzman AM, Tracey Watson J, Freudigman P, Katz HV, Ilizarov S (2006) Simultaneous treatment of tibial bone and soft-tissue defects with the Ilizarov method. J Orthop Trauma 20(3):197-205
  12. Sen C, Kocaoglu M, Eralp L, Gulsen M, Cinar M (2004) Bifocal compression-distraction in the acute treatment of grade III open tibia fractures with bone and soft-tissue loss: a report of 24 cases. J Orthop Trauma 18(3):150-157
  13. Nho SJ, Helfet DL, Rozbruch SR (2006) Temporary intentional leg shortening and deformation to facilitate wound closure using the Ilizarov/Taylor spatial frame. J Orthop Trauma 20(6):419-424
  14. Yokoyama K, Itoman M, Nakamura K, Uchino M, Tsukamoto T, Suzuki T (2006) Primary shortening with secondary limb lengthening for Gustilo IIIB open tibial fractures: a report of six cases. J Trauma 61(1):172-180
  15. Lee J (1997) Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res 339:71-75
  16. Valenziano CP, Chattar-Cora D, O'Neill A, Hubli EH, Cudjoe EA (2002) Efficacy of primary wound cultures in long bone open extremity fractures: Are they of any value? Arch Orthop Trauma Surg 122:259-261
  17. Okike K, Bhattacharyya T (2006) Trends in the management of open fractures. A Critical Analysis. J Bone Joint Surg Am 88:2739-2748
  18. Pulate A, Olivier LC, Agashe S, Rallan R, Kamal V, Nast-Kolb D (2001) Adaptation of Ilizarov ring fixator to the economic situation of developing countries. Arch Orthop Trauma Surg 121(1-2):79-82
  19. MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, Smith DG, Sanders RW, Jones AL, Starr AJ, McAndrew MP, Patterson BM, Burgess AR, Castillo RC (2005) Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am 87(8):1801-1809
  20. Muller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, Berlin
  21. Muller ME, Allgower M, Schneider R, Willenegger H (1991) Manual of internal fixation. Classification of soft tissue injuries. Springer, Berlin, pp 151-157
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.