Strategies in Trauma and Limb Reconstruction

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VOLUME 9 , ISSUE 2 ( August, 2014 ) > List of Articles

Original Article

Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis

Ashraf A. Khanfour, Mohamed M. El-Sayed

Keywords : Femur, Ilizarov, External fixation, Infective nonunion, Compliant

Citation Information : Khanfour AA, El-Sayed MM. Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis. 2014; 9 (2):101-109.

DOI: 10.1007/s11751-014-0199-6

License: CC BY-NC-SA 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Percutaneous transosseous Ilizarov wiring, whilst preferred in the tibia because of its unique properties, carries a high risk of complications in the femur. The aim of this work was to evaluate the efficacy of a more patient-friendly semicircular pin external fixator module built up from parts of the Ilizarov fixator components and its use in managing diaphyseal femoral nonunions. A group of 20 patients with infected diaphyseal nonunions of the femur after internal osteosynthesis were included in this study. The mean age of the patients at the time of surgery was 46 years (range 16–60, SD 15.6). The mean morbidity time since the original trauma was 10.2 months (range 6–15, SD 2.5). All the cases were fixed by the described external fixator module. Bony union with resolution of infection occurred in 18 (94.7 %) out of 19 cases after a mean period in the fixator of 11.2 months (range 8–18 SD 2.9). After a mean follow-up period of 3.5 years (range 2–9, SD 2.6), there were 14 excellent, 3 good, 1 fair and 1 poor results from radiological evaluation and 10 excellent, 7 good, 1 fair and 1 poor results from functional assessment. In conclusion, the described semi-circular pin fixator module is patient-friendly and effective in managing infected nonunions of the femoral diaphysis.


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  1. Ricci WM, Gallagher B, Haidukewych GJ (2009) Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg 17(5):296-305
  2. Krishnan A, Pamecha C, Patwa JJ (2006) Modified Ilizarov technique for infected nonunion of the femur: the principle of distraction-compression osteogenesis. J Orthop Surg (Hong Kong) 14(3):265-272
  3. Ueng SW, Wei FC, Shih CH (1999) Management of femoral diaphyseal infected nonunion with antibiotic beads local therapy, external skeletal fixation, and staged bone grafting. J Trauma 46(1):97-103
  4. Saridis A, Panagiotopoulos E, Tyllianakis M, Matzaroglou C, Vandoros N, Lambiris E (2006) The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Jt Surg [Br] 88-B:232-237
  5. Khanfour AA, Zakzouk SA (2012) Distal femur non-union after interlocked intramedullary nailing. Successful augmentation with wave plate and strut graft. Acta Orthop Belg 78(4):492-499
  6. Grivas TB, Magnissalis EA (2011) The use of twin-ring Ilizarov external fixator constructs: application and biomechanical proofof principle with possible clinical indications. J Orthop Surg Res 6:41
  7. Moss DP, Tejwani NC (2007) Biomechanics of external fixation: a review of the literature. Bull NYU Hosp Jt Dis 65(4):294-299
  8. Fenton P, Phillips J, Royston S (2007) The use of Ilizarov frames in the treatment of pathological fracture of the femur secondary to osteomyelitis: a review of three cases. Injury 38(2):240-244
  9. Kishan S, Sabharwal S, Behrens F, Reilly M, Sirkin M (2002) External fixation of the femur: basic concepts. Tech Orthop 17(2):239-244
  10. Fragomen AT, Rozbruch SR (2007) The mechanics of external fixation. HSS J 3(1):13-29
  11. Green SA, Harris NL, Wall DM, Ishkanian J, Marinow H (1992) The Rancho mounting technique for the Ilizarov method. A preliminary report. Clin Orthop Relat Res 280:104-116
  12. Belhan O, Ekinci A, Karakurt L, Yýlmaz E, Serin E (2008) The treatment of femoral shaft fractures in adults with hybrid Ilizarov external fixator. Jt Dis Rel Surg 19(2):50-54
  13. Cavusoglu AT, Ozsoy MH, Dincel VE, Sakaogullari A, Basarir K, Ugurlu M (2009) The use of a low-profile Ilizarov external fixator in the treatment of complex fractures and non-unions of the distal femur. Acta Orthop Belg 75:209-218
  14. Benedetti GB, Argnani F (1991) Group. ASAMI. Fractures of the femur. In: Maiocchi AB, Aronson J (eds) Operative principles of Ilizarov fracture treatment—nonunion—osteotomies—lengthening— deformity correction. Williams and Wilkins, Baltimore, Hong Cong, London, Sydney, pp 125-145
  15. Baran O, Havitcioglu H, Tatari H, Cecen B (2008) The stiffness characteristics of hybrid Ilizarov fixators. J Biomech 41(14):2960-2963
  16. Mahran MA, Elgebeily MA, Ghaly NA, Thakeb MF, Hefny HM (2011) Pelvic support osteotomy by Ilizarov's concept: is it a valuable option in managing neglected hip problems in adolescents and young adults? Strateg Trauma Limb Reconstr 6(1):13-20
  17. Catagni MA (2003) Atlas for the insertion of transosseous wires and half-pins Ilizarov method. 2nd. ed. Melan-Italy: Il quadratino Italy; p. 23-29
  18. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R (1989) Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res 241:146-165
  19. Paley D, Maar DC (2000) Ilizarov bone transport treatment for tibial defects. J Orthop Trauma 14(2):76-85
  20. Barbarossa V, Matkovic BR, Vucic N, Bielen M, Gluhinic M (2001) Treatment of osteomyelitis and infected non-union of the femur by a modified Ilizarov technique: follow-up study. Croat Med J 42(6):634-641
  21. Bronson DG, Samchukov ML, Birch JG, Browne RH, Ashman RB (1998) Stability of external circular fixation: a multi-variable biomechanical analysis. Clin Biomech (Bristol, Avon) 13(6):441-448
  22. Karaharju EO, Aalto K (1983) The deformation of external fixation devices during loading. Int Orthop 7(3):179-183
  23. Willie B, Adkins K, Zheng X, Simon U, Claes L (2008) Mechanical characterization of external fixator stiffness for a rat femoral fracture model. J Orthop Res 27:687-693
  24. Pugh KJ, Wolinsky PR, Pienkowski D, Banit D, Dawson JM (1999) Comparative biomechanics of hybrid external fixation. J Orthop Trauma 13(6):418-425
  25. Lenarz C, Bledsoe G, Watson J (2008) Circular External Fixation Frames with Divergent Half Pins. A Pilot Biomechanical Study. Clin Orthop Relat Res 466:2933-2939
  26. Baruah RK (2007) Ilizarov methodology for infected non union of the Tibia: classic circular transfixion wire assembly vs. hybrid assembly. Indian J Orthop 41(3):198-203
  27. Sabharwal S, Kishan S, Behrens F (2005) Principles of external fixation of the femur. Am J Orthop 34(5):218-223
  28. Sabharwal S (2005) Role of Ilizarov external fixator in the management of proximal/distal metadiaphyseal pediatric femur fractures. J Orthop Trauma 19(8):563-569
  29. Khalily C, Voor M, David S (1998) Fracture Site Motion with Ilizarov and “Hybrid” external fixation. J Orthop Trauma 12(1):21-26
  30. Blum AL, Bongio Vanni JC, Morgan SJ, Flierl MA, dos Reis FB (2010) Complications associated with distraction osteogenesis for infected nonunion of the femoral shaft in the presence of a bone defect: a retrospective series. J Bone Jt Surg Br 92(4):565-570
  31. Rose R (2009) Complications of Femoral Lengthening using the Ilizarov Fixator. Internet J Orthopedic Surg 15(1):1-6
  32. Benedetti M, Catani F, Benedetti E, Berti L, Gioia A, Giannini S (2010) To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty? Int Orthop 34:1115-1121
  33. Struijs PA, Poolman RW, Bhandari M (2007) Infected nonunion of the long bones. J Orthop Trauma 21(7):507-511
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