Strategies in Trauma and Limb Reconstruction

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2015 | April | Volume 10 | Issue 1

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Original Article

Marc L. Wagener, Marleen Dezillie, Y vette Hoendervangers, Denise Eygendaal

Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Chevron osteotomy, Re-fixation, Tension band

   DOI: 10.1007/s11751-015-0211-9  |  Open Access |  How to cite  | 


Exposure of the distal humerus in case of an articular fracture is often performed through a Chevron osteotomy of the olecranon. Several options have been described for re-fixation of the Chevron osteotomy. Pull-out of the hard-wear is often seen as complication. In this study, an evaluation of the re-fixation of the Chevron osteotomy through a cancellous screw and suture tension band was performed. The data of 19 patients in whom a Chevron osteotomy was re-fixated with a cancellous screw in combination with a suture tension band were used. Evaluation was performed by assessment of the post-operative X-rays and documentation of complications. In all 19 cases, evaluation of the post-operative X-rays showed complete consolidation without dislocation or other complications. Re-fixation of a Chevron osteotomy of the olecranon with a large cancellous screw with a suture tension band provides adequate stability to result in proper healing of the osteotomy in primary cases when early post-operative mobilisation is allowed. Complications as pull-out of the hard-wear were not reported.


Original Article

Petr V. Skomoroshko, Victor A. Vilensky, Ahmed I. Hammouda, Matt D. A. Fletcher, Leonid N. Solomin

Mechanical rigidity of the Ortho-SUV frame compared to the Ilizarov frame in the correction of femoral deformity

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:7] [Pages No:5 - 11]

Keywords: Osteotomy, Fracture, Biomechanical stability, External fixator, Hexapod, Rigidity of osteosynthesis

   DOI: 10.1007/s11751-015-0214-6  |  Open Access |  How to cite  | 


The Ortho-SUV frame (OSF) is a novel hexapod circular external fixator which draws upon the innovation of the Ilizarov method and the advantages of hexapod construction in the three-dimensional control of bone segments. Stability of fixation is critical to the success or failure of an external circular fixator for fracture or osteotomy healing. In vitro biomechanical modelling study was performed comparing the stability of the OSF under load in both original form and after dynamisation to the Ilizarov fixator in all zones of the femur utilising optimal frame configuration. A superior performance of the OSF in terms of resistance to deforming forces in both original and dynamised forms over that of the original Ilizarov fixator was found. The OSF shows higher rigidity than the Ilizarov in the control of forces acting upon the femur. This suggests better stabilisation of femoral fractures and osteotomies and thus improved healing with a reduced incidence of instability-related bone segment deformity, non-union and delayed union.


Original Article

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

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

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:8] [Pages No:13 - 20]

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

   DOI: 10.1007/s11751-015-0213-7  |  Open Access |  How to cite  | 


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.


Original Article

Konstantin Horas, Reinhard Schnettler, Gerrit Maier, Gaby Schneider, Uwe Horas

The role of soft-tissue traction forces in bone segment transport for callus distraction

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:6] [Pages No:21 - 26]

Keywords: Traction force measurement, Soft tissues, Callus distraction system, Intramedullary, Distraction osteogenesis, Bone defect treatment

   DOI: 10.1007/s11751-015-0220-8  |  Open Access |  How to cite  | 


Callus distraction using bone segment transport systems is an applied process in the treatment of bone defects. However, complications such as muscle contractures, axial deviation and pin track infections occur in the treatment process using the currently available devices. Since successful treatment is influenced by the applied distraction force, knowledge of the biomechanical properties of the involved soft tissues is essential to improve clinical outcome and treatment strategies. To date, little data on distraction forces and the role of soft-tissue traction forces are available. The aim of this study was to assess traction forces generated by soft tissues during bone segment transport using a novel intramedullary callus distraction system on eight human femora. For traction force measurements, bone segment transport over 60-mm femoral defects was conducted under constant load measurement using 40- and 60-mm bone segments. The required traction forces for 60-mm bone segments were higher than forces for 40-mm bone segments. This study demonstrates that soft tissues are of relevance biomechanically in bone segment transport. The size of the bone segment and the selection of the region for osteotomy are of utmost importance in defining the treatment procedure.


Original Article

Leonard Charles Marais

Bone transport through an induced membrane in the management of tibial bone defects resulting from chronic osteomyelitis

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:7] [Pages No:27 - 33]

Keywords: Chronic osteomyelitis, Bone transport, Distraction osteogenesis, Induced membrane, Masquelet technique, Circular external fixation

   DOI: 10.1007/s11751-015-0221-7  |  Open Access |  How to cite  | 


Wide resection of infected bone improves the odds of achieving remission of infection in patients with chronic osteomyelitis. Aggressive debridement is followed by the creation of large bone defects. The use of antibiotic-impregnated PMMA spacers, as a customized dead space management tool, has grown in popularity. In addition to certain biological advantages, the spacer offers a therapeutic benefit by serving as a vehicle for delivery of local adjuvant antibiotics. In this study, we investigate the efficacy of physician-directed antibiotic-impregnated PMMA spacers in achieving remission of chronic tibial osteomyelitis. This retrospective case series involves eight patients with chronic osteomyelitis of the tibial diaphysis managed with bone transport through an induced membrane using circular external fixation. All patients were treated according to a standardized treatment protocol. A review of the anatomical nature of the disease, the physiological status of the host and the outcome of treatment in terms of remission of infection, time to union and the complications that occurred was carried out. Seven patients, with a mean bone defect of 7 cm (range 5–8 cm), were included in the study. At a mean follow-up of 28 months (range 18–45 months), clinical eradication of osteomyelitis was achieved in all patients without the need for further reoperation. The mean total external fixation time was 77 weeks (range 52–104 weeks), which equated to a mean external fixation index of 81 days/cm (range 45–107). Failure of the skeletal reconstruction occurred in one patient who was not prepared to continue with further reconstructive surgery and requested amputation. Four major and four minor complications occurred. The temporary insertion of antibiotic-impregnated PMMA appears to be a useful dead space management technique in the treatment of post-infective tibial bone defects. Although the technique does not appear to offer an advantage in terms of the external fixation index, it may serve as a useful adjunct in order to achieve resolution of infection.


Original Article

James Youngman, Dimitri Raptis, Khalid Al-Dadah, Fergal Monsell

An accurate method of determining a single-plane osteotomy to correct a combined rotational and angular deformity

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:5] [Pages No:35 - 39]

Keywords: Osteotomy, Correction, Deformity, Realignment, Single cut

   DOI: 10.1007/s11751-015-0222-6  |  Open Access |  How to cite  | 


Conventional osteotomy used for the correction of deformity is performed out of the plane of deformity creating a wedge either opening or closing when the deformity is corrected. Deformity that is a combination of rotation and angulation exists in a single plane that is oblique to the coronal, sagittal and axial planes depending on the magnitude of deformity measured in each plane. Accurate planning and a simple method of finding this oblique plane operatively is presented. This method starts by finding the bisector of angulation. This is marked by a wire that lies in the plane of angulation and along the bisector of angulation. The saw blade is rotated about this bisector axis according to the proportion of angulation and rotation. There is no second reorientation of the saw blade required making the final plane much easier to define. This single-plane oblique osteotomy allows accurate realignment of the limb.


Original Article

Sherif Ahmed El Ghazaly, El-Hussein Mohamed El-Moatasem

Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:7] [Pages No:41 - 47]

Keywords: Knee valgus, Varus knee, Frontal knee deformity, Focal osteotomy, Femoral osteotomy, Dome osteotomy

   DOI: 10.1007/s11751-015-0218-2  |  Open Access |  How to cite  | 


Focal dome osteotomy (FDO) allows deformity correction without secondary translational deformity. The purpose of this study was to evaluate the degree of correction and knee functional outcome after correction of frontal knee deformity using femoral supracondylar FDO fixed with plate and screws. A prospective study included 12 consecutive cases of femoral frontal plane deformity that underwent correction using supracondylar focal osteotomy fixed by plate and screws. Average age was 27 years, while mean follow-up was 2.1 years. Functional assessment was done using the Hospital for Special Surgery (HSS) knee score. The HSS knee score improved from 85 to 96.8 points. Desired correction was achieved in all cases. Postoperative mechanical axis analysis on long film and scanogram showed no secondary deformity. The overall postoperative mechanical axis was at 3.2 mm medially (range 2–5 mm). Autogenous bone graft was not used in any case, and uneventful osteotomy union was achieved at a mean of 13.8 weeks. Minor complications were encountered in two cases. There were no implant failures or reoperations. Supracondylar FDO of the femur with plate fixation is a reproducible technique that can produce full correction of distal femoral frontal plane deformity, while avoiding creating a secondary deformity. Knee function was improved with good patient satisfaction.


Original Article

S. S. Madan, K. Robinson, P. D. Kasliwal, M. J. Bell, M. Saleh, J. A. Fernandes

Limb reconstruction in Ollier's disease

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:6] [Pages No:49 - 54]

Keywords: Ollier's dysplasia, Ollier's deformity, Ollier's limb reconstruction

   DOI: 10.1007/s11751-015-0223-5  |  Open Access |  How to cite  | 


We present our experience of lengthening and correction of complex deformities in the management of patients with Ollier's dysplasia (multiple enchondromatosis) from 1985 and 2002. All patients were under 18 years with a minimum follow-up time of 2 years (mean 9.6 years, range 2–15 years). There were a total of ten patients of which seven were male and three female. The mean age at presentation was 10.7 years (range 5–17 years; SD 3.7 years). The total length gain was 42.3 mm (range 30–110 mm; SD 28.9 mm). The number of days in external fixation was 164.8 days (range 76–244 days; SD 42.9 days). The bone healing index was 32.5 days/cm (18–50 days/cm; SD 10.3 days/cm). Patients with Ollier's disease have limb length inequality and angular deformities and require multiple reconstructive procedures owing to a high incidence of recurrence. We identified a tendency for the osteotomy to prematurely consolidate and advise the latency period after surgery to be 4–5 days and for distraction to proceed at a faster rate.



Antonio Panella, Angela Notarnicola, Giuseppe Solarino, Biagio Moretti

“Open-book” pelvic fracture with soft tissue serious damage in a child

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:3] [Pages No:55 - 57]

Keywords: Open-book fractures, Child, Surgery, Skin lesions

   DOI: 10.1007/s11751-015-0216-4  |  Open Access |  How to cite  | 


Open-book fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. The case discussed is an open-book fracture (type B1, Tile classification) associated with triradiate cartilage injury (type I, Salter–Harris classification) in an 11-year-old female. Surgical treatment was delayed for 2 months due to an associated extensive cutaneous lesion which required an adequate treatment. The delayed intervention did not affect the radiological and clinical healing of the fracture.



Gerald Eliot Wozasek

Limb salvage in a partially amputated distal femur with extensive segmental bone loss using the nailing after lengthening technique: a case report

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:5] [Pages No:59 - 63]

Keywords: Subtotal amputation with segmental long bone defect, Cement spacer, Bifocal lengthening, Secondary nailing

   DOI: 10.1007/s11751-015-0212-8  |  Open Access |  How to cite  | 


Segmental long bone defects resulting from high-energy trauma with severe soft tissue loss are difficult problems to manage. Amputation was for a long time the primary mainstay of treatment. This is the report on a 15-year-old male patient who sustained a third-degree open, traumatic fracture with partial amputation of the left distal femur and extensive bone loss of 26 cm. Successful limb salvage was performed after vascular repair, shortening of the bone defect, primary placement of an antibiotic cement spacer and simple external fixation. This was followed by bifocal lengthening modifying the simple frame until limb equality was achieved and secondary intramedullary nailing 11 months after injury.


Acknowledgement to Referees

Reviewers 2014

[Year:2015] [Month:April] [Volume:10] [Number:1] [Pages:1] [Pages No:65 - 65]

   DOI: 10.1007/s11751-015-0217-3  |  Open Access |  How to cite  | 


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