Strategies in Trauma and Limb Reconstruction

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2011 | November | Volume 6 | Issue 3

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Original Article

Alexander Kirienko, Andrea Peccati, Ibrahim Abdellatif, Yasser Elbatrawy, Zayed Mahmoud A. Mostaf, Valentina Necci

Correction of poliomyelitis foot deformities with Ilizarov method

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:14] [Pages No:107 - 120]

Keywords: External fixation, Foot deformities, Ilizarov, Poliomyelitis, Surgical techniques

   DOI: 10.1007/s11751-011-0111-6  |  Open Access |  How to cite  | 


Poliomyelitis is an infectious disease caused by a neurotrophic virus targeting anterior horn cells of lower motor neurons resulting in flaccid paralysis and represents a common condition in developing countries, and even nowadays, most of both treated and untreated cases result in foot deformities. Between 1994 and 2007, 27 patients were treated by classic ring Ilizarov fixator, aiming at producing a stable plantigrade and cosmetically acceptable foot and followed up for meanly 7.17 years. Additional procedures were performed if needed. The mean time in frame was 4.2 months. All the patients were satisfied with their gait, compared to preoperative status. A painless and plantigrade foot was obtained in all patients, and limb-length discrepancy was always corrected where present. No major complications were encountered. In conclusion, the Ilizarov method allows simultaneous progressive correction of all components of severe foot deformities associated with limb-lengthening discrepancy with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding important shortening of the foot.


Original Article

Ramin Espandar, Siamak Yousef Sibdari, Elham Rafiee, Shideh Yazdanian

Necrotizing fasciitis of the extremities: a prospective study

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:5] [Pages No:121 - 125]

Keywords: Necrotizing fasciitis, Skin diseases, bacterial, Musculoskeletal disease, fasciitis

   DOI: 10.1007/s11751-011-0116-1  |  Open Access |  How to cite  | 


Necrotizing fasciitis is a rapidly progressive infection and is a necrosis of the fascia and surrounding tissues. Despite recent advances in its management, outcomes have not improved and mortality rate is still high. Between September 2007 and August 2009, we prospectively studied twenty-four histopathologically proven necrotizing fasciitis patients to assess the prognostic factors that indicate the outcome. Mortality rate was 20.8%. Twelve patients (50%) improved, while seven patients (29.2%) were complicated by limb loss. Mortality rates related to upper and lower limb involvement were similar (20% vs. 22.2%). The rates of gangrene and amputation in patients with diabetes mellitus were significantly higher than other comorbidities. Patients with gram-positive infections had significantly lower rates of amputation (15.4% vs. 54.5%, P = 0.04). Mean band cell count and serum potassium level were significantly higher in the nonsurvivors same as leukocyte count in the patients with gangrene, while serum sodium level was significantly lower in nonsurvivors. We conclude that hyponatremia, hyperkalemia, and increased band cells in the peripheral blood of patients may be useful parameters in distinguishing life-threatening necrotizing fasciitis; hence, we recommended lower threshold to amputation during surgery for this group of patients.


Original Article

Rajesh Rohilla, Roop Singh, Seema Rohilla, Narender K. Magu, Ashish Devgan, Ramchander Siwach

Locked intramedullary femoral nailing without fracture table or image intensifier

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:9] [Pages No:127 - 135]

Keywords: Fracture, Femur, Image intensifier, Fracture table, Intramedullary nailing, Interlocking, Closed reduction technique

   DOI: 10.1007/s11751-011-0122-3  |  Open Access |  How to cite  | 


The present retrospective study aims to evaluate the outcome in 41 patients of femoral shaft fractures, who had closed intramedullary nailing in lateral decubitus position without fracture table or image intensifier. Mean age was 33.2 (range, 18–70) years. The cannulated reamer in proximal fragment (as intramedullary joystick) and Schanz screw in the distal fragment (as percutaneous joystick) were simultaneously used to assist closed reduction of the fracture without the use of image intensifier. Closed reduction was successful in 38 patients. Open reduction was required in 3 patients. Schanz screw was used for closed reduction in 12 patients. Average number of intra-operative radiographic exposures was 4.4. Two patients had exchange nailing using large diameter nails. One patient had nonunion. Angular and rotatory malalignments were observed in seven patients. We are of the opinion that the present technique is a safe and reliable alternative to achieve closed locked intramedullary nailing and is best suited to stable, less comminuted (Winquist–Hansen types I and II) diaphyseal fractures of the femur.


Original Article

P. M. Robinson, M. C. Papanna, B. V. Somanchi, S. A. Khan

High tibial osteotomy in medial compartment osteoarthritis and varus deformity using the Taylor spatial frame: early results

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:9] [Pages No:137 - 145]

Keywords: Ilizarov, Tibia, Osteotomy, Knee, Osteoarthritis

   DOI: 10.1007/s11751-011-0123-2  |  Open Access |  How to cite  | 


We report the early results of high tibial osteotomy (HTO) in medial compartment osteoarthritis (OA) and varus deformity using the Taylor spatial frame (TSF). Between October 2005 and April 2007, 9 patients with medial compartment OA and varus deformity underwent TSF application and medial opening wedge HTO. Pre- and post-operative Oxford knee scores, SF-12 and visual analogue pain scores were recorded along with radiographic outcomes. Median follow-up was 19 months (range 15–35). Mean age at operation was 49 years (range 37–59). The median time spent in the frame was 18 weeks (range 12–37). The mean preoperative Oxford knee score was 28.7. This improved to a mean of 35.4 post-operatively (P = 0.0142). 6 (67%) patients had a documented pin-site infection. With TKR as an end point, the survival rate of HTOs was 88.9% at a median of 19 months follow-up. This study demonstrates that in selected patients the TSF provides a viable treatment option for performing HTO in medial compartment OA with varus deformity.


Original Article

G. Taglialavoro, C. Biz, G. Mastrangelo, R. Aldegheri

The repair of the Achilles tendon rupture: comparison of two percutaneous techniques

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:8] [Pages No:147 - 154]

Keywords: Achilles tendon, Rupture, Percutaneous technique, Tenolig, Ma and Griffith

   DOI: 10.1007/s11751-011-0124-1  |  Open Access |  How to cite  | 


This study proposes a comparison between two percutaneous techniques of subcutaneous Achilles tendon rupture by evaluating the risk of lesion developing, the morbidity of the surgical technique adopted and the effectiveness of each technique. Sixty patients were operated at Padua Orthopaedic Clinic by using the two different procedures: (1) Ma and Griffith in 30 cases and (2) Tenolig in 30 cases. Risk of rupture developing has been evaluated in relation to sex, age, side, kind of trauma, work and presence of preoperative risk factors. The Morbidity of surgical technique has been evaluated in with respect to surgical time, hospital permanence, immobilization, active nonweight-bearing mobilization, assisted weight bearing until the full one, number of early and late complications before and after hospital discharge. Effectiveness has been evaluated in relation to return time to common life, work and sport; anatomical and functional features have been evaluated using McComis score, rating results as: very good (from 80 to 70), good (from 69 to 60), fair (from 59 to 50) and poor (<50). Tenolig group shows shorter average time from hospital admission and operation, hospital permanence and immobilization (P < 0.05), and it results in an easier and quicker execution and functionally stimulates the tendon healing in a short time. Effectiveness was the same for both techniques because average McComis score was good (P = 0.35), and there was no significant differences in common life returning time (P = 0.12). Tenolig technique seems to be preferable to Ma and Griffith.



Shabir A Dhar, Tahir Ahmed Dar, Asif Sultan, Abdul Rouf Malik, Mohammed Ramzan Mir

The reciprocal ledge closing wedge osteotomy for post traumatic coxa vara

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:4] [Pages No:155 - 158]

Keywords: Reciprocating ledge, Closing wedge

   DOI: 10.1007/s11751-011-0120-5  |  Open Access |  How to cite  | 


To report a proximal femoral osteotomy with retention of bone ledges in a reciprocal position to increase bone contact and stability. The method was applied to 5 patients over a 3-year period. All patients had coxa vara. The average length gained was 1.5 cm, and the average neck shaft angle improvement was 30°. The Harris hip score improved from an average of 63 to 82. The reciprocal ledge osteotomy is technically less demanding and also allows conversion of normal shear forces around the upper femur to stabilizing forces. This method allows easier use of the DHS implant as potential rotation about the axis of the screw is negated by the ledges and the dynamic forces.



J. Fagg, A. Gulihar, J. A. Fernandes

“Asymmetric scalloping of the regenerate”: a radiological sign of pseudoaneurysm in distraction osteogenesis

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:4] [Pages No:159 - 162]

Keywords: Asymmetric scalloping, Regenerate, Pseudoaneurysm, External fixator, Distraction osteogenesis

   DOI: 10.1007/s11751-011-0121-4  |  Open Access |  How to cite  | 


Pseudoaneurysm formation is an uncommon but well-recognised and important complication in limb reconstruction surgery. Postoperative diagnosis is usually clinical or an incidental finding. We present an 11-year-old girl, who underwent two-stage limb lengthening with a circular fixator, for a previously treated pseudoarthrosis of the tibia. During the lengthening plan, a concave defect was noted on one side of the regenerate, which was found to be due to extrinsic compression by a pseudoaneurysm. Normal regenerate formation was seen after selective embolisation of the pseudoaneurysm. This concave appearance on one side of the regenerate has previously been described secondary to a difference in stability on the two sides of the osteotomy, when a monolateral fixator is used, but not due to extrinsic compression by a pseudoaneurysm. The authors propose that this radiographic appearance of “asymmetrical scalloping” on one side of the regenerate may represent a radiological sign of a pseudoaneurysm formation and should provoke investigation for the same.



Syed Kamran Ahmed, Boris Kwok Keung Fung, Wing Yuk Ip, Shew Ping Chow

Lateral tibial condyle reconstruction by pedicled vascularized fibular head graft: long-term result

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:4] [Pages No:163 - 166]

Keywords: Lateral tibial condyle reconstruction, Pedicled vascularized fibular graft, Aggressive giant cell tumours

   DOI: 10.1007/s11751-011-0108-1  |  Open Access |  How to cite  | 


The technique of pedicled vascularized fibular graft for lateral tibial condyle reconstruction after en bloc resection of aggressive giant cell tumours was described by SP Chow et al. Early follow-up of two patients was presented in 1986. We present the 25 years follow-up of one patient with a literature review of alternative present day treatment options. The patient maintained community ambulant status despite developing late stage osteoarthritis. Although this procedure is performed rarely, it remains an alternative to the more sophisticated treatment options making it a useful method in centres with limited facilities and expertise.



Yasser Elbatrawy, Giby C. Philips

Treatment of a fibular autograft non-union with a resulting deformity by stabilization, progressive correction and callotasis using an Ilizarov fixator: a case study

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:5] [Pages No:167 - 171]

Keywords: Ilizarov, Tumour, Graft, Osteosarcoma, Bone defect, Reconstruction, Deformity correction

   DOI: 10.1007/s11751-011-0106-3  |  Open Access |  How to cite  | 


Bone tumours present a challenge to reconstructive surgery when the tumour breaches the physeal and periphyseal region of the growing bone. Though a host of options are available, these are not without complications. We report one such case of osteosarcoma of the tibia treated initially with wide resection of the tumour and intercalary fibular strut grafting using plate and screws. The operation was complicated by a non-union at the proximal tibio-fibular autograft junction. This leads to a multiplanar deformity with severe procurvatum at the proximal tibio-fibular graft junction, which was successfully treated by callotasis using an Ilizarov fixator. Appropriate consent was obtained from the patient and parents to publish this case report.



Jaime L. Bellamy, Courtney A. Holland, Mark Hsiao, Joseph R. Hsu, STReC (Skeletal Trauma Research Consortium)

Staged correction of an equinovarus deformity due to pyoderma gangrenosum using a Taylor spatial frame and tibiotalar calcaneal fusion with an intramedullary device

[Year:2011] [Month:November] [Volume:6] [Number:3] [Pages:4] [Pages No:173 - 176]

Keywords: Pyoderma gangrenosum, Equinovarus, Staged fusion, Taylor spatial frame

   DOI: 10.1007/s11751-011-0119-y  |  Open Access |  How to cite  | 


Pyoderma gangrenosum is a rare autoinflammatory syndrome manifested by skin lesions eventually creating ulcers. Surgical management can lead to scarring and contracture at the site of the lesion due to the pathergy phenomenon. A 43-year-old woman presented with a 5-year history of severe equinovarus deformity due to chronic pyoderma gangrenosum on her posteromedial ankle. She underwent a staged fusion. A gradual “closed” correction was performed in a Taylor spatial frame for 8 weeks in order to obviate the need for a surgical release in the area of the ulcer. She was ambulatory and full weight-bearing within 4 weeks of her frame removal. She maintained her correction with an accommodative foot orthosis until she had an uneventful tibiotalar calcaneal fusion with an intramedullary device. This case represents the success of using a Taylor spatial frame for staged fusion involving soft-tissue correction of severe, rigid equinovarus deformity due to pyoderma gangrenosum.


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