Arkady Blyakher

Distraction of hypertrophic nonunion of tibia with deformity using Ilizarov/Taylor Spatial Frame. Report of two cases.

Abstract. Two cases of hypertrophic nonunion of the tibia with deformity for which distraction treatment using an Ilizarov/Taylor Spatial Frame (Smith & Nephew, Memphis, TN) are presented. This frame utilizes a computer program to help plan correction of the deformity.

Humeral lengthening and deformity correction with the multiaxial correction system.

Limb lengthening for humeral length discrepancy is typically accomplished using a traditional monolateral external fixator frame or an Ilizarov-type device, which have distinct shortcomings for the correction of concomitant deformity and application to the upper extremity, respectively. A new monolateral frame, the multiaxial correction (MAC) system, provides advantage over other monolateral frames and Ilizarov-type devices for humeral lengthening and may achieve similar outcomes. The purpose of this study was to report on the use of the MAC system for limb lengthening in pediatric patients, each with humeral length discrepancy and deformity. Surgical technique for applying the frame to the humerus is described briefly. A retrospective review of all pediatric patients with humeral length discrepancy treated with the MAC system by one orthopedic surgeon at a major teaching hospital was performed. Clinical data, operative records, and radiographs were reviewed for each patient. A total of three humeri in three children were lengthened over a 3-year period. There were two girls and a boy, with a mean age of 10.3±1.9 years. Etiologies for their discrepancies were osteomyelitis and posttraumatic physeal arrest. Mean initial humeral length discrepancy was 9.4±2.3 cm. All patients had proximal varus deformities, which were partially corrected during treatment. Mean lengthening was 6.5±0.8 cm, and mean healing index was 27.1±4.1 days/cm. Mean follow-up was 23.0±9.9 months. There were no major complications. In conclusion, the MAC system is well suited to the correction of humeral length discrepancies and associated humeral deformities in children. Level of evidence: level IV case series.

Knee arthrodesis with simultaneous lengthening using the Ilizarov method.

Objective: To determine whether knee arthrodesis with simultaneous lengthening using the Ilizarov method for a nonreconstructable knee joint with bone loss and infection is a successful salvage procedure. Design: Retrospective review of patients. Setting: University hospital-based orthopaedic practice. Patients: From 1999 to 2001, 4 consecutive patients with a nonreconstructable knee joint, bone loss, and infection after trauma underwent knee arthrodesis with simultaneous lengthening. Intervention: Arthrodesis of the knee with simultaneous limb lengthening through an osteotomy of the tibia and/or femur and the use of an Ilizarov frame. External bone stimulation was used at the knee arthrodesis site and the lengthening sites. Application of this device began during the early distraction phase and continued until frame removal. Main Outcome Measures: Bony union at the arthrodesis and bone lengthening sites, alignment of the lower extremity, limb length discrepancy, infection, pain, and outcome scales (SF-36 scores and American Academy of Orthopaedic Surgeons lower limb modules). Results: Bony union of the knee arthrodesis and lengthening sites and good alignment were achieved in all 4 patients. Mean amount of lengthening was 5.4 cm (range 2.5-11.5 cm). Average time in frame was 11 months (range 6-17 months). Limb length discrepancy after treatment averaged 1.8 cm (range 0.6-3.7 cm). Mean duration of follow-up after frame removal was 35 months (range 28-48 months). At follow-up, infection had not recurred, pain was not present, and assistive devices were not needed for ambulation. Average SF-36 scores improved in all 8 categories, and the average American Academy of Orthopaedic Surgeons lower limb modules improved from a mean of 33 (range 11-37) to a mean of 68 (range 51-76). Conclusion: Knee arthrodesis with simultaneous lengthening can be performed successfully using the Ilizarov method. It enables surgeons to optimize limb length during knee arthrodesis. The use of external fixation and the avoidance of internal implants may be advantageous in the presence of or history of infection. The Ilizarov frame provides stability that allows weight bearing during treatment.

Distraction Arthroplasty for the Ankle Using the Ilizarov Frame

Treatment options for ankle arthrodesis continue to be an area of interest for orthopaedic surgeons. Distraction arthroplasty for the ankle has been shown to be a viable alternative to ankle fusion for some people. This paper reviews the various treatment options for ankle arthrodesis while describing in detail the use of the Ilizarov frame in distraction arthroplasty of the ankle.

A modified surgical technique for lengthening of a metatarsal using an external fixator.

Brachymetatarsia is a congenital or developmental condition that results in a short metatarsal. Problems that arise from this condition can include pain, difficulty with shoe wear, and cosmetic concerns. Multiple techniques have been described that successfully correct the deformity, including both acute and gradual distraction. We describe a modification of the technique of gradual lengthening by way of distraction osteogenesis in which an axial transarticular K-wire is incorporated into a monolateral frame, thereby increasing the stability of the construct and potentially minimizing complications.

Fibula lengthening using a modified Ilizarov method.

A combination of external and internal fixation techniques for a fibular lengthening procedure using the Ilizarov method is described. The technique is minimally invasive, allows precise deformity correction, enables early weight bearing, and minimizes the time that the patient wears the external fixator.

Traumatic segmental Bone loss in a pediatric patient treated with bifocal Bone transport

Summary: Bone transport is a method of distraction osteogenesis that allows the creation of regenerate bone using a dynamic external fixator. We report on the use of bifocal bone transport to treat a skeletally immature patient with 15 cm of post-traumatic segmental bone loss from the distal tibia.

Ilizarov Method for Treatment of Extraarticular Distal Humerus Fractures

The Ilizarov method for fracture management has historically been reserved for complex deformities, recalcitrant nonunions, and high-grade open fractures. Advances in the understanding of fracture healing and the importance of the soft tissue envelope have led to the use of external fixation for routine fracture management. Application of the Ilizarov method provides stable fixation by allowing early range of motion while minimizing soft tissue trauma and preserving the fracture fragment blood supply. The authors present a technique and illustrative case describing the use of the Ilizarov method for acute extraarticular distal humerus fracture management.