[Ilizarov procedure in pseudarthrosis].
The treatment of nonunions has made an important development through the work of Ilizarov describing the principles of compression and distraction by using the ring-fixator. While local compression is sufficient in hypertrophic nonunions, the treatment of choice for atrophic infected nonunions with bony defects is a corticotomy followed by a segmental transport, especially in case of an osseous defect larger than 3 cm. Primary shortening poses a better starting point both for soft-tissue reconstruction and for early docking. External fixation systems are the ring-fixator, the unilateral fixator and hybrid systems combining both fixation methods. The use of a ring-fixator makes a shorter time of osseous consolidation possible when compared to a unilateral system (25,8 d/cm - 35,8 d/cm). Soft-tissue reconstruction before initiation of transport also shortens the time of osseous consolidation compared to later soft-tissue coverage. A docking-region in the metaphyseal area is supported by minimal internal fixation and cancellous bone graft. Segmental transport is complicated by local infection, regenerate failure (4.3% and regenerate fracture (2.9%).
Josten
C
C
Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliche Kliniken Bergmannsheil, Bochum.
Kremer
M
M
Muhr
G
G
D000328:Adult; D000367:Age Factors; D001852:Bone Lengthening / Q000379:methods; D001861:Bone Regeneration; D004867:Equipment Design; D016267:External Fixators; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation*; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000601:surgery; D010027:Osteotomy / Q000379:methods; D011542:Pseudarthrosis / Q000628:therapy*; D017695:Soft Tissue Injuries / Q000150:complications / Q000601:surgery; D013524:Surgical Flaps
Das Ilizarov-Verfahren bei Pseudarthrosen.