Temporary intentional leg shortening and deformation to facilitate wound closure using the Ilizarov/Taylor spatial frame.
Infected tibial nonunions with bone loss pose an extremely challenging problem for the orthopaedic surgeon. A comprehensive approach that addresses the infection, bone quality, and overlying soft-tissue integrity must be considered for a successful outcome. Acute shortening with an Ilizarov frame has been shown to be helpful in the treatment of open tibia fractures with simultaneous bone and soft-tissue loss. Cases in which the soft-tissue defect considerably exceeds bone loss may require an Ilizarov frame along with a concomitant soft-tissue procedure; however, there are a number of potential difficulties with vascularized pedicle flaps and free tissue flaps, including anastomotic complications, partial flap necrosis, and flap failure. The technique described in this report involves acute shortening and temporary bony deformation with the Ilizarov apparatus to facilitate wound closure and does not require a concomitant soft-tissue reconstructive procedure. Once the wound is healed, osseous deformity and length are gradually corrected by distraction osteogenesis with the Ilizarov/Taylor Spatial frame.
Nho
Shane J
SJ
Limb Lengthening and Deformity Service, Orthopaedic Trauma Service, The Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
Helfet
David L
DL
Rozbruch
S Robert
SR
D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation*; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013978:Tibial Fractures / Q000601:surgery*; D014945:Wound Healing