Lower limb deformity due to failed trauma treatment corrected with the Ilizarov technique: factors affecting the complication rate in 52 patients.
OBJECTIVE
Failed treatment of fractures may be corrected by the Ilizarov technique but complications are common. In 52 patients with compromised healing of femoral and tibial fractures, the results of secondary reconstruction with Ilizarov treatment were investigated retrospectively in order to identify the factors that contribute to the risk of complications.


METHODS
52 consecutive patients was analyzed. The median interval between injury and secondary reconstruction was 3 (0.1-27) years. The patients had failed fracture treatment resulting in bone defects, pseudarthrosis, infection, limb length discrepancy (LLD) caused by bone consolidation after bone loss, malunion, soft-tissue loss, and stiff joints. Most patients had a combination of these deformities. The results were analyzed by using logistic regression in a polytomous universal mode (PLUM) logistic regression model.


RESULTS
The median treatment time was 9 (4-30) months, and the obstacle and complication rate was 105% per corrected bone segment. In 2 patients treatment failed, which resulted in amputation. In all other patients healing of nonunion could be established, malunion could be corrected, and infections were successfully treated. The statistical analysis revealed that relative bone loss of the affected bone was the only predictor for occurrence of complications. From these data, we constructed a simple graph that shows the relationship between relative bone loss of the affected bone and risk of complications.


CONCLUSIONS
Relative bone loss of the affected bone segment is the main predictor of complications after Ilizarov treatment of previously failed fracture treatment. The visualization of the analysis in a simple graph may assist comparison of the complication rates in the literature.
Oostenbroek
Hubert J
HJ
Department of Orthopedics, University Medical Centre, Utrecht, The Netherlands. hj@oostenbroek.nl
Brand
Ronald
R
van Roermund
Peter M
PM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001862:Bone Resorption / Q000209:etiology / Q000601:surgery; D002648:Child; D005260:Female; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000150:complications / Q000601:surgery*; D005599:Fractures, Ununited / Q000150:complications / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects; D007869:Leg Injuries / Q000150:complications / Q000601:surgery*; D007870:Leg Length Inequality / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult