title: Management of massive posttraumatic bone defects in the lower limb with the Ilizarov technique.
abstract: Massive bone defects have been treated by various methods with variable success rates. The Ilizarov technique has been advocated as a preferred method for treatment of large segmental defects. Twenty five patients with massive post traumatic bone defects of the lower limb (22 tibiae, 3 femurs) were treated using Ilizarov's technique. After radiological evaluation, the patients were subjected to bone transport. Bifocal osteosynthesis was performed in all except those needing >12 cm of bone transport. Distraction was started between day 4 and 7 at the rate of 1 mm per day in four increments. All were males with a mean gap of 8.9 cm (range: 5-17 cm), mean age of 28.24 years (16-40) and having undergone a mean of 2.6 previous surgeries. Mean time in Ilizarov frame was 8.8 months and external fixator index was 0.98 months. Mean duration of follow-up after frame removal was 23.5 months. Union was achieved in 23 (92%) cases. Bone grafting was required in 9 (36%) According to ASAMI criteria, bone results were excellent in 13, good in 1, and poor in 11 patients. Functional results were excellent in 6 patients, good in 9, fair in 4, and poor in 6 patients. A total of 72 complications occurred (2.88 complications per patient). Union was achieved in all except two patients. The Ilizarov external fixator offers a limb salvage solution even in large bone defects but the surgeon should set realistic goals both for himself and his patients while offering this method of treatment.
authors.affiliation: Department of Orthopaedics, University College of Medical Sciences and GTB Hospital, Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Chaddha
authors.forename: Divesh
authors.initials: D
authors.lastname: Gulati
authors.forename: Arun Pal
authors.initials: AP
authors.lastname: Singh
authors.forename: Ajay Pal
authors.initials: AP
authors.lastname: Singh
authors.forename: Lalit
authors.initials: L
authors.lastname: Maini
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation; D005264:Femoral Fractures / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D023821:Limb Salvage; D008297:Male; D009177:Mycoplasma pneumoniae; D013978:Tibial Fractures / Q000601:surgery*; D055815:Young Adult