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If you have had a fracture, we usually have time to before the operation for you to see a model frame with the physiotherapists, to meet other members of the frame team and to have your questions answered. Unfortunately you may have to wait for your surgery if you are admitted at a busy time and sometimes your surgery may be postponed for emergency cases. What happens afterwards? You will not be able to drive so please arrange for someone to drive you home on your day of discharge. You should not drive until you are released to do so by your surgeon. You will need to inform the DVLA and your insurance company that you are wearing an ilizrov frame. Acute shortening was not possible in 5 cases with defects under 5 cm because of scarred soft tissues or neurovascular compromise on shortening. When the fibula was intact, with good alignment, bone transport was used to avoid fibula osteotomy. Infection Recurrence We present a treatment algorithm comprising 4 Ilizarov methods in managing infected tibial nonunion, using nonunion mobility and segmental defect size to govern treatment choice. Design:
The tibia is one of the most commonly fractured long bones in the body since much of it is subcutaneous and hence vulnerable to trauma. 1 , 2 , 3 Since one-third of its surface is subcutaneous, it is also marred with open fractures associated with tissue damage and bone loss which can be secondary to debridement of necrotic or infected bone. Tibial shaft fractures are further complicated by non-union, delayed union, and infection. 4 , 5 , 6 , 7 Gap non-union of the tibia is seen as a big challenge especially when it is associated with the history of previous surgeries and infection and is difficult to treat with traditional methods such as internal fixation and bone grafting. 8 Management of such non-union is technically demanding and physically and mentally difficult for the patient as well. The patient might require multiple surgeries but the non-union can persist despite the series of treatments and the surgeon might have to resort to the option of amputation. 9 It will take you some time to adjust to the practicalities of living with the frame by making adjustments to clothing, your sleeping position and daily activities. Before you go home we will make sure you know how to look after your frame and signs of any complications that you need to look out for. How do I prepare for the frame? This system helps provide a structural support to the limb and holds the broken bone fragments together so healing can take place over a period of time. It may be necessary to have this frame on your limb for a number of months. a b c Svetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp.3–6. ISBN 0849340519.
What happens when you get to hospital?
Monofocal compression: used with mobile nonunions (>7 degrees motion) with segmental bone loss after excision of less than 1 cm (bone touching bone). Acute correction of deformity was done after fibular osteotomy, and the nonunion was compressed. Gradual compression was maintained for 4–5 weeks at 0.5 mm per week.
Hammerschlag achieved substantial fusion in all ten of his patients, including two who had previously failed arthrodesis, utilizing a basic two-ring circular frame [ 16]. Yanuka et al. conducted Ilizarov arthrodesis on six patients suffering from posttraumatic arthrosis both with and without infection. All patients had a painless fusion between 7 and 15weeks [ 25]. Keightley AJ, Nawaz SZ, Jacob JT, Unnithan A, Elliott DS, Khaleel A. Ilizarov management of Schatzker IV to VI fractures of the tibial plateau-105 fractures at a mean follow-up of 7.8 years. Bone Joint J. 97-B(12) Trauma Robin G, Simon DO, Brinker M. Use of Ilizarov external fixation for a periprosthetic supracondylar femur fracture. J Arthroplast. 1999;14(1):118–21. All patients with a frame will experience some pain and discomfort initially. We will provide pain relief medication to help with this. Please let us know if you are in pain. There is never any guarantee that your bone will heal (unite), especially if you had an open injury. Smoking is the biggest risk factor for delayed or non-union as it delays bone and soft tissue healing. To reduce the risk of this complication we recommend that you must stop smoking. Please tell us if you need support to stop smoking.Patients were followed up for a mean of 40.8 months after frame removal (range 6–131). Microbiology We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you. Ilizarov technique is paramount for the management of such non-unions and gives excellent results with gap non-union of the tibia. 10 , 11 It helps with segmental bone transport and distraction histogenesis, which is carried out slowly and under control, after corticotomy, to fill the bone gap. It has many advantages such as ease of correction of deformities, better stability, and early weight-bearing. There are disadvantages like it can be cumbersome, requires practice, and has difficulties such as wound dressing, patient compliance, and the length of time it requires for the complete union. Seventy-nine patients (61 men and 18 women: median age 43.0 years, range 10–84 years) were treated with the Ilizarov method. All patients had infected nonunion, defined as having clinical and radiologic signs of infection in the presence of an established nonunion, accompanied by at least one of the following:
There are many associated obstacles to healing, such as poor vascularity and bad soft tissue cover. In gap non-union tibia with deprived soft tissue cover, it's all the more difficult to accommodate bone grafts. 12 The Ilizarov fixator comes as one of the excellent tools to overcome these problems.Having an External frame fitted can require a big adjustment to you (and your families) life. Following the application of your External Fixation you may find you have emotional ‘ups and downs’. Some frame users have described feelings of: The primary outcome measure was the absence of recurrent infection. Secondary outcomes included bone union, complications, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores and any need for further unplanned surgery (defined as any additional surgery undertaken beyond frame removal). If you have access to the internet, you can also arrange a delivery with a local grocer or supermarket. The Ilizarov surgical method of distraction osteogenesis (regeneration of bone and soft tissues) for repairing complex fractures of the bones of the limbs is the preferred treatment for cases featuring a high risk of bacterial infection; and for cases wherein the extent and severity of the fracture precludes using internal fixators to immobilise the damaged bone for proper repair. [7]
There is some evidence that anti-inflammatory drugs like ibuprofen or diclofenac can slow bone healing, please do not use these whilst your frame is on. We would also advise you not to drink fizzy drinks as these may harm bone health. Further surgery There are many ways you can retain your independence in the kitchen. Your Occupational Therapist will discuss these with you during your assessment.
Prospective information was collected on demographics, comorbidities, associated deformity, microbiology and histology data from intraoperative sampling, the nonunion stiffness, complication rate, and outcomes during the treatment period and follow-up.
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