Use of the Ilizrov Method in the treatment of Nonunions, Infected nonunions, Infected nonunions with bone defects, malunions, infected malunions, infected/ open fractures of the femur.

Abstract

We present a series of 33 patients with various complications of femoral fractures involving 34 limb segments (1 bilateral) treated by the Ilizarov method at the Pakistan Society for the Rehabilitation of the disabled Orthopaedic Hospital, Sir Ganga Ram Hospital and Services Hospital Lahore from July 1996 to January 2001. At the time of writing 3 patients had been lost to follow- up (9.1%) and 4 had not completed treatment (12.1%) and were excluded from the study. Of the remaining 26 (78.8%)there were 20 males (76.9%) and 6 females (23.1%). The mean age was 28.1± 15.6 years (±1 sd, Range 4-40 years) the indications for surgery were infected nonunions of the femur 8 (29.6%), injected femoral nonunions with bone defects 7 (25.9%), infected /open femoral fractures 6 (22.2%), femoral malunions with or without shortening 4(14.8%), non-infected nonunions of the femur 2 (7.4%). Treatment was successful in 25 cases (92.6%) and failed (failure of healing) in 2 (7.4%). The mean time to fixator removal was 305.4 ± 164.4 days (mean ±Isd, Range 59 to 637 days) or approximately 10.2 months. According to Plaey’s criteria for the assessment of bone results we achieved 15 excellent (55.6%), 8 good (29.6%), and 2 fair (7.4%) with 2 failures (7.4%) 20/27 cases had 31 problems, obstacles and complications. 20/27 (74.1%) cases had one or more episodes of Grade I or II pin track infections. There were 3 cases of saphenous nerve irritation leading to pain and paraesthesiae. There was one case of multiple half-pin loosening, which required revision. 8 cases (29.6%) developed significant knee stiffness. One case with a distal femoral infected malunions underwent spontaneous boney anklylosis of the knee during treatment. In two cases (7.4%) there was pin track osteomyelitis, which settled following curettage, 2 cases (7.4%) refractured and were considered failures because up to the time of writing they had not agreed to further treatment. We feel that with attention to detail and patience on the part of both surgeon and patient excellent can be obtained with this technique in patients with complications following femoral fractures.