Pelvic support osteotomy by Ilizarovs concept: Is it a valuable option in managing neglected hip problems in adolescents and young adults?

For evaluating pelvic support osteotomy as a salvage procedure in managing neglected hip problems in adolescents and young adults, PSO was performed for 20 hips in 20 patients (5 men and 15 women). The mean age was 21.5 years. The etiology was neglected developmental dysplasia of the hip in 9 patients, post-septic hip sequelae in 9 patients, and paralytic dislocation due to poliomyelitis in 2 patients. All patients were treated by two osteotomies: a proximal femoral osteotomy to support the pelvis and correct the flexion and rotational deformities of the hip and a distal varization and lengthening osteotomy. Final clinical evaluation was done 6 months after frame removal. The mean external fixation time was 6.4. Lengthening and mechanical axis parallelism was achieved in all patients. At the final follow-up and according to a predesigned scoring system, there were 7(35%) excellent results, 6(30%) good results, 7(35%) fair results, and no poor results. Hip reconstruction by Ilizarovs concept can be technically demanding and involving lengthy period wearing the frame but found to be a valuable salvage procedure for numerous neglected hip problems particularly in young patients.

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Strategies Trauma Limb Reconstr. 2011 Apr; 6(1): 13/20.

Published online 2011 Mar 1. doi: 10.1007/s11751-011-0104-5

A safer technique for the double elevation osteotomy in severe infantile tibia vara .

Infantile tibia vara is a deformity of abrupt angulation into varus due to an affection of the postromedial aspect of the proximal tibial physis. The deformity often includes internal tibial torsion and limb length discrepancy. Gradual correction of the deformity is currently the treatment of choice for these challenging cases as it requires less invasive surgery, allows progressive and adjustable correction, permits bone lengthening if needed and achieves a more accurate correction compared to acute correction. Elevation of the depressed medial tibial condyle allows restoration of the joint architecture. Different techniques described to elevate the depressed medial tibial plateau are all technically demanding and carry potential risks of unsalvageable intra-operative complications. The aim of this study is to report the results of a safer technique for the double elevation osteotomy combined with gradual correction using the Ilizarov frame, allowing it to be more reproducible, less technically demanding and avoid those potential complications. This study included 12 limbs in 8 patients (mean age 9 years), all were classified as stage V or VI according to the Langenskiold classification. All osteotomies healed completely in all patients. The mean time in the frame was 23 weeks. The mean preoperative femoral shaft-tibial shaft angle was 36 of varus. This improved to 5 of varus. The mean preoperative femoral condyle-tibial shaft angle was 58. This improved to 84. The mean preoperative angle of depressed medial tibial plateau was 63. This improved to 8. All patients were maintaining full extension of the knee at the final follow-up, and all patients noticed a significant improvement in their gait pattern. We believe that this technique is safer and less invasive compared to traditional and even newly described techniques for elevating the depressed medial tibial plateau and correcting the deformity in severe infantile tibia vara, which will allow it to be more reproducible.

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Strategies Trauma Limb Reconstr. 2010 Aug; 5(2): 79/85.

Published online 2010 May 20. doi: 10.1007/s11751-010-0088-6

A New Double Elevating Osteotomy in Management of Severe Neglected Infantile Tibia Vara using the Ilizarov Technique

Neglected infantile Tibia Vara is a very challenging clinical problem with many technical problems including distorted joint line secondary to the medial tibial plateau depression, obesity leading to difficulty in exposure, performing osteotomies and difficulty in osteotomy fixation. The aim of this study is to evaluate the clinical and radiological results of treatment of severe neglected infantile Tibia Vara using a new osteotomy to elevate the depressed medial tibial plateau in conjunction with the Ilizarov technique. Seven tibias in five patients were included in this study. These were all Stage V and VI according to Langenskiold and Riska classification. The average age at surgery was 11.6 years (ranging from 8 to 15), and the average follow-up was 6.2 years (ranging from 3 to 10). A new double osteotomy technique was used to elevate the depressed medial tibial plateau and correct the varus deformity. Correction was done gradually using the Ilizarov Frame. The results were assessed clinically and radiologically. The femoral shaft -- tibial shaft angle improved from an average of 36 degrees of varus preoperatively to 4 degrees of varus. The femoral condyle-tibial shaft angle improved from an average of 58 degrees to 83 degrees. The angle of depressed medial tibial plateau improved from an average of 53 degrees to 10 degrees. We believe that our new double elevating osteotomy in conjunction with Ilizarov technique is an excellent modality for patients with stage V and VI according to the Langenskiold and Riska classification. The advantages of this technique include correction of the deformity with simultaneous correction of the joint architecture, immediate weight bearing, and avoidance of excessive dissection needed for internal fixation.

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Published online March/April 2006 - Volume 26 - Issue 2 - pp 233-237.

doi: 10.1097/01.bpo.0000218530.59233.ab

Knee/Tibia: Original Article

ANKLE JOINT RECONSTRUCTION IN FIBULAR HEMIMELIA IN CONJUNCTION WITH THE ILIZAROV TECHNIQUE

Introduction & Aim: The usual clinical presentation in Fibular hemimelia involves equinovalgus deformity of the foot and ankle instability with absence of the lateral rays of the foot. The aim of this study is to evaluate the results of ankle joint reconstruction, using remnants of the fibula, fibular analge or contra lateral fibular graft, in conjunction with the Ilizarov Technique.

Methods: We reviewed 13 limb segments in 12 patients with fibular hemimelia, with an average age of 4.7 years. According to Catagni�s classification 2 limbs were type I, 1 limb was type II and 10 limbs were type III. The ankle joint was reconstructed using remnants of the fibula if present in type I, fibular analge or a contra lateral fibular graft. The Ilizarov technique was then used to correct limb length discrepancy and any concomitant deformities.

Results: The results were assessed by the satisfaction of patients and families, the functional outcome in terms of daily activities and clinical examination of the patients. A satisfactory stability of the ankle foot complex was achieved in all patients. The average lengthening achieved using the frame was 5.6 cm and all limbs were equalized to within 2 cm.

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H. Shalaby, H. Hefny, M. Thakeb, S. El-kawy, E. Elmoatasem

Published 1 March 2006

Ankle Reconstruction in Fibular Hemimelia: New Approach

Background : Fibular hemimelia is a congenital disorder that is characterized by the absence of the fibula that could be either partial or complete. Successful management aims to restore normal weight bearing and normal limb length. The introduction of the Ilizarov method of limb lengthening has provided an attractive alternative to amputation. During lengthening, the tight posterolateral soft-tissue structures, the thick fibrous fibular band, and the shortened Achilles tendon become tighter and transfer a valgus force to the talus and calcaneus, further aggravating the deformity.

Methods : A prospective non-randomized clinical trial included ten ankles in eight patients with fibular hemimelia Paley type III (two patients had bilateral deformity). The patients� ages ranged from 7 to 36 months.

Results : After a follow-up ranging from 48 to 96 months, a stable plantigrade foot was achieved in nine ankles; one ankle had residual equinus, five ankles had residual valgus heel, and eight ankles had complete range of motion of the ankle, whereas one patient lost 5� of dorsiflexion. One ankle had equinus deformity.

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Hefny, H., Elmoatasem, E.M., Mahran, M. et al. HSS Jrnl (2016). doi:10.1007/s11420-016-9524-6

Published online 19 September 2016

Correction of complex foot deformities using the V-osteotomy and the Ilizarov technique .

Abstract : Complex foot deformity is a multiplanar deformity with or without foot shortening. It also includes deformed feet with poor soft-tissue coverage, relapsed or neglected cases, and those with acompanying problems such as leg-length discrepancy, lower leg deformity, osteomyelitis and nonunions. Traditionally, correction of these deformities can be achieved by extensive soft tissue releases, osteotomies or arthrodesis with or without internal fixation. This usually involves excision of large appropriate bony wedges and has many disadvantages, including neurovascular injury, soft tissue problems and a shortened foot. We present our experience with a group of severe deformities of the foot that we managed using the V-osteotomy combined with the Ilizarov technique. We present our algorithm of management of complex foot and ankle deformities, together with our prerequisites for patient selection. A detailed description of the operative technique, postoperative care and possible complications is also presented. The combination of the Ilizarov technique and the V-osteotomy offers versatility in foot deformity correction, enabling correction of individual components of the deformity at rates that may be tailored to achieve accurate three-dimensional control.

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Strategies in Trauma and Limb Reconstruction 2(1):21-30 � May 2007.

Published online May 2012