Multi-stage correction of shortening and deformities of the lower leg in children and adolescents with an external fixation device according to ilizarov

doi:10.15406/mojor.2023.15.00629

MOJ

eISSN: 2374-6939

Orthopedics & Rheumatology

Short Communication Volume 15 Issue 3

Multi-stage correction of shortening and deformities of the lower leg in children and adolescents with an external fixation device according to ilizarov

Bari AM Shayan R,¹ Bari MM,²

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Islam Shahidul³

¹Medical oflcer, Bari-Ilizarov Orthopaedic Centre; PhD resident in Tashkent scientific research institute of orthopaedics and traumatology, Uzbekistan
²Prof. Ph.D, Chief Consultant, Bari-Ilizarov Orthopaedic Centre, Visiting and Honored Prof., Russian Ilizarov Scientific Centre, Russia
³Prof. Bari-Ilizarov Orthopaedic Centre, Bangladesh

Correspondence: Bari MM, Bari-Ilizarov Orthopaedic Centre 1/1, Suvastu Shirazi Square, Lalmatia Block E, Dhaka-1207, Bangladesh, Tel +8801819211595

Received: June 01, 2023 | Published: June 7, 2023

Citation: Bari AMSR, Bari MM, Islam S. Multi-stage correction of shortening and deformities of the lower leg in children and adolescents with an external fixation device according to ilizarov. MOJ Orthop Rheumatol. 2023;15(3):112-116. DOI: 10.15406/mojor.2023.15.00629

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Abstract

Ilizarov Technique is a fantastic tool for correcting Shortening and deformities of the lower leg in children and Adolescents. The principle of compression-distraction histiogenesis of bone and soft tissue is the basis of treatment of the Ilizarov ring fixator. Distraction histiogenesis generates new bone and soft tissue under gradual distraction. All my research was carried out at Bari-Ilizarov Orthopaedic Centre from Jan 2013 to Dec 2022.

Introduction

Deformities of limbs may be congenital and can become apparent in early childhood. The concerned bones are the femur, tibia, fibula, radius ulna and humerus. The bones of the head and foot may be involved too.^1,2

Types of deformities of lower limb

Lower Limb Deformities may be:
Non-unions
Genu Varum
Genu Valgum
Limb Length Discrepancy
Procurvatum
Recurvatum

Patient criteria
Children to adolescents- age ranged from 3yrs. to 17 years.³

LLD of lower limb (femur/tibia) with
Osteomyelitis
Non-unions
Pathological fractures

Number of patients: 34
12 females, 22 males

Limb lengthening

By small incision the bone is cut, and Ilizarov device is applied on limb.

The devices gradually pulled; apart the fragments from each other leading to new bone (callus) formation. [LAW OF TENSION STRESS]⁴

Bone and soft tissues can grow under mechanical tension which is very close to natural growth.

Corticotomy is a

Low energy Osteotomy with the preservation of-

Periosteum

Endosteum

Bone Marrow

Ilizarov classical corticotomy……all wires frame

Treatment options

By Ilizarov

Biological parameters

0.25mm X 4 times a day 0.125mmX 8 times a day

60 times a day by automatic distractor⁵

Results

From January 2013 to December 2022, 34 patients with shortening and Deformities of The Lower Leg were treated by Ilizarov. The average time of treatment was 6 months (range 4-12 months). Osteogenesis and tissue genesis of the distraction gap was achieved in all the 34 patients. There were no incidents of neurovascular complications.

Conclusion

Ilizarov technique is a promising method that can be used for correcting deformities of the limbs. It can be applied at multiple levels of the affected limb. Sometimes, two or three steps surgery is required.

Case 1:

5 years old boy é 4cm LLD Lt tibia/fibula é varum (Front view)
5 years old boy é 4cm LLD Lt tibia/fibula é varum (Back view)
X-ray showing Cora and LLD
Patient with Ilizarov apparatus
8 cm LLD at age 11 (Front view)
8 cm LLD at age 11 (Back view)
LLD visible in lying position
X-ray showing LLD of left tibia/fibula by 8 cm
Patient with Ilizarov apparatus
X-ray showing lengthening of both upper and lower tibia/fibula
After full correction (Front view)
AP view of left tibia/fibula after full correction
Lateral view
Final follow up at the age of 17 (12 years follow up)
Back view with full knee flexion
Final follow-up of x-ray

Case 2:

Chronic osteomyelitis é pathological fracture Rt femur of 4 years old boy é discharging sinus (Front view)
Chronic osteomyelitis é pathological fracture Rt femur of 4 years old boy é discharging sinus (Back view)
Pathological fracture Rt femur (X-ray)
Patient with Ilizarov apparatus
X-ray showing union of femoral shaft
Weight bearing with Ilizarov frame
After Removal of frame (Back view)
Front view after removal
X-ray of Rt femoral with 12.5cm LLD at age 13
12.5 cm LLD (Front view)
12.5 cm LLD (Back view)
After application of Ilizarov in both femur and tibia/fibula
Stress X-ray showing 12.5 cm LLD Rt femur
X-ray of Rt hip to knee showing lengthening of femur
X-ray of Rt tibia/fibula showing lengthening going on
After removal of frame and application of full plaster
After removal of plaster
Application of brace for support
Stress x-ray showing full correction of LLD
Final follow up at age 14 after 11 months of treatment
Stress X-ray showing full correction