Effectiveness of Ilizarov Ring Fixator in the treatment of infected Nonunion of Tibial Fractures in Adults

Aravindh, T (2013) Effectiveness of Ilizarov Ring Fixator in the treatment of infected Nonunion of Tibial Fractures in Adults. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: Infected non-union of bones is a challenging problem to any orthopaedic surgeon. Since by definition, non unions can only be diagnosed retrospectively when at least six months have elapsed since the fracture and when there is evidence that union will not take place, infection under these conditions tend to become chronic often with multi-drug resistant organisms. Infected nonunion brings together the problems of resistant bone infection and loss of stability of bone. Introduced by Prof.Gavril Abramovich Ilizarov has changed the face of treatment of open fractures, bone defect, non-union and deformities. From 1990, till date, for the past 20 years, Ilizarov’s method has been gradually replacing other modalities of treatment for infected muscular skeletal conditions. Osteoporotic fracture fragments with infected bone defects and poor soft tissue condition, remain a challenge for orthopedic surgeons. Internal fixation with a flap, massive autografting with a flap are other options .In presence of infections, such treatment with internal fixation modalities give poor results due to formation of biocalyx on the implant site. AIMS AND OBJECTIVES: The aim of this work is to study and analyze the effectiveness of Ilizarov ring fixator in the treatment of infected non union in adult tibial fractures. The aim of treatment of infected non-union is to achieve a stable union without residual infection, deformity or shortening. The various techniques that have been used previously for this condition including surgical debridement, bone grafting, electrical stimulation etc. have all produced inconsistent results. The principle of Ilizarov method along with the technique of bone transport allows the orthopaedic surgeon unprecedented control over osteogenesis, radical debridement of infected bone and soft tissue while maintaining stability, improves the vascularity of local tissues, simultaneous correction of deformity and limb length discrepancy while allowing early post operative mobilization and rehabilitation. MATERIALS AND METHODS: This study was conducted 21 cases of infected nonunion of tibia during the period from May 2010 to December2012 in the Department of OrthopaedicsThanjavur Medical College and Hospital, The patient’s age range from 23 to 60 yrs. There were 19 male and two female patients. All cases were result of open injuries. Out of 21 cases, 2 cases were due to accidental fall from height and others were due to vehicular accidents. The latency period before applying Ilizarov fixator range from 3 to 24 months. According to Gustilo and Anderson grading 11 cases were grade III, 8 cases were grade II and 2 cases were grade I. 17 cases had been treated by debridement and external fixator, 2 cases by long leg plaster and 2 cases by internal fixation. CONCLUSION: The permutations and combinations of the Ilizarov ring fixator made it versatile and almost a salvage procedure as it addressing all the problems of open or infected musculo-skeletal injuries and achieving union in 90 percent cases in this series. However it has a slow learning curve. The few complications which occurred in our earlier cases did not recur later. The main way to avoid mistakes and complications in ring external fixation is to follow the advice from the master Prof G.A.Ilizarov. "A surgeon should know not only the device but also the method proposed with it, therefore its detailed mastering is a must".

Item Type: Thesis (Masters)
Uncontrolled Keywords: ilizarov ring fixator, treatmen, infected nonunion, tibial fractures, adults.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 18 Sep 2017 01:08
Last Modified: 26 Mar 2020 02:43
URI: http://repository-tnmgrmu.ac.in/id/eprint/3006

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