Outcomes of Ilizarov Ring Fixator in Infected Nonunion of Tibia

Objective: This study was designed to evaluate the effectiveness of Ilizarov. We aimed to explore the infection rate, bony union, and functional outcomes of Ilizarov fixators. Methodology: This retrospective study was conducted in Orthopedic department of Bolan Medical Complex Hospital Quetta Pakistan from June 2020 to June 2021. In this timeframe total of fifty-five patients of infected nonunion tibia were enrolled for Ilizarov technique treatment. For surgical intervention, patients were placed in a supine position on a radiolucent table. Ilizarov fixator was prepared on the behalf of patient's limb length, infection site, and ankle and knee functional status. We applied assembled Ilizarov fixator at the tibial shaft while keeping in mind that the rings were positioned in on the proximal and distal fragments. The ring was placed parallel to the joints whereas pins were inserted perpendicular to the tibial mechanical axis. Results: A total of 55 patients were recruited for this study. The mean age of the selected participants was 45.65±16.69 years. The overall successful bone results of the ASAMI score were observed as 80% whereas 88% functional outcomes were achieved. In bone results, we observed 28 (50.9%) cases with excellent results, 16 (29%) with good, 7 (12.7%) with fair, and 3 (5.4%) with poor outcomes. On the other hand, 25 (45.4%) cases observed excellent functional results, 25 (45.4%) with good, 4 (7.6%) with fair, and 2 (3.6%) with poor outcomes. Conclusion: Our results show a high success ratio therefore we recommend Ilizarov external fixators for infected nonunion tibial fracture. This method helps to recover limbs without any amputations. However, the discomfort of patients is one of the main problems with this method of treatment.

Restoration of Constitutional Alignment in TKA with a Novel Osteotomy Technique

Many studies have shown that restoration of the preoperative constitutional varus may lead to a normal knee status in total knee arthroplasty (TKA). It is also known that coronal femoral lateral bowing contributes to constitutional varus of the femoral shaft, and bilateral femoral lateral bowing (BFLB) can decelerate medial knee osteoarthritis progression. In this sense, the BFLB should be reserved in TKA. To date, no study has yet reported the technique to reserve BFLB in TKA. Our study showed that the proximal and distal femur had no significant geometric difference between patients with varus knees and BFLB (> 5°) and volunteers with healthy knees and straight femoral shaft. So, the virtual center of femoral head fell on the distal femoral mechanical axis (DMA) after accurate correction of the bowing, indicating that the DMA should be the femoral original constitutional mechanical axis (CA). Subsequently, the distal femoral osteotomy was performed perpendicular to DMA in TKA, and the postoperative angle formed by DMA and tibial mechanical axis (TMA) was measured to assess whether CA was restored successfully. In this study, the gap balance was achieved without medial collateral ligaments release, and the patient's CA was successfully restored (range of DMA–TMA angle 178.2°–179.9°). This study provides a novel technique to restore preoperative CA in patients with varus knees and BFLB. It is found that the distal femur should be cut perpendicular to DMA, so the lower limb alignment and soft tissue strains can be restored to the preoperative state, and the knees would be stable and in a natural status after TKA.