Karim Bakhsh, Hamidullah Khan, Edi Mohammad, Attiq-ur Rehman, Amanullah.
Functional and radiological outcome of ilizarov method for non-union of tibia and femur in pediatrics and adolescents.
Pak J Surg Jan ;36(1):46-52.

Objective: To review a single unit experience of functional and radiological outcome of ilizarov method for non-union of femur and tibia in pediatrics and adolescent patients. Material and Methods: Femoral and tibial shaft fractures are severe injuries and challenging for both, the patient and surgeon. Un-eventful healing of both entities is expected in 8 to 12 weeks in about 90% of patients. However non-union rates of 2 to 12% for femoral and 60 to 80% for tibial shaft fractures have been reported even in the presence of advance surgical techniques. Non-union of femur and tibial shaft fractures can be managed by open reduction and internal fixation and bone grafting, external fixation and bone grafting, the Masquelet technique of induced-membrane formation. Distorted local anatomy, recipient site complication, graft failure, thrombosis, two stage surgery and re-fracture with induced-membrane technique are possible complications of trending treatment modalities. Ilizarov method has been reported in multiple studies to have been used successfully for the treatment of wide range of orthopaedic problems. Th ere are few studies regarding the role of ilizarov in segmental bone transport for non-union of femur and tibia in pediatrics and adolescents internationally, no local studies. The study was an observational study where descriptive analysis was done at the Bolan Medical Complex Hospital Quetta a, from February 2016 to February 2019. Results: All the 30 patients (100.0%) which were included in the study had infected nonunion of femur 11 (36.7%), infected non union tibia 8 (26.7 %), Non-union femur 9 (30.0 %), non union tibia 2 (6.7%). 8-patients (26.7) had no previous surgeries, 9 (30.0%) patients had only one surgery and 13 (43.3%) had 2-previous surgeries. Bone debridement and excision of seclerosed and necrosed bone was done in all 30 (100.0%) patients. The bone defect ranged from 1 to 5 cm. Th e most common previous surgery was ORIF with Narrow DCP/Ex Fix 8 (26.7%) and ORIF with LCP/ Ex Fix 8 (26.7%) Infection was eradicated in all 30 cases (100.0%) and union was achieved in all 30 patients (100.0%). Th e operative time ranged from 70 to 150 minutes mean+S.D 116.50( 20.13). Th e most common complication was pin tract infection in 16(43.4%) with 5 patients (16.7%) superficial pin tract infection and 11 (36.7%) deep pin tract infection. The other complications were loosening of wires 3-patients (10.0%), loosening of Shan screws 6-patient (20.0%), Amputation 2-patients (6.7%), Refracture 4-patient (13.3%), poor regenerate 6-patients (20.0%). No severe limb oedema (0.00), loss of Knee mobility 9-patients (30.0%), loss of Hip mobility 2-patient (6.7%). The loose wires and schanz screws were removed and replaced by new ones in 5-patients (16.7.0%), shortening of less then 2 cm in 3-patients (10.0%). Conclusion: The method of ilizarov which can reconstruct the bone is safe and effective method for the treatment of non-union of femoral and tibial shaft fractures in pediatrics and adolescents. Despite the associated complications a detailed pre-operative plan, regular follow-up and timely management can help to achieve a satisfactory outcome. However our study lack direct comparison with any other treatment options therefore further randomized control trials are needed to draw more valuable conclusions.

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