Faculty Bibliography

The Ilizarov technique allows new histogenesis of soft tissue as well as bone. This process, extended to the foot, has allowed correction of complex three-dimensional deformities. The method is described and demonstrated to illustrate the action and limitations as well as the complications of the method.

Differences in the care of the pins used in association with the Ilizarov apparatus and technique are found in various countries and institutions. During a recent visit to the Ilizarov Institute in Russia, the methods of caring for the Ilizarov pins were extensively investigated and documented. The U.S. infection rate at pin sites has been reported to be nearly 10%. No specific infection rate has been reported from Russia. What constitutes an infection at the Ilizarov Center in Kurgan was investigated, as were methods of treatment. Our conclusion is that pin care in Russia is conducted under a more vigorous and stringent regimen, but less often, than in the United States. Soviet record keeping is different, and therefore the infection rates cannot be compared. In Kurgan, specific diligence is exercised in addressing the problems at each pin site. Treatment is directed toward alleviating these problems.

A transmetatarsal pin was used as part of an Ilizarov apparatus to correct equinovarus deformity of a foot in a 7-year-old patient. The pin created synostosis between the metatarsal bones. The synostosis led to persistent flattening of the transverse arch of the foot, producing a painful gait. To avoid this problem, we recommend that the metatarsal wire be placed only through the first and fifth metatarsals rather than through the neighboring metatarsals.

An Ilizarov apparatus was successfully used in the treatment of a six-year-old child with a radially deviated hand caused by congenital pseudoarthrosis of the distal radius after previous traditional surgery failed. The limb length was restored, the pseudoarthrosis healed, and the deviated hand corrected. A second child, five years old, with Poland's syndrome, had a 90 degrees flexion contracture of the wrist that was treated with the Ilizarov apparatus. The flexion contracture was gradually corrected. It seems that the Ilizarov apparatus can be an important tool in the treatment of complex limb deformities

The new technique of leg lengthening and deformity correction with different types of external fixators has given the orthopedic surgeon a tool that allows correction of very difficult deformities and leg length discrepancies of the lower extremity. Dissemination of this knowledge has demonstrated that there are many associated problems with these techniques: one of which is resulting equinus deformity after correcting the tibia. The shortened soleus-gastrocnemius-achilles tendon complex is the cause of this deformity. Several techniques are suggested on avoiding this complication and how to correct it once it has occurred

Twenty-nine children underwent 36 Ilizarov procedures for a variety of limb deformities. We present the results in 11 patients, six with leg length discrepancies and five with achondroplasia, who underwent lengthening procedures using the Ilizarov method. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus length 11 cm (40%). Eleven complications occurred. The most common were pin tract infections (4), joint contractures (2), transient nerve injury (4), premature consolidation (5), and three fractures of the regenerated bone. The complication rate was as high as in other methods, but with the Ilizarov apparatus longer segments of bone were lengthened and more complex deformities were treated. The number of complications were lessened as experience was gained

Several complications following Pavlik harness splintage for congenital dislocated hips have been described. Two cases are reported where prolonged Pavlik splintage without concentric hip reduction caused posterior acetabular deficiency. Open reductions were required in both cases to correct deformity.

Massive scarring of the Z-lengthened flexor digitorum and flexor hallucis longus is a constant finding in clubfoot surgery. A method of fractional lengthening of the tendons is described. This method has been proven effective in preventing this complication

Thirty percent to 50% of clubfeet will not respond to conservative treatment and will require surgery. The average failure rate in clubfoot surgery is 25% (range, 13% to 50%). Many complications can occur during surgery and postoperatively. Preoperative planning of the appropriate skin incision and special attention to wound closure may prevent some of these complications. Awareness of the multiple complications that can occur such as cavus, persistent adductus, overcorrection of the hindfoot, and recurrent deformity allows the surgeon to prepare and plan for these often unavoidable problems.