Faculty Bibliography

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

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

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

Nine patients have undergone percutaneous epiphysiodesis using a 4.5-mm drill and image intensification fluoroscopy. The minimal surgical exposure resulted in minimal postoperative discomfort, excellent cosmesis, and complete closure of the physis in all patients in three to five months. No complications were encountered. The procedure is easy to perform and reliable.

An atypical case of nonossifying fibroma involving the femoral neck of a 7-year-old white male is presented. The radiographic characteristics of the lesion were consistent with this diagnosis, although the location is rare. The differential diagnosis included fibrous dysplasia, unicameral bone cyst, chondroblastoma, and eosinophilic granuloma. A final diagnosis was obtained through tissue biopsy and histopathologic review.

A case of medial subtalar dislocation associated with a calcaneonavicular coalition is presented. The trauma of the dislocation resulted in fracture of the coalition.

Twenty-nine reoperated clubfeet were reviewed. The age range of the patients at the time of the revision surgery was 1-12 years. The average follow-up period was 30 months (range 9-36 months). The surgical procedure used most often in the revision surgery was complete soft tissue release alone or combined with plantar release, calcaneocuboid fusion, and capsulotomies of the navicular first-cuneiform joint and the first-cuneiform first-metatarsal joint. In 27 of 29 feet the results were considered acceptable (19 of 29 were rated excellent or good). An algorithm that suggests surgical solutions to a variety of clubfoot deformities in different age groups has been developed, as well as an objective functional rating system to evaluate long-term results in revision clubfoot surgery.

Fifteen deformed limbs in 10 patients with neuromuscular problems were treated by the Ilizarov technique. Five patients with cerebral palsy had, respectively, two deformities, two tight hamstrings and knee flexion contractures, and one bilateral external tibial torsion; two patients with spina bifida (L5-S1) had foot deformities; one arthrogrypotic patient had flexion contractures of both knees; one poliomyelitis patient had flexion contractures of both knees and equinovarus deformities of the feet; and one patient with Poland's syndrome had a 90 degree flexion contracture of the wrist. Complications were few, and none compromised full correction which was achieved in nine patients. The Ilizarov method is a new and efficient tool which can be successfully applied in the treatment of neuromuscular patients.