Ilizarov technique, satisfactory outcome with limited resources

Introduction. Complex lower limb fractures leading to non-union are unique problem in the developing countries which mostly requires extensive reconstructive and usually multiple surgeries. Ilizarov technique to manage this problem has shown satisfactory results and is practically suitable in financially constrained cohort of patients in medical centers where appropriately trained professionals are available. Patients and methods. This is a retrospective study conducted from January 2014 to March 2016 at Shah Bhitai secondary care hospital, Hyderabad, Pakistan. Inclusion criteria were complex, open fractures and septic or aseptic non-union of femur and tibia. All patients underwent stabilization of the limb with Ilizarov fixator. Outcome parameters were time duration to achieve union, functional and bony results and these were assessed using Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Results. Thirteen patients were included in the study, with a mean age of 41.08 years. Ten patients (76.9%) had tibial injury while rest of 3 had femur fracture. At presentation in our Institute bone defect was present in 54% of the patients and mean bone defect found was 2.31 cm (range 0-6 cm). On initial assessment in our hospital, 12 out of 13 patients had discharging wound, although 4 out of 13 patients (30.8%) had closed fracture as their initial limb injury. Mean time to get union in our patients was 9.67 months (range 5-12 months). Mean bone segment transport done was 1.62 cm (range 3-5 cm). Functional outcome was found to be excellent in 1 patient (7.7%), good in 9 (69.2 %), fair in 2 (15.4%), whereas bone union variable showed excellent outcome in 1 patient (7.7%) and good in 11 (84.6%) patients. Mean followed up of the patients was 17.7 months (range 3-34 months). Complications noted were pin track infection in 5 of our patients (38.5%), shortening of the limb in one patient, fracture of the regenerate in one patient, residual deformity (recurvatum of tibia) and re-fracture in 1 patient and mortality because of medical problem in 1 patient. Conclusion. Ilizarov technique is an effective treatment method for complex limb injuries which is especially applicable to developing countries and furthermore in limited resources secondary care public hospitals. Ilizarov technique stabilizes the limb leading to union at the same time effectively addressing other coexistent issues of deformity correction, equalization of leg length and soft tissue healing.