Ilizarov Lower Limb Lengthening

1
Ilizarov Lower Limb Lengthening
Functional outcome

• G. H. Shahcheraghi MD FRCS(C)
• Mahzad Javid MD
• Orthop.Surgeon
• Fatemeh Hadavi MD.
• Orthop. Surgeon
• Nemazee Hospital..Shiraz Medical
• University-Shiraz Iran

2
Material

• In 13 years(1991-2004) the lower
• limb lengthenings were studied
• Single surgeons experience
• (GHS)
• Recall of 68 ?56, showed up
• (83.2 follow-up)
• 61 lower limb segments in 56
• patients
• Bifocal lengthening 11

3
Material

• Cause of LLD- 5 groups
• Congenital bone deficiencies
• 17 (30.3)
• Paralytic post polio 11 (19.6)
• Post traumatic, physeal injury
• 11 (19.6)
• Post infection 8 (14.3)
• Miscellaneous 9 (16.2)
• (OI, pseudoarthrosis tibia, myelomeningocel,
  DDH, bone dysplasia, Ollier disease)
  

4
Evaluation

• Physical exam
• Functional out come Questionnaire
• SMFA
• SF36
• WOMAC
• MACTAR
• parents and patients satisfaction
  scale
• Radiographic assessment

5
Case details

• 30 M, 26 F
• 34 tibia, 27 femur (4 tibia and femur)
• Simultaneous angular and rotational correction
  (20 cases)
• Age at surgery 14.7Y(5-38.5)
• Age at F/U 20.8 Y (10-42)
• F/U 73.4 mo (17 -180)

6
Material Healing
Index(HI)

• 32 patients lt 15Y
• 24 patients gt15Y
• Length gain
• femur 5.8 cm (3-10)
• tibia 7.4cm (3-14)
• below 14 Y / over 14 Y ? 8.3 / 6.4 cm
• Bifocal / unifocal ?
  11.2 / 7.2 cm

• Mean (HI) 28.3 days/cm
• Unifocal 30.5 days/cm
• Bifocal 19.2days/ cm
• Over 14Y versus under 14Y 31.2/ 26.2
• Faster healing in bifocal and younger age
  (Plt0.05)

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Healing Index Final length

• Cause related
• Congenital cases 24.8
• Trauma 28.4
• Infection 28.9
• Miscellaneous 30.8
• Polio 32.8
• Time difference non significant

• Achieved planned
• length 44 , . 78.2
• Re- lengthening
• planned- Still immature
• 4 , . 7.1
• Still unequal at
• maturity 8 ,. 14.2

8
Side effects

• Problem (35)
• 32 pin tract infection
• 2 stiffness / sublux.
• 1 early consolidation
• Obstacle (19 in 14 cases)
• 4 pressure sore
• 10 early consolidation
• 3 joint subluxation
• More major side-effects in femoral
  bifocals congenital cases

• Complication 21 in 19 cases)
• peron.neuroparaxia1
• stiff knees6
• ankle equinus9 (47 plantigrade
• malunion 4
• 0.4 per femoral
• 0.8 tibial side effects

9
Stiffness recovery / Functional results

• Functional Recovery
• SMFA, SF36
• excellent 53.7
• fair 42.9
• poor 3.6
• WOMAC
• excellent 71.4 , fair 28.6
• Patients and parents satisfaction scale
• excellent 73.2 ,
• fair 19.7 , poor4
• 50cases(89.2) would still go for surgery

• Stiffness recovery
• Polio 2 months
• Congenital 5.4 months

10
End result

• Lengthenings were in Complex, complicated cases
• major lengths were gained
• 60 from villages or small towns
• No group therapy, no formal physiotherapy
• Complications equal or less than literature
• 89 satisfaction,
• Most would have done it again
• Functional outcome was excellent