Journal of Musculoskeletal Trauma

Thermal Injury Complicating Improperly Reamed Intramedullary Nailing of the Tibia: A Case Report: Bo Kun Kim, Hyun Dae Shin, Jung Mo Hwang; J Korean Fract Soc 2011;24(2):178-184. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.178

Abstract PDF: Endosteum and bone marrow thermal necrosis caused by reaming during tibial intramedullary nail insertion, and unskilled operation of soft tissue penestration by reamer resulted in chronic osteomyelitis and soft tissue defect. So, several times of free flaps were done but the result was unsuccessful. At last, the authors performed radical necrotic bone resection and internal bone transport using Ilizarov external fixator. The authors report case with literature review.

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Comparison of Treatment Outcomes of Infected Nonunion of the Tibia by Ilizarov Fixator according to Location of Nonunion and Reconstruction of Soft Tissue Defect: Soo Kyung Lee, Jung Ryul Kim, Jong Han Lim, Jun Mo Lee; J Korean Fract Soc 2010;23(1):57-63. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.57

Abstract PDF: PURPOSE
To study clinical results and complications in the treatment of infected nonunion of the tibia according to location of nonunion and reconstruction for soft tissue defect.
MATERIALS AND METHODS
36 cases of tibia infected nonunion which were treated with the llizarov included in this study. There were proximal 1/3 in 14, middle 1/3 in 10, and distal 1/3 in 11 cases. Coverage of the soft tissue were treated with the free flap in 8 cases as classified group A and non-free flap in 17 cases classified group B. We evaluated the healing index, complications and comparing the results of each treatment by the Paley method.
RESULTS
Bone union was achieved in all cases. The proximal nonunion showed better results than those in the middle and distal area; average healing index: 35.6 days/cm (p=0.038), bone results: 92.9% (p=0.025), functional result: 90.5% (p=0.03). Group B showed significantly better results as it showed average healing index: 30.3 days/cm (p=0.015), bone results: 85.7% (p=0.025), functional results: 90.5% (p=0.015).
CONCLUSION
The nonunion of proximal 1/3 showed better results than other sites. Soft tissue reconstruction with free flap that control infection more effectively, could be improved the treatment outcomes.

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator: Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee; J Korean Fract Soc 2007;20(4):323-329. Published online October 31, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.4.323

Abstract PDF: PURPOSE
We analyed the mid-term results of distal tibial fractures treated with ilizarov external fixator and functional results according to delayed metaphyseal healing and fracture pattern.
MATERIALS AND METHODS
We reviewed 23 distal tibial fractures treated with ilizarov external fixator followed for minimum two year (mean 53 months). There were 10 A fractures, 2 B fractures, and 11 C fractures according to the AO classification. Radiographically, we analyzed bony union time according to translation of diaphyseal-metaphyseal fracture line and assessed arthritic score. Functional results was assessed with AOFAS score and analyzed according to delayed healing and fracture pattern.
RESULTS
Average union time was 21 weeks. Delayed healing of metaphyseal fracture line was associated translational displacement >3 mm (p=0.01). AOFAS scrore was averaged to 68 and there was no stastical significance between delayed metaphyseal healing and functional results (p=0.31). But, low AOFAS score and arthritis score was related to fracture type (p=0.02). In 11 C fractures, radiographic arthritic change were developed in 6 cases (55%).
CONCLUSION
The main prognosis of distal tibial fractures depends on articular involvement and to shorten the external fixation time, metaphyseal fracture should be reduced within 3mm.

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Arthroscopically Assisted Limited Open Reduction and Ilizarov External Fixation of Tibial Pilon Fractures: Jin Young Lee, Gab Lae Kim, Hyung Seok Oh, Kun Ho Shin, Deok Yong Park; J Korean Fract Soc 2006;19(2):176-181. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.176

Abstract: PURPOSE
To evaluate the clinical results of the pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation.
MATERIALS AND METHODS
This is a retrospective study of the clinical result, bone union, complication and postoperative ankle function of 22 pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation between January 1999 to March 2004.
RESULTS
Clinical follow up averaged 16 months, with an average age of 39.2. All patients with type 1 and 2 fracture had excellent or good score by Ovadia and Beals criteria. Closed fractures healed within 13 weeks and open fractures within 16 weeks after surgery in average. Average range of motion of the ankle was 12o dorsiflexion (0~20 degree) and 25o plantar flexion (15~35 degree).
CONCLUSION
Minimal soft tissue dissection and anatomical reduction are very important factor for minimizing complication and satisfactory ankle function. So, arthroscopically assisted limited open reduction and Ilizarov external fixation is an effective treatment option for tibial pilon fractures.

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Radical Necrotic Bone Resection and Ilizarov Technique for Infected Nonunion of the Tibia: Keun Bae Lee, Byung Soo Kim, Sung Taek Jung, Eun Kyoo Song, Kyung Do Kang; J Korean Fract Soc 2005;18(4):405-409. Published online October 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.4.405

Abstract PDF: PURPOSE
To evaluate the clinical results of radical necrotic bone resection and distraction osteogenesis for the treatment of infected nonunion of tibia using the Ilizarov technique.
MATERIALS AND METHODS
32 patients who were followed up at least 1 year after the treatment of infected nonunion of tibia from March 1995 to March 2001 were evaluated. Their mean age was 43 years and mean duration of follow-up was 37 months. The results were divided into bone results and functional results and analyzed by grading to excellent, good, fair, and poor.
RESULTS
The average amount of bone lengthening was 5.3 cm (range, 2~10 cm) and the average healing index was 61.5 days/cm (range, 52.7~70.4 days/cm). Bony union was obtained at average 10.3 months in all cases. The bone result was excellent in 9 cases, good 18, and fair 5. The functional result was excellent in 8 cases, good 16, fair 7, and poor 1 case.
CONCLUSION
Ilizarov technique is an effective method in the treatment of infected nonunion of tibia for early range of motion exercise, weight bearing and correction of limb shortening.

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Internal Bone Transport in the Management of Tibial Bone Defects: Chang Wug Oh, Woo Kie Min, Hee Soo Kyung, Il Hyung Park, In Ho Jeon, Byung Chul Park, Poong Taek Kim, Young Heon Sohn; J Korean Fract Soc 2005;18(1):36-42. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.36

Abstract PDF

PURPOSE
To retrospectively review the results of internal bone transport in the management of tibial bone defect using ilizarov fixator.
MATERIALS AND METHODS
We treated 39 cases of tibial bone defect (16 of traumatic bone loss, 23 after treatment of osteomyelitis). The mean age of index procedure was 33.8 years (range, 13~66 years), and all of them had follow-up study for a mean of 3.5 years (range, 1.6~8 years). The mean transported amount was 6.3 cm (range, 2.7~20 cm), and the external fixator was removed after 345 days (range, 120~700 days). The mean external fixation index was 60.3 days/cm (range, 13.1~121.3 days/cm).
RESULTS
Primary union of distraction and docking site was achieved in all, but two patients had failure in union of docking site. Functional results showed 6 excellent, 19 good, 10 fair, and 4 fair. The patients under age 20 showed better functional outcomes than the others. Among 73 complications (incidence, 1.87 cases/ patient), 27 of major complications with residual sequelae occurred in 20 patients. The residual sequelae were more common in the patients who had the concomitant injuries in the same leg.
CONCLUSION
Internal bone transport can solve the large amount of tibial bone defect. However, the complications are not uncommon, which might be related to the concomitant injures in the same leg.

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Bone Transport Over the Intramedullary Nail for Defects of Long Bone
Jae-Young Roh, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Byung-Chul Park, Woo-Kie Min, Joon-Woo Kim, Chang-Hyun Cho
Journal of the Korean Fracture Society.2008; 21(1): 37. CrossRef
Minimally Invasive Plate Osteosynthesis to Prevent or Treat the Deformity after Distraction Osteogenesis
Chang-Wug Oh, Byung-Chul Park, Il-Hyung Park, Hee-Soo Kyung, Woo-Kie Min, Seung-Hoon Baek, Seung-Kil Baek
The Journal of the Korean Orthopaedic Association.2007; 42(6): 764. CrossRef

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Treatment of Tibial Plateau Fractures using Ilizarov Fixation (Schatzker Type IV, V, VI): Hee Gon Park, Moon Jib Yoo, Myung Ho Kim, Woo Sup Byun, Ji yong Chun; J Korean Fract Soc 2004;17(3):230-236. Published online July 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.3.230

Abstract PDF

PURPOSE
To evaluate the effectiveness of Ilizarov fixation in tibial plateua fractures (Schatzker type IV, V, VI), the clinical and radiological results were analysed retrospectively.
MATERIALS AND METHODS
Of the tibial plateau fractures (Schatzker type IV, V, VI) which had been treated by using Ilizarov fixatrion method at Dankook university from June 1995 to June 2004, we clinically, radiologically analysed the 47 cases with follow-up study of a mean 38 months. Overall results which were evaluated according to Blokker's evaluation system.
RESULTS
The average start time of the range of motion excercise was 4.2 weeks, and the average start time of partial weight bearing was 4.6 weeks. Results which were evaluated according to Blokker's evaluation systems were "satisfactory" in 8 cases (80%) of the type IV fractures, in 9 cases of the type V fracures, and in 18 cases (69%) of the type VI. Overall results were "satisfactory" in 35 cases (74.4%), "unsatisfactory" in 12 cases (25.5%).
CONCLUSION
When use Ilizarov fixation in tibial plateau fracture (Schatzker type IV, V, VI), we have many advantages that the early start time of the range of motion, the early start time of weight bearing, the acceptable results of Blokker's evaluation system. Therefore, we conclude that Ilizarov fixation in tibial plateua fracure (Schatzker type IV, V, VI) is effective.

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Treatment of Shatzker Type VI Tibia Plateau Fracture Using Lateral and Posteromedial Dual Incision Approach and Dual Plating
In-Jung Chae, Sang-Won Park, Soon-Hyuck Lee, Won Noh, Ho-Joong Kim, Seung-Beom Hahn
Journal of the Korean Fracture Society.2009; 22(4): 252. CrossRef
Dual Plate Fixation Compared with Hybrid External Fixator Application for Complex Tibial Plateau Fractures
Jae-Sung Lee, Yong-Beom Park, Han-Jun Lee
Journal of the Korean Fracture Society.2008; 21(2): 124. CrossRef

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Treatment of the Segmental Fractures of Tibia with Ilizarov External Fixation: Kwang Soon Song, Chul Hyung Kang, Byung Woo Min, Si Hyun Jeon, Ki Chul Bae, In Kyu Kim; J Korean Fract Soc 2004;17(1):25-31. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.25

Abstract PDF: PURPOSE
To emphasis an effectiveness of the Ilizarov circular external fixator in treatment of the complicated segmental fractures of the tibia MATERIALS AND METHODS: We had analyzed 15 cases in 14 persons, treated from November 1993 to March 2000. We analyzed several considering factors including age, etiology, type of fracture, number of the segmentation, associated injuries, open or closed fracture, healing time, additional bone graft, clinical results and complications.
RESULTS
The mean period of follow up was 22 months. The mean age was 45 years. The etiology was traffic accident in 13 persons. Open fracture were 11 cases (73%). Associated injuries were noted in 8 persons (53%). The number of segmentation were three segments in 9 cases (60%) and four segments in 6 cases (40%). Additional manipulations after first application were needed in 10 cases (67%). Bone graft were performed in 5 fracture site (9.8%), proximal fracture site in two and distal in two, middle in one. Mean period of application of external fixator for healing was 8.1 Months. Procedures for soft tissue injuries performed in 3 cases including two split thickness skin graft and distant flap surgery. The results were graded as excellent in 5 cases, good in 2 cases, fair in 1 cases, poor in 7 cases. Limitation of motion in ankle joint was major cause of poor results CONCLUSION: We considered that ilizarov circular external fixator is one of effective treatment modality in treatment of the complicated segmental tibia fractures.

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Treatment of Segmental Fractures Associated with Periarticular Fracture of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Moon Ki Choi, Kwang Bok Lee, Jong Hyuk Park, Ju Hong Lee, Jun Mo Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 2003;16(4):504-510. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.504

Abstract PDF: PURPOSE
We analyzed the results and complications of the treatment of segmental fractures of the tibia associated with periarticular fracture by using Ilizarov external fixator.
MATERIALS AND METHODS
We reviewed 17 patients of segmental fractures of the tibia were treated by Ilizarov external fixator and were followed for a minimum one year. There were twelve closed fractures, three type 3A, and two type 3B open fractures. According to Melis classification, there were five type I, four type II, and eight type III. All closed fractures were reduced and fixed with Ilizarov external fixator within seven days. Open fractures were performed immediate wound irrigation and radical debridement and fixed with Ilizarov external fixator. Autogenous iliac bone graft was done in five severe comminuted fractures. Average time in bone graft was 7.5 weeks after operation. We analyzed bony union time according to configuration and site of the fractures, results of the treatment, and complications. The functional outome was assessed with rating system of Tucker.
RESULTS
In all cases, bony union was obtained, and average union time was 20.5 weeks. According to modified Melis classification, our results showed no difference between each criteria with respect to bony union and there was no difference bony union time between proximal and distal fracture site. There were two leg-length discrepancy less than 2 cm, one partial ankylosis of the knee joint, and ten pin tract infections. The functional results was excellent in 11 cases, good in 5 cases, and fair in one case.
CONCLUSION
Ilizarov external fixator can be useful method for the treatment of segmental fractures of the tibia associated with juxtaarticular fracture in respect of bony union and functional results.

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Treatment of the Distal Metaphyseal Fractures of Tibia - Comparison between Internal Fixation with a Plate and screws and External Fixation with Ilizarov Device: Sung Churl Lee, Moon Jib Yoo, Hyun Seok Seo; J Korean Soc Fract 2002;15(3):371-378. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.371

Abstract PDF

PURPOSE
The purpose of this study was to compare the results between open reduction and internal fixation with plate and screws and closed reduction and external fixation with Ilizarov device for the fracture of disatal metaphyseal fracture of tibia.
MATERIALS AND METHODS
In this study, the results in treatment of the 19 distal metaphyseal fractures of tibia with closed reduction and external fixation with Ilizarov device were compared with those in treatment of the 23 fractures with open reduction and internal fixation with a plate and screws. The cases were the patients who had been treated for the fractures at the Department of Orthopaedic Surgery, Dankook University Hospital from May 1997 to December 2000. The results of treatment were analysed using functional evaluation by Mast and Teipner and radiological evaluation by Ovadia and Beals.
RESULTS
The results were as follows: 1. The major causes of injury were motor vehecle accidents, fall-downs, and falls from a height in order. 2. Treatment of the fractures with closed reduction and external fixation with Ilizarov device showed comparable results to that with open reduction and internal fixation with a plate and screws. 3. Complications in treatment were a little more frequent in open reduction and internal fixation with a plate and screws than in closed reduction and external fixation with Ilizarov device.
CONCLUSION
Considering the results, closed reduction and external fixation with Ilizarov device is thought to be one of recommendable options in treatment of the distal metaphyseal fractures of tibia with the advantages in wound management, prevention of stiffness of ankle joint, and convenience in removal of the device.

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator
Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee
Journal of the Korean Fracture Society.2007; 20(4): 323. CrossRef

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Treatment of Severe Open Fractures of Tibial Shaft: Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing: Hyoun Oh Cho, Kyoung Duck Kwak, Hong Joo Lee, Dae Hwan Lim, Sang Min Ahn, Jae Ho Chang, Kyung Ku Kang; J Korean Soc Fract 2002;15(2):234-242. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.234

Abstract PDF: PURPOSE
We tried to compare the results of Ilizarov external fixation cases with the cases of secondary intramedullary nailing after tempory Ilizarov fixation.
MATERIALS AND METHODS
From the January 1996 to February 2001 , 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. According to Gustilo- Anderson classification, it consisted of type II 2 ,IIIA 7 ,IIIB 9 ,IIIC 2cases in Ilizarov group ,and type II 2, IIIA 7, IIIB 5cases in secondary intramedullary nailing group.
RESULT
There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the secondary nailed group had slightly better motion , less final angulation and felt more comfortable . It is the treatment preferred by patients and does not require the same high level of patient compliance as external fixation.
CONCLUSION
Secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open fractures of tibia.

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IIizarov Method of Tibial Plafond Fracture: Myung Hwan Son, Byung Chul Kim, Nam Wook Kang, Min Yong Kim; J Korean Soc Fract 2001;14(4):643-650. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.643

Abstract PDF: PURPOSE
To report the result and the advantage of Ilizarov device when treating the tibial plafond fractures described as difficult to manage.
MATERIALS AND METHODS
We retrospectively reviewed 10 cases of tibial plafond fractures treated with Ilizarov device form March 1996 to October 1999. If necessary, limited internal fixation was combined and the mean follow-up time was 11 months. The clinical and the radiological results were evaluated after operation.
RESULTS
The objective clinical results were classified as good (4 cases), fair (5 cases), and poor (1 case). The average union time was 13 weeks and there were ankle pain, wound infection and traumatic arthritis after opertion, but severe complications such as osteomyelitis and nonunion were not appeared.
CONCLUSION
For tibial plafond fractures, Ilizarov device minimize the soft tissue injury and combined limited internal fixation improve the result.

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Treatment of Tibial Condylar Fractures Using the Ilizarov External Fixator: Dong Wha Lee, Kyoo Seog Shin, Jong Soon Kim, Yong Whee Kim, Jin Ho Seok; J Korean Soc Fract 2001;14(3):404-411. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.404

Abstract PDF: PURPOSE
The aim of this study is to report results of treatment of tibial condylar fracture using the Ilizarov external fixator. MATERIALS & METHOD: 21 Cases of tibial condylar fracture, which were operatively treated with Ilizarov external fixator were evaluated clinically & radiographically. All patients were followed for at least 1 years.
RESULTS
Primary bony union was achieved in 15 cases(71.4%) and bony union after secondary operative procedure was obtained in 6 cases(28.6%). The fracture was united within 6 months except 2 cases. As complications, pin irritation was observed in 6 cases and Joint stiffness in 1 case, delayed union in 1 cases, nonunion in 1case CONCLUSION: We could obtain satisfactory clinical results with using of Ilizarov external fixator in treating of tibial condylar fractures. The good indications for the use of Ilizarov external fixator seems to be high energy tibial condylar fracture difficult to fixation with other method. In cases of bony defect or severe comminuted fractures, we shall obtain better outcome when bone graft is performed.

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Treatment of Infected Nonunion of the Tibia by Ilizarov External Fixator: Jung Ryul Kim, Keun Ho Yang, Byung Yun Hwang; J Korean Soc Fract 2000;13(4):921-927. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.921

Abstract PDF: PURPOSE
To analyze the clinical results and complications of the Ilizarov technique in the treatment of the tibial nonunion.
MATERIALS AND METHODS
Twenty-seven patients who had infected nonunion of the tibia were managed with Ilizarov external fixator form January 1992 to January 1997. Types of nonunion were classified according to Paley and status of infection were divided into AO classification. We evaluated clinical outcomes and complications which were assessed with rating system of Paley.
RESULTS
All cases obtained bony union. The mean time to union was 11.5 months. On average, healing index was 51.4 days/cm(range 28-72 days/cm) and percentage of increment was 18.5 %(range, 13-31.5 %). According to Paley criteria, bone results were good to excellent in 22 cases(81.5 %), and functional results were good to excellent in 24 cases(88.9 %). Total thirty five complications were occurred, which were classified by Paley criteria, problems in 15 cases, obstacles in 17 cases, and complication in 3 case.
CONCLUSION
Ilizarov technique is a useful method in management of the tibial nonunion, but we have to consider the complications and endeavor to reduce them.

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Ilizarov/Hybrid-Ring External Fixation in the Management of Tibial Plafond Fractures: Chang Wug Oh, Byung Chul Park, Joo Chul Ihn, Sung Jung Kim, Hee Soo Kim, Saeng Guk Lee; J Korean Soc Fract 2000;13(2):244-251. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.244

Abstract PDF

PURPOSE
: To evaluate the results of the treatment of distal tibial fracture using ring or hybrid ring external fixator and to compare the results according to the influencing factors.
MATERIALS AND METHODS
: The authors analized 30 patients, 31 cases of distal tibial fracture who were treated by Ilizarov ring external fixator or hybrid ring external fixator at our hospital from May 1996 to August 1998 and were followed up over 1 year. The type of distal tibial fractrue were classified according to AO group, type A was 7 cases, and type C was 24(C1:5, C2:4, C3:15)cases. Restoration of articular surface of the distal tibia was performed through closed method or minimal invasive technique by minimal internal fixation with K-wire or screw. Then fixation of th distal tibia was done by ring external with multiple transfixing wire. Connection to the tibial shaft was done by Ilizarov ring external fixator(15 cases), or mono-external fixator(Dyna-Extor, 16 cases).
RESULTS
: By Tornetta's assessment of functional results, excellent was 5, good 19, fair 4 and poor 3cases. According to AO classification, the functional results of type A, 7cases were all above good results, among 24 cases of type C, 4cases of C1, 2 cases of C2, and 11 cases of C3 were above good results and there was no statistical difference between the results and the fracture type(P=0.024). One of 3 cases of poor functional results was open type C3 fracture and was complicated with osteomyelitis and refracture, and others two cases type C2 fracture which were complicated with malunion.
CONCLUSION
: The authors had a good results without soft tissue complication after the treatment of distal tibial fracture patients by Ilizarov ring external fixator or hybrid ring external fixator.

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Mid-term Results of Distal Tibial Fractures Treated with Ilizarov External Fixator
Suk Kyu Choo, Kyung Wook Nha, Hyoung Keun Oh, Dong Bong Lee
Journal of the Korean Fracture Society.2007; 20(4): 323. CrossRef

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Treatment of Humerus Fracture using Ilizarov External Fixator: Suk Myun Ko, Myung Gu Kim, Ryuh Sup Kim, In Suk Oh, Joung Yoon Lee, Hyeok Chae Jeong; J Korean Soc Fract 2000;13(1):30-37. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.30

Abstract PDF

PURPOSE
Recently, the incidence of humerus fracture not allowing open reduction and internal fixation has been increased with increment of traffic accident and industrial accident. But, there have been a few reports in the use of Ilizarov external fixator. The purpose of this study is to report the authors'experience with Ilizarov external fixation for the treatment of the patients with fractures of the humerus.
MATERIALS AND METHODS
From June 1996 to July 1998, we reviewed sixteen patients with humeral fracture who were treated by the Ilizarov external fixator. Three fractures were in the middle third of the shaft; two, in the proximal third; two, in the distal third; seven, in the proximalmiddle; two, in the middle-distal. The fractures that were located within the joint of the shoulder or the elbow were excluded. Five fractures had been open and six had been associated with multiple trauma. Two had been initially treated by open reduction and internal fixation but failed : one, because of infection; the other, because of loss of fixation. We performed the Ilizarov external fixator procedure in the case of soft tissue trauma so severe that internal fixation was impossible, and in the case of the comminution too extensive and severe for internal fixation.
RESULTS
The average time to radiologic union was 12.7 weeks. According to Stewart and Hundley's functional assessment system, excellent or good results were obtained in 14 cases. There was no poor result.
CONCLUSION
Although the Ilizarov external fixator was a technically demanding procedure, it was a good method comparing with any other operative methods for the treatment of fractures of the humerus not allowing the open reduction and internal fixation.

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Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Tae-Soo Park, Joon-Hwan Lee, Tai-Seung Kim, Kwang-Hyun Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2008; 21(4): 292. CrossRef

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Treatment of Comminuted Fractures of Femur & Tibia with Ilizarov Apparatus: Soo Bong Hahn, Hong Jun Park, Hui Wan Park, Sung Hun Kim; J Korean Soc Fract 2000;13(1):20-29. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.20

Abstract PDF: PURPOSE
To evaluate the effectiveness of Ilizarov external fixator for the treatment of unstable closed or open comminuted femoral and tibial fractures, especially those with severe soft tissue injury by clinical and radiological analysis.
MATERIALS AND METHODS
Fifty six consecutive femoral or tibial fractures were treated using Ilizarov external fixator between May 1991 and August 1998 and followed up for minimum 12 months upto 36 months with the average of 16 months. All of them consisted of comminuted or segmental fractures. And thirty five cases of them were open fractures. There were nine Type I, seventeen Type II, five Type IIIA, and four Type IIIB fractures. Primary closure was performed for Type I and II fractures. Split-thickness skin graft (5 cases) and free vascularized flap (3 cases) were used for severe soft tissue defects.
RESULTS
All fractures healed within the average of 7.7 months (from minimum 3 months to maximum 24 months). Bone grafts were performed in 39 cases. Bony union was obtained in all the cases with Ilizarov method. The most common complication, the adjacent joint contracture was developed in 21 cases (37.5%). Pin site infection in 12 cases (21.4%), delayed union in 3 cases (5.4%), angulation deformity in 2 cases (3.6%) were developed.
CONCLUSION
The Ilizarov external fixation technique is one of the effective methods in the management of unstable closed or open comminuted femoral or tibial fractures.

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Ilizarov Treatment of Nonunions with Bone Defect in the Tibia: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(1):13-19. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.13

Abstract PDF: PURPOSE
To analyze the clinical results and complications of internal transport by Ilizarov for defect nonunion of tibia MATERIALS AND METHODS: We performed a retrospective review of 24 patients undertaken internal transport by Ilizarov for defect nonunion of tibia from January 1991 to December 1997. There were 21 males and 3 females with a mean age of 33.4 years(range, 17-64 years). On average, the size of bone defect measured 7.9 cm(range, 2-17 cm). Bone defects were gradually closed by progressive internal transport. After internal transport, bone grafts on 14 docking sites were performed because of delayed union. Soft tissue defects were treated with secondary closures(6 cases), skin grafts(4 cases), and flaps(4 cases).
RESULTS
According to Paley and Catagni's classification, bone results were excellent in 19 cases, good in 4 cases, and poor in 1 case. Functional results were excellent in 2 cases, good in 21 cases, and poor in 1 case. According to Paley's classification, the complications were developed as follows; Problems were pin site infections(12 cases), joint contractures(9 cases), and distraction gap delayed consolidations(3 cases). Obstacle was absent. Complication was refracture(1 case). The average distraction consolidation index was 39.4 days/cm. The average percentage transport was 139.7 %.
CONCLUSION
The application of Ilizarov to defect nonunion of the tibia is effective, but correct technique and careful follow-up is required.

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Ilizarov Method for Treatment of Tibia Nonunion Associated with Bone Defects: Sung Taek Jung, Keun Bae Lee, Eun Kyoo Song, Sung Nam Jung; J Korean Soc Fract 1999;12(4):932-939. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.932

Abstract PDF: PURPOSE
: This study was to evaluate the results and complications in gap nonunions of the tibia treated by Ilizarov method MATERIALS and METHODS : We reviewed 30 patients of tibial nonunions(23 atrophic, 7 hypertrophic) with bone loss(1-l3cm, mean 4.6cm) who were treated by Ilizarov technique. The causes of bone defect were open fracture with bone loss(15 cases) and infected nonunions(15 cases). Bone defects were closed by Ilizarov bone transport technique.
RESULTS
All patients had satisfactory union. The mean distraction-consolidation index (distraction-consolidation time/ distraction gap) was 1.3 months/cm. The younger patients and metaphyseal lengthening healed faster than the older patients and diaphyseal lengthening. Even though, we met with the numerous complicationt such as pain around the pin site, pin site infection and delayed union, we could successfully treat most of them.
CONCLUSION
: The application of Ilizarov techniques to nonunions of the tibia with bone defect was very effective, but correct technique and careful follow-up examination was required to avoid complications.

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Treatment of comminuted Tibial Fractures using Ilizarov Method: Eui Hwan Ahn, Sung Tae Lee, Hyeon Seok Kang; J Korean Soc Fract 1999;12(4):916-923. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.916

Abstract PDF: From March 1996 to March 1999, thirty two cases of comminuted tibial fractures were treated with Ilizarov external fixator. 13 cases were closed fractures and 19 cases open fractures. Among 19 open fractures, there were 3 cases of Gustilo type I, 10 cases of type II and 6 cases of type III fractures. All the cases could not be initially treated by open reduction and internal fixation because of open wound or severe comminution. Among 32 cases, 4 were tibial condyles, 22 were tibial shafts, 6 were tibial plafonds. All the cases were followed up from a minimum 12 months up to 35 months with an dverage of 22 months. We obtained satisfactory bony union in ail cases with the average duration of 18.1 weeks. Bone graft was done initially in two cases. Numerous complications were encountered, most commonly, joint stiffness and pin tract infection were developed but they were treated well. To avoid such complications, careful management was needed. According to Tuckers clafsification, the result was graded as excellent in 8, good in 18, fair in 4 and poor in 2 cases. We conclude that Ilizarov external fixatior is a very useful method for initial treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in cases of communited tibial fractures whether open or closed.

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Operative Treatment of the Tibial Pilon Fractures: Suk Woong Yoon, Tae Sung Hwang, Byung Gue Park, Sang Deog Kim; J Korean Soc Fract 1999;12(3):622-631. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.622

Abstract PDF: Pilon fracture which is defined as a comminuted intraarticular fracture of distal tibia has been known to be difficult to manage because high axial compression and rotational forces to the ankle joint result in impaction, severe comminution, metaphyseal disruption, and soft tissue trauma. Several authors have reported good results using an AO group treatment principle. However, others have documented less favorable results such as skin slough, wound infection, and osteomyelitis. Recently, satisfactory results were obtained by the treatment with open reduction and fixation using Ilizarov method. We reviewed and analyzed 22 cases of the pilon fracture treated by the two methods O.R.I.F. and fixation by Ilizarov method) and compared the results to find out the usefulness of fixation by Ilizarov method, from Feb. 1993 to Mar. 1997 at the Department of Orthopedic Surgery, Seoul Red Cross Hospital. Fixation by Ilizarov method using ligamentotaxis and occasional minimal open reduction was effective for fracture reduction. It also decreased complications such as wound infection, skin necrosis, and osteomyelitis because it did not need extensive soft tissue dissection. And, it was also useful for severe comminuted fracture, open fracture, and fracture with extensive diaphyseal extension to proximal metaphysis.

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Ilizarov External Fixation for Severe Open Tibial Shaft fractures in Adults: Jeung Tak Suh, Tae Wook Nam, Chong Il Yoo; J Korean Soc Fract 1999;12(3):549-556. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.549

Abstract PDF: PURPOSE
It is to evaluate and discuss the result of severe open tibial shaft fractures treated by Ilizarov external fixation.
MATERIALS and METHODS
From the January 1992 to July 1997, 34 cases of severe open tibial shaft fracture in adults were treated with Ilizarov external fixator. 20 males and 14 females were followed for at least 1 year.
RESULTS
Fractures were evenly distributed through proximal 1/3 to distal 1/3 and its pattern was mostly comminuted one. According to Gustilo-Anderson classification, it mainly consisted of type IIIa &IIIb(28 cases: 82%). Mean bony union time was 40.2 months. There were 5 cases(15%) of delayed union, 2 cases(6%) of nonunion, 5 cases(15%) of deep infection including 3 cases(9%) of osteomyelitis, 10 cases(29%) of pin tract infection, 4 cases(12%) of malunion and 11 cases(32%) of ankle stiffness.
CONCLUSION
Conclusively, in the first place, for the successful treatment with Ilizarov external fixator, determining appropriate indications is the most important. Secondly, active reconstruction of soft tissue environment and early prophylactic bone graft, if necessary, are also essential to shorten union time. Thirdly, meticulous care of pin site and ankle motion is needed for the prevention of the two most common complications even though they are considered to be minor.

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Treatment of comminuted supracondylar fractures of the femur using Ilizarov method: Myung Chul Yoo, Yoon Je Cho, Ki Tack Kim, Young Soo Chun, Na Sil Pyo, Sung Gun Kim; J Korean Soc Fract 1999;12(3):529-537. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.529

Abstract PDF: PURPOSE
To evaluate the effectiveness of the Ilizarov method as a treatment of open or comminuted supracondylar fractures which are uncommon, and difficult to manage because of the wide range of potential complications.
MATERIALS and METHODS
Between 1992 and 1999, we treated open or comminuted supracondylar fractures of the femur by Ilizarov method in whole period or conversion to OR/IF with or without bone graft after transient Ilizarov fixation. There were 13 cases in 11 patients. Open comminuted fractures were seven cases and closed comminuted fracutres were six cases. We compared Ilizarov method in all procedures and temporary mode followed by internal fixation for definite care.
RESULTS
According to Schatzker and Lamberts assessment the results were good or excellent in ten cases(77%). And the results were rated as good or excellent in 67% of case of Ilizarov method in all procedures, and 86% of cases changed to OR/IF.
CONCLUSION
Ilizarov technique is an useful method in cases of open and/or comminuted supracondylar fractures of the femur. And after initial stabilization of fracture, conversion to OR/IF is advisable to prevent pin site infection and allow ROM excercise of the knee joint.

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Treatment of Tibial Fractures with the Ilizarov External Fixator: Suk Myun Ko, Myung Ku Kim, Jung Yoon Lee, In Suk Oh, Sang Eun Kim; J Korean Soc Fract 1998;11(4):833-840. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.833

Abstract PDF: Between June 1996 and July 1997, 29 tibial fracture patients were treated using the Ilizarov method and apparatus. The mean follow-up petiod was 18 months. Among 29 cases, 11 were closed fractures with comminution and 18 were open fractures. There were 2 Gustilo-Anderson type I, 5 type II, and 11 type III open tibial fractures. Complications included 4 pin tract average time from application of the device to complete fracture healing was 26.3 weeks. According to Tucker's functional criteria, the results were 14 excellent, 9 good, 4 fair, 2 poor. No practical contraindications to the use of the Ilizarov device in the management of tibial fractures were encountered. We concluded that Ilizarov method is indeed a useful adjunct for the treatment of either open or closed tibial fractures.

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Treatment of Open Fractures of the Tibial Shaft by Sequential Compression technique in Ilizarov device: Suk Ku Han, In Ju Lee, Nam Yong Choi, Sung Jin Park, Gyeol Yoo, Hyo Seng Ahn; J Korean Soc Fract 1998;11(4):817-824. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.817

Abstract PDF: External skeletal fixation is used widely in the management of open or closed tibial fractures, but delayed healing is common. There is concern that this might be due not only due to the severity of injury but also to the mechanical conditions imposed at the fracture site by the fixator. Since fractures treated by external skeletal fixation can rarely be reduced to perception nor held with absolute stability, union occurs by indirect healing, which is acutely sensitive to both the charactericstics and timing of mechanical stimulation. So, the achivevment of the optimum mechanical environment is particularly important where delay in bone healing is likely. Ilizarov external fixator is useful in treating open fractures of the tibial shaft because it permits axial micromotion which enhances bridging callus formation with stable fixation as well as its complications such as infected nonunion or limb length discrepancy. The impared healing with external fixation is often caused by wrong surgical technique, such as distraction of fracture fragments by fixation device. Sequential compression at fracture site may overcome any fracture gap in external skeletal fixation and also enhance endosteal bone formation. We applied sequential compression forces at the fracture site in 18 open fractures of the tibial shaft, trated by Ilizarov external fixator with or without autogenous bone grafting. Sequential compression technique is composed of initial compression with 1 mm/wk for 4 weeks and then compression 1 mm/10 days until adequate apposition of cortex and callus formation in radiograph. We acquired successful bony union in all cases except one which had additional bone grafting in open fractures of the tibial shaft by sequential compression technique using Ilizarov device.

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Treatment of Pilon Fracture, limited ORIF with External Fixation by Ilizarov Method: Bu Hwan Kim, Jong In Im, Yong Kyun Yim, Deog Jeong Kang, Uk Nam; J Korean Soc Fract 1998;11(4):798-805. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.798

Abstract PDF: The authors retrospectively reviewed 22 pilon fractures in 22 patients treated with limited ORIF with external fixation by Ilizarov method. Clinical follow up averaged 28 months (range, 16-45 months). Interfragmental screw fixation of key fragments were done in fifteen cases and bone-grafting was done in thirteen cases. The average duration of external fixation was fourteen weeks. All of the fractures healed (one after delayed bone-grafting). The subjective and objective results were classified according to Ovadia and Beals. Sixteen patients (72%) had good and excellent results at final follow up. On the basis of these early results, the prevalence of complications asociated with pilon fractures and their treatments can be decreased by external fixation of Ilizarov method and limited internal fixation. We conclude that this method is good treatment modality on tibial pilon frature.

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Treatment of Intraarticular Calcaneal Fractures using Ilizarov Exteranl Fixation: Byeong Yeon Seong, Dong Seong Park, Seung Jun Park, Sang Wook Kim; J Korean Soc Fract 1998;11(3):591-596. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.591

Abstract PDF

Open reduction and internal fixation (ORIF) is gaining in popularity as method of choice for the treatment of displaced intraarticular calcaneal fracture since diagnosis and classification of computed tomography have become routine. But early weight-bearing cannot be allowed by convertional ORIF, and delayed weight-bearing may contributed to heel had pain and dystrophy. We performed combined technique of limited internal fixation and Ilizrov external fixation to ten-cases of displaced intraarticular calcaneal fractures, between February 1994 and February 1996. The follow-up period in this study was at least two years. This method can provide not only anatomical reduction, but also stable fixation. None of patients complained of heel pad pain, which was attributed to the desensitization of the heel by early weight-bearing. None of patients went on to late collapse of the posterior facet. clinical results were rated as excellent in six, good in three, and fair in one case. Pin-track infection, complicated operative technique, cumbersomeness and expensiveness of the external fixator itself were shortcomings of this method. We consider this method as one of options for the treatment of displaced intraarticular calcaneal fracture.

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A Comparison of Extensile Lateral Approach and Sinus Tarsi Approach for the Sanders Type II Calcaneal Fracture
Jeong-Seok Moon, Woo-Chun Lee
Journal of the Korean Fracture Society.2009; 22(1): 13. CrossRef

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Treatment of Unstable Open Tibial Fractures with Ilizarov System: Won Sik Choy, Kwang Won Lee, Ha Yong Kim, In Sung Hwang; J Korean Soc Fract 1998;11(3):567-575. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.567

Abstract PDF: The treatment of open comminuted tibial shaft fractures have a high incidence of complications and often result in poor outcomes. General principles of treatment are accepted throughout most surgeons, which include aggressive debricdement, antibiotics, early stabilization, early soft tissue coverage, and prophylactic bone graft. But, recently there is a controversy on the bony stabilization methods; one group of authors favors external fixator, and the other group favors unreamed interlocking intramedullary nail. In this paper, we carried out retrospective study of the 42 cases of open comminuted tibial shaft fractrues managed with Ilizarov external fixator (minimum follow up of one year(average: 2.8 years)). The purpose of this study is to evaluate the results of treatment with an Ilizarov method for the patients with open comminuted tibia fractures (open type III-A and more by Gustilo and Anderson classification and, type B and more by AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification). The results were as follows; 1. It has taken 7.4 months to achieve bony union with relatively delayed healing time for the diaphyseal fractures and fractures with higher energy injury on AO classification. 2. Forty eight additional operations were needed for 27 patients; 24 bone grafts for 19 atients, 1 case of bone marrow injection, 4 cases of corticotomy and bone transport, 4 cases of sequestrectomy, 3 cases of internal fixation with plate, 2 cases of IM nailings, and 2 cases of Ilizarov correction in operating room. 3. Following complications were resulted in; delayed union 14 cases, nonunion 1 case, superficial infection 2 cases, deep infection 8 cases, chronic osteomyelitis 3 cases, refracture 2 cases, knee stiffness 6 cases, ankle stiffness 5 cases, subtalar stiffness 8 cases, lateral angulation 4 cases, anteroposterior angulation 4 cases, and leg length discrepancy 5 cases. 4. Twenty patients, at the final follow-up, could walk without limping and live their life with no activity limitation. 5. At the final follow-up, 19 patients complained intermittent pain on fracture sites, knees or feet and ankles. We could conclude that the Ilizarov external fixator can be a stabilizer of choice for the open comminuted (Gustilo type III and more than AO type B) tibial shaft fractures of which fracture line extended over the proximal or distal metaphysis.

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The Treatment of Infected Nonunion of Femur after Open Reduction and Internal Fixation: Hee Soo kyung, Joo Chul Ihn, Byung Chul Park, Yong Goo Kim; J Korean Soc Fract 1998;11(3):540-545. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.540

Abstract PDF: Infected nonunion developed after open reduction and internal fixation is one of the serious complications among the treatments of fracture of long bone. It is very difficult to eliminate the infection, to correct the deformity and defect at the same time obtaining union. All six cases were male, the average of age was 34 years old from 21 to 49. Five cases were closed fracture and one was open fracture. For the primary internal implant, five cases were plate and one was intramedullary nail. About the 6 cases of infected nonunion of femur from June, 1994 to October, 1996, we performed the following procedure : after removal of internal fixation, extensive debridememt, complete sequestrectomy, firm fixation with Ilizarov external fixator, compression at fracture site and early autogenous cancellous bone graft. We obtained following results : 1. The average duration of infection was 7.8 months, average duration of bone union was 5.8 months. Average duration of follow-up was 17.5 months. 2. The average shortening of leg was 1.4cm. 3. According to classification of Paley and Catagni, the bone results were excellent in all cases, functional results were excellent in 4 cases and fair in 2 cases. 4. In conclusion, firm fixation with Ilizarov fixator, sequestrectomy, early autogenous cancellous bone graft and compression is one of the good treatment modalities of infected nonunion of the femur.

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Use of the Ilizarov Technique for Treatment of Infected Non-Union: Sung Taek Jung, eun Kyoo song, Bong suk Bae; J Korean Soc Fract 1998;11(2):398-404. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.398

Abstract PDF: We reviewed infected non-union of tibia and femur which had been treated by radical resection of the necrotic bone and Ilizarov method in thirty-nine patients. All patients had either one-segment or two segment lengthening of bone with a technique of bone transport. The size of the bone defect that was bridged averaged 5.7cm (range, 2 to 16cm). All cases attained bone union and the infection was eradicated in all pattints before the fixator was removed. The mean duration of external fixator was 14 months(range, 4-28months). The mean external fixation index was 1.6 months/cm and the mean distraction index was 23.2 days/cm. The functional results were exellent in 3 patients, good in 19, fair in 9, poor in 8. The bone results were excellent in 5 patients, good in 20, fair in 10, poor in 4. Complication were pin tract infection in 15 patients, equinus contracture of ankle in 2, knee flexion contracture in 1, transient sensory change in 1, axial deviation in 2, premature consolidation in 2, delayed union in 2, and leg length discrepancy in 2, and refracture in 1. In conclusion, the Ilizarov method is very effective for treatment of infected non-union with bone loss, limb shortening and soft tissue defect.

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Treatment of Infected Nonunion with Bone Defect with Ilizarov Lenthening apparatus: Joo Chul Ihn, Byung Chul Park, Il Hyung Park, Hee Soo Kyung, Chang Wug Oh, Jin Hum Cho; J Korean Soc Fract 1998;11(1):91-99. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.91

Abstract PDF: From June 1993 to May 1997, 12 patients aged from 13 to 41 years were treated for infected nonunion with bone defect by the Ilizarov technique. Of 12 cases, 9 cases were tibia and 3 cases were femur. The cuases of nonunion were open comminuted fractures with initial bone loss and bone defect after removal of sequestrum. Infection was managed by radical resection of the infected necrotic bone and insertion of antibiotics mixed cement beads. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length inequality was achieved by means of external lenghthening technique. Corticotomies were performed at the proximal level(7), at the distal level(5). The average optained length averaged 4.8cm in length and healing index averaged 67.4days/cm According to paley and Catagni's callification bony and functional results were either excellent or good execpt I case (nonunion, poor bony result). The complications (devided by paley to 3 categories: problems, obstacles, complications) were pin tract infecton(8), pain(5), mild flexion contracture of joint(1), delayed consolidation(3), soft tissue impingement(2), joint stiffness(3) and nonunion(1). We concluded that Ilizarov techinque was very effective for treatment of infected nonunion with bone defect and soft tissue defect.

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Treatment of Commiuted Fractures of the Proximal Tibia Using Ilizarov External Fixator: Jae Ik Lee, Myung Hwan Son, Jae Hong Park, Kang Hoon Kim; J Korean Soc Fract 1998;11(1):198-204. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.198

Abstract PDF: Twenty one comminuted fractures of the proximal tibia in 21 patients were treated with Ilizarov external fixator from May 1990 to May 1996 in Pusan City Medical Center. The average duration of external fixation was 17weeks, and all of the fractures healed without bone graft. The mean time to union was 18weeks in closed comminuted fractures, and 21 weeks in Gustilo type I, II open fractures. The complications with this technique were pin tract infection 3 cases, pin loosening 6 cases, septic arthritis 1 case, post-traumatic osteoathritis 1 case, and joint ankylosis 1 case. The average duration of follow up was 18 months. The range of knee motion of 19 cases of the the 21 patients was at least 115-degrees arc. Post-operative immediate exercise was possible, and partial weight bearing with crutch was also possible after post-operative 4 weeks. We concluded that Ilizarov external fixation is a satisfactory technique for the treatment of selected comminuted fractures of the proximal tibia.

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Treatment of Open Type-III Tibial Shaft Fractures -Comparison Between Ilizarov External Fixation and Secondary Intramedullary Nailing-: Hoon Kim, Woo Dong Nam, Ki Chan Ahn, Seung Seok Seo, Young Chang Kim, Jang Seok Choi, Young Goo Lee; J Korean Soc Fract 1998;11(1):191-197. Published online January 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.1.191

Abstract PDF: Open type III tibial shaft fractures have a high incidence of complication and a poor outcome. The most usual method of stabilization is by external fixation, but there are several complications as infection, delayed union and nonunion. We tried to compare the results of Ilizarov external fixation cases with the case of secondary intramedullary nailing after temporary Ilizarov fixation. There was no significant difference in the union time of Ilizarov external fixation and secondary intramedullary nailing after temporary Ilizarov fixation. But the patients were more comfortable in the secondary intramedullary nailing. In conclusions, secondary intramedullary nailing after temporary Ilizarov fixation is the useful method in the treatment of open type III tibial shaft fractures.

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Application & Use of an Ilizarov Technique for the Pilon Fracture: Jin Hong Ko, Beom Koo Lee, Do Hyun Moon, Sung We; J Korean Soc Fract 1997;10(4):879-885. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.879

Abstract PDF: A pilon fracture, which is defined as a comminuted intraarticular fracture of distal tibia, violates the articular region and the metaphysis with occasional extension into the diaphysis, and renders the bone difficult to restore to its anatomic shape. The best known treatment of the pilon fracture is, as recommended by A-O group. In the treatments of the fractures with severe comminution or with significant open soft tissue injury aggressive tries for internal fixation with plate and screws in the distal tibia will result in inevitable stripping of the soft tissue and the periosteum. Therefore, dangers of the delayed union, nonunion, soft tissue necrosis and infection will be increased. The authors treated 14 cases by the Ilizarov external fixation technique for treatment of pilon fracture of the tibia. The average duration of external fixation was thirteen weeks. The results were as follows. v1. Such techniques are especially useful in those injuries with extensive aricular communition and in the open pilon fracture with significant soft tissue compromise. 2. The average duration of external fixation was 13 weeks and the time to clinical union averaged 16.4 weeks. 3. In case of accurate reduction, the better clinical result was obtained.

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Treatment of Chronic Uncontrolled Infected Nonunion of Femur and Knee with the Ilizarov Instrument: 3 cases reports: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suck Ha Lee, Hyung Gon Jee; J Korean Soc Fract 1997;10(4):801-811. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.801

Abstract PDF: We analysed three cases, repectively. The first case was chronic uncontrolled infected nonunion of femur due to open type III fracture which had been operated unsuccessfully at least 5 times. The second case was a infected nonunion and shortening of leg due to infecton of soft tissue surgery and then after knee arthrodesis. The third case was result from the total knee arthroplasty failure and then after knee arthrodesis. Ilizarov instrument was applied to this case for the knee joint arthrodesis. All cases showed bony union after average 14.6 months. The exact bony lengthening in the two cases after treatment was 11cm and 13cm and the healing index was 49.Odays/cm and 50.8days/cm The complications included the pin tract infection in all three cases and pin breakage in 2 of the cases. We achieved bony lengthening and bony union with relief of infection in 3 cases of chronic uncontrolled infected nonunion of femur treated with extensive saucerizaton and fixation using the Ilizarov instrument. These are the results of our treatment of chroic uncontrolled infected nonunion of femur using the Ilizarov instrument.

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Management of Unstable Proximal Tibial Fractures Using the Ilizarov: Hong Gee Park, Beom Goo Lee, Soo Chan Lee, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Hyun Park; J Korean Soc Fract 1997;10(2):332-337. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.332

Abstract PDF: We reviewed fifteen cases of unstable tibial fractures treated with Ilizarov method from May 1995 to May 1996. We attained satisfactory bony union in all cases without bone graft(Average time 19 weeks). There were numbers of complications, such as pin tract infection, angular deformity and joint ankylosis but its were soluble and careful management & numbers of minor surgery were needed to prevent & solve such complications. Post-op immediate weight bearing and ROM exercise were possible and showed no difficulty in getting mainteance of reduction & fracture healing, and serious joint ankylosis waa not developed. In conclusions, Ilizarov method is an excellent treatment in getting reduction, maintenance of reduction, early ambulation and fracture healing in the cases of unstable tibia fractures.

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Treatment of Infected Nonunion of the Femur Using the Ilizarov Apparatus: Duck Yun Cho, Eun Sung Koh, Suk Cho Kong; J Korean Soc Fract 1996;9(4):899-906. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.899

Abstract PDF: Infected nonunion is serious complication in the long bone fractures and it is sometimes resulted in significant disability. From December 1990 to February 1994, we reviewed 11 cases who were treated for infected nonunion of the femur by using the Ilizarov apparatus at National Hedical Center, Active infection was controlled by radical resection of the infected necrotic bone and soft tissue and continuos irrigarion with antibiotics mixed saline for 3 weeks. After sequrstrectomy, bone deject was ranged from 2.5cm to 12.5cm(average, 7.2cm) in 11 cases. Preoperative leg length discrepancy(LLD) was ranged from 2.0cm to 8.Ocm(average, 3.9cm) in 7 of 11 cases. Bone defects were gradually treated by internal bone transport technique and solid bone union was achived by internal fixation and bone graft. The average of transporation was 8.9cm(range, 2.5-15.5cm). The average of healing index was 1.6menths/cm(range, 1.0-3.6months/cm). The percentage of increment was ranged from 5% to 32%(average, 19.6%). According to Paleys classification, bony results was poor in 11 cases and functional results was good in four, fair in three, poor in four. We concluded that the application of Illizarov technique to infected nonunion of the femur with large bone defect was useful method but internal fixation and bone graft was necessary for nonunion of doicking site.

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Ilizarov Method for Treatment of Large Bone Defect: Hae Ryong Song, Young June Park, Ji Yeon Kim; J Korean Soc Fract 1996;9(3):794-800. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.794

Abstract PDF: Twenty eight long bone defects were treated with internal bone transport using Ilizarov method. The causes of defect were open fracture (ten cases), infected non-union(nine cases), and osteomyelitis(nine cases). The mean bone defect was 8.5cm ranging from 2.5cm to 22cm in open fracture and 5.8cm ranging from 1.8cm to 17cm in an infected nonunion, and 7.2cm ranging from 3.4cm to 12cm in osteomyelitis. Internal bone transport was performed with transverse ring system. Free latissimus dorsi muscle flap was done in three cases and rotational muscle flap in seven cases. Single level lengthening was done in 26 cases and double level lengthening in two cases. Fibular transport was done in five cases. All cases obtained bone union. The radiologic consolidation index was 89 day/cm in tibia, 71d ay/cm in femer, and 42.5 day/cm in humerus. External fixation index was 96 day/cm in tibia, 86 day/cm in femur, and 48.5 day/cm in humerus. Complications were pin tract infection(25 cases), equinus contracture of ankle(7 cases), knee flexion contracture(4 cases), delayed union(11 cases), premature consolidation(2 cases) and refracture(1 case). Ilizarov method is a useful treatment for large bone defect inopen fracture and infected nonunion. To obtain better result, careful postoperative management and intensive physiotherapy are recommended.

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Treatment of Infected Nonunion of the Tibia Using the Ilizarov Apparatus: Duck Yun Cho, Eun Sung Koh, Suk Cho Kong; J Korean Soc Fract 1996;9(3):665-673. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.665

Abstract PDF: Infected nonunion of the tibia was most serious complication in the tibial fracture and it have had many obstacles in treatment. Various treatment methods for infected nonunion have been performed to achieve bony union and restore bony defects after sequestrectomy. From Febrary 1991 to June 1993, the authors reviewed 12 cases who were treated for infected nonunion of the tibia with bone defect by the Ilizarov technique at National Medical Center to achieve union. to correct deformity, to eradicate infection, to reestablish limb length, and to eliminate bone defect. These infected nonunions were treated by on bloc resection of the diaphyseal shaft and internal bone transport. Final equalization of leg length inequality was achieved by external lengthening technique. Preoperative shortening was present in 1 of 12 cases and ranged from 1cm to 4cm (average,2.0cm). Bone defects size was ranged from 2cm to 7cm(average 4.5cm). Tibial corticotomies were performed at the proximal level in 8 cases and at the distal level in 4 cases. Regnerated new bone was ranged from fun to 9cm(average, 5.8cm). The average healing index was 2.54 months/cm. At an average 18 months follow up, according to Paley and Catagnis classification, bony results were excellent in five, good in six, poor in one and functional result were excellent in one, good in five, fair in five. poor in one. We concluded that the application of Ilizarov technique to resistant infected nonunion of the tibia with bone defect was very encouraging and useful method.

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Management of open Supracondylar Fractures of Femur using the Ilizarov Method: Bum Ku Lee, Do Hyun Moon, Jin Hong Ko, Soo Chan Lee, Ki Dong Kang, Jong Seob Park; J Korean Soc Fract 1996;9(3):567-573. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.567

Abstract PDF: It is extremely difficult to treat to the comminuted open fractures of supracondyle of femur Internal fixation with plates and screw or intramedullary nailing of open fracture is high risk of infection and circulatory compromising at the fracture site. External fixation reduces the risk of infection and permits easy access for wound care, early mobilizatioll of joints and weight bearing. We reviewed nine cases of open supracondylar fractures of femur treated with Ilizarov method from February 1993 to December 1995 and obtained the following results. 1. The average time of bony union was 2 weeks. According to AO classification, the average time of bony union was 22.7 weeks in type A and 29.3 weeks in type C. According to classification of Gustilo and Anderson, the average time of bony union was 21 weeks in type II,27.3 weeks in type Illa and 30 weeks in type IIIb. 2. The Neers criteria was based on the final functional and anatomical rating for supracondylar fracture of femur. According to this criteria, excellent was 1 case, satisfactory in 7 cases and unsatisfactory in 1 case. 3. The complications were divided into problem, obstacle and complication;Problem in 9 cases, bstacle in 5 cases and complication in 3 cases. We conculded the Ilizarov technique is a useful method in management of the severe comminuted fractures and extensive soft tissue injury of the supracondylar fractures of femur.

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Treatment of Nonunion of the Tibia Fracture: Dong Heon Kim, Kyu Cheol Shin, Hee Cheol Park, Ju Yong Shin; J Korean Soc Fract 1996;9(1):112-118. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.112

Abstract PDF: Nonunion after tibia fracture is a relatively common problem. The cases of nonunion have been known open and comunited fracture, extensive soft tissue injury, interposition of the soft tissue, distarbance of the blood supply and inadequate fixation. A number of methods stimulating union have born described. These include fibular osteotomy followed by weight-bearing in a cast, autogenous boone graft with or without additional stabilization, internal or external fixation with compression, open or closed IM nailing and even electromagetic stimulation. In this paper we carried out retrospective study of the 24 nonunion of the tibia fracture which were treated at the Department of Orthopeadic Surgery, Kon-Kuk University Hospital from March 1990 to March 1995. The results were as follows: 1. Among 24 cases of monunions, 16cases(66.6%) were communited fractures and 18cases(75%) were open fractures. 2. Hypervascular nonunion were 12cases and avascular nonunion were 12cases. Previous methods of treatinent were conservative treatment in 6cases of closed fracture and were treated with Ender nailing, multiple K-wire fixation, Ilizarolr external fixation, monofixator external fixation in 1 Bcases of open fractures. 3. The average duration from injury to dignosis of nonunion was 7 months tweets.(Range 5 months to 24months) 4. Tibial nonunion were treated with plate and screw with bone graft(Bcases), Interlocking IM nail ing(14cases), and nizarov external fixation with bone graft(teases). 5. The average time of union was 23weeks in all patients: 24 weeks in the case of plate and screw with bone graft. 20 weeks in the case of interlocking IM nailing. 28 weeks in the case Ilizarov external fixation with bone graft. 6. The main complications were joint stiffness due to long-term cast irnrnobiliBation in the case of plate and screw with bone graft, LROM of joint contracture and external pin site in the case of Ilizarov external fixation with bone graft, deep infection Icase and knee joint pain teases due to proximal nail protrusion in the case of Interlocking IM nailing.

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Treatment of Neglected Fracture-Dislocation of the Ankle Using llizarov Device: A case report: Hong Jun Han, Dong Churl Kim, Seong Ho Lee; J Korean Soc Fract 1995;8(3):615-619. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.615

Abstract PDF: There was a close correlation between the final clinical result and the quality of reduction of the fracture fragments. Fracture-dislocations of the ankle are relatively rare and unstable injuries in which anatomical reduction and difficult by closed method. More recently, anatomical reduction, secure internal fixation and early motion have been advocated as principle of treatment for a success ful clinical outcome in fracture-dislocation of the ankle. We reviewed the result of a case of the neglected ankle fracture-dislocation that have been reduced anatomically by closed method using a Ilizarov device. Clinical and radiographic results of the technique were satisfactory after length of follow-up thirty-eight months.

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Ilizarov External Fixation for the Complications of Supracondylar Fracture of Femur: Report of two cases: Eun Kyo Song, Go Hun Chung, Keun Bae Lee; J Korean Soc Fract 1995;8(3):528-532. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.528

Abstract PDF: Two patients of nonunion of supracondylar fracture of femur with bone loss and angular deformity were treated by the Ilizarov external fixator. Large bone defect was closed by bone transport technique and angular deformity was corrected by means of hinges on the Ilizarov apparatus. The final results were satisfactory in two cases.

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The Treatment of Tibial Infected Nonunion by the Ilizarov Method: Chang Yeul Yang, Kyung Soo Choi, Young Ki Lee; J Korean Soc Fract 1995;8(2):361-369. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.361

Abstract PDF: The goal of treatment in infected nonunion include the elimination of infection, complete bony union and prevention of bony defects and deformity. Twenty patients with infected nonunion were treated using ilizarov external fixator from January 1992 to August 1993. The results were summarized as follows, 1. The main causes of infection were mixed infection in all cases and main causative agents were pseudomonas and staphylococcus. 2. Ninteen cases of infected nonunion were achieved bony union and one case was failed. The mean time to union was 10.6 months. The healing index averaged 51.3 days. 3. The bone results were excellent in sixteen cases, good in three and poor in one. The functional results were excellent in seven cases, good in eight and fair in five. 4. We experienced 35 complications, five were joint ankylosis. one was nonunion and we could solve the rest of complications with conservative treatment and minor surgery. 5. There were no problems in getting the bony union at bony distraction site in all cases. But, there were numbers of problem at the docking site such as autogenous bone graft, nonunion. So, it is important to wide resection of infected necrotic tissue and early bone graft. 6. We could solve the poor soft tissue problem with acute shortening method of bone.

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The Treatment of Infected Nonunions of the Tibia by the Methods of Ilizarov: Chil Soo Kwon, Yong Uck Kim, Byung Hyun Jung, Kyung Seog Shin; J Korean Soc Fract 1995;8(2):347-353. Published online April 30, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.2.347

Abstract PDF

Chronic infection of the shaft of tibia is one of the most perplexing dilemmas in orthopedic surgery. Difficult or resistant infection usually require more radical debridement of the septic bone and soft tissue in addition to application of stable fixation to enhance soft-tissue healing and bony union. The application of Ilizarov is possible to correct deformities, regenerate new bone tissue without the use of bone grafts, progressirely lengthen the extremity and allow weight bearing during the treatment period. Application of Ilizarov were preformed on eigtheen patients with infected nonunion of tibia between November 1989 February 1993. The result were as follows; 1. There were 16 males and 2 females with an average age of 39 years. 2. Fifteen of 18 patients had infected tibial nonunion associated with bone loss. 3. Two of 15 patients had infected nonunions associated with hemicircumferential bone loss. These tibiae were treated by hemicircumferential corticotomy and partial bone transport. 4. Twelve of 15 patients had an average 6.6cm of segmental bone loss. These were treated by coitictomy and internal bone transport. 5. The mean duration of treatment was 10.3 months. 6. The application of Ilizarov technique to diaphyseal infected nonunion and segmental defect is very encouraging. It may prove to be an excellent technique for further management of resisitant diaphyseal infection of bone.

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Bone Transport Over the Intramedullary Nail for Defects of Long Bone
Jae-Young Roh, Chang-Wug Oh, Jong-Keon Oh, Hee-Soo Kyung, Byung-Chul Park, Woo-Kie Min, Joon-Woo Kim, Chang-Hyun Cho
Journal of the Korean Fracture Society.2008; 21(1): 37. CrossRef

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The IliBarov Technique in the Treatment of Nonunions of Long Bone: Hong Jun Han, Dae Moo Shim, Sang Hoon Cha; J Korean Soc Fract 1995;8(1):254-261. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.254

Abstract PDF: Orthopaedic surgeons have employed many different techniques for the management of nonunion of long bone. But, nonunion of long bone continued to challenge ouhopaedic surgeons. We used llizarov apparatus for the chronic infected nonunions or nonunions with large bone defect to achieve union, to correct deformity, to eradicate infection and to eliminate bone defect. Twenty-eight patients were treated for nonunions of long bone with llizarov apparatus by the same surgeon between 1990 March and 1992 August. Followings are the summary of the results. 1. 21 patients achieved solid bony union. The average duration of application of apparatus was 10.12 months. 2. 8 patients with less than 2cm shortening were treated by monofocal compression osteosynthesis, with an average healing time of 6.3 months. None of these 8 cases had infection. 3. 14 patients with infection and less than 2cm bone defect were also treated by monofocal compression osteosynthesis, with an average healing time of 8.7 months. 4. 6 patients with more than 2cm shortening or bone defect were treated by bone lengthening or bone transport. The average length gain was 5.6cm. 5. We have not any significant complications with llizarov method. The most common complication was a superficial pin tract infection in 12 patients(43%). 6. If the bony defect was not large, it was thought to be better to change B, or B, type nonunion to B, type to improve bony contact and healing. We find ourselves capable of solving increasingly more difficult problems with a level of sucess rarely, if ever, achieved with other conventional method.

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Extensively Comminuted Type III Open Fracture of Tibial Shaft: 4 Case Treated by Ilizarov External Fixator: Ju Hai Chang; J Korean Soc Fract 1994;7(2):480-489. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.480

Abstract PDF: It is extremely difficult to treat to the type III open fractures of the tibial shaft which have been severely comminuted and splitted in the long length. Early internal fixation with plates and screws or intramedullary nailing of type III open fracture is contraindicated because of high infection rate and circulatory compromising at the fracture site. External fixation is the method of choice for the treatment of type III open fracture of the tibia. It reduces the risk of infection and permits easy access for wound care, early mobilization of joints and weight bearing. Four type III open fractures of the tibial shaft that were very unstable had entered this hospital from November 1990 to June 1992. The patients were all young males. The causes of injury were one explosion and three motor vehicle accidents. The open fractures were three type III A and one type III B according to Gustilos classification. These fractures were stabilized with Ilizarov external fixator. Parenteral antibiotic therapy was started from the emergency room to prevent infection. Illzarov fixator was applied 17 to 63 days(av. 37 days) after injury and maintained for 6 to 12 months(av. 8 months). Subsequent autogenous bone grafting and internal fixation were done in three patients 7 to 8 months after external fixation because of delayed union. Follow-up period ranged from 1 year and 11 months to 2 years and 6 months(av. 2 years and 2 months). Solid union was obtained in all patients between 1 year 1 month and 1 year and 7 months(av, 1 year and 3 months) without active osteomyelitis. At last follow-up, there were mild limitation of ankle joint motion in all patients and tibial shortening of 18 to 34mm(av. 25 mm)on the roentgenograms of three patients. No significant working disability or malalignment of the leg was noted in all patients. The final results were very good compared to the severity of their injuries.

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The Treatment in Infected Nonunion of Distal Femoral Fracture: Report of two cases: Jong Oh Kim, Yon Sik Yoo, Suk Ha Lee, Sung Jong Lee, Taek Sun Kim, Jae Ik Sim; J Korean Soc Fract 1994;7(1):161-166. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.161

Abstract PDF: It is reported that infected pathological fracture of distal femur has a difficulty in treatment The difficulties lie in; choosing a internal fixator, adequate sequestrectomy of infected lesion, limb shortening, long duration of immobilizatlon. We uses the external fixator in treatment of distal femoral fracture because it needs less devices in fracture site than the internal fixator, and it could get a rigid fixation. we uses the Ilizarov apparatus. The merits of Ilizarov are, early weight bearing; limb lengthening and easy compression and distraction. The one case in which limb length discrepancy is occured, is peformed by limb lengthening. In this study, we are going to argue about the two cases, of infected non-unlon of distal femoral fixation comparing with one another.

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The Treatment of Infected Large Defect of the Long Bone - Allograft Transplantation and Ilizarov Technique: Duck Yun Cho, Sung Bum Yang, Kwang Chang; J Korean Soc Fract 1992;5(2):400-409. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.400

Abstract PDF: Infected large defect of the long bone have had many obstacles in treatment. It is usually very difficult to obtain union and to correct coexisting infection, deformity, & leg length discrepancy, Allograft transplantation have been traditionally used to treat infected large defect of the long bone. And Ilizarov technique has recently gained popularity as a multifactorial approach to the management of infected large defect of the long bone. We performed allograft transplantation in 5 cases and Ilizarov technique in 6 cases with infected large defect of the long bone at National Medical Center from 1987 through 1991. The results were as follows; 1. In the cases of allograft transplantaton, the average size of the bone defect was 9.6cm (range from 6cm to 3cm) and the average length of leg length discrepancy was 2.4cm (range from 0cm to 4cm). 2. In the six cases of Ilizarov technique, the average size of the bone defect was 2.5cm(range from 0.5cm to 4.5cm) and the average length of leg length discrepancy was 3.7cm(range from 0cm to 7cm). 3. In the cases of allograft transplantation, the bone union was achieved in two cases. Two cases have been followed up for 19 and 26 months each and they showed complete bone union in the proximal side of host-graft junction, but not complete union in the distal side. In one case, developed the osteolysis of the grafted bone due to the infection. After operation, the average length of leg length discrepancy was 1.4cm(range from 0 cm to 2cm). 4. In the cases of Ilizarov technique, bone union was achieved in three cases. One case have been followed up for 15 menths and showed incomplete bone union. In two cases, additional operation was performed due to the nonunion and the fracture between the junction of the proximal bone fragment and the transportated bone fragment in each. So we report our results of diferent two methods of treatment even if limited cases and experiences.

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Application of the Ilizarow technique to the complications of tibial open fracture report of two cases: Eun Kyoo Song, Ju Chull Jeung, Sung Man Rowe, Hyung Soon Kim; J Korean Soc Fract 1991;4(2):332-339. Published online November 30, 1991; DOI: https://doi.org/10.12671/jksf.1991.4.2.332

Abstract PDF: No abstract available.

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