Limb reconstruction with the Ilizarov method

In chapter 1, the background and origins of this study are explained. The aims of the study are defined. In chapter 2, an analysis of the complications rate of limb reconstruction in a cohort of 37 consecutive growing children was done. Several patient and deformity factors were investigated by logistic regression in a polytomous ordinal regression model. The only independent statistical factor influencing the complication rate was the initial relative limb length discrepancy. A simple graph was constructed, allowing comparison of the results with other reconstruction units. In chapter 3, the lower limb reconstruction of a cohort of 30 growing children, followed up for at least 2 years, and still growing, has been analyzed. The analysis is focused on the reaction of the paediatric limb to the trauma of lengthening. 15 patients showed increased growth rates in the operated limb compared to the pre-operative growth rate. This was statistically related to large frames including the femur and tibia with joint distraction. In chapter 4 the results of an experiment are described. The documented increased growth rate after paediatric lengthening was further investigated in an animal experiment. The concept is that the application of a femur external fixator and joint distraction could have a stimulative effect on the growth plate of the proximal tibia during tibial lengthening. The application of a femoral Ilizarov frame during tibial lengthening stimulates tibial growth significantly after the lengthening. Joint distraction has an insignificant minor additional effect to the application of a femoral frame in all animals. Chapter 5 describes the scintigraphic reaction in the growth plates during and after the experiment as described in chapter 4. It was thought that the scintigraphic activity of the growth plates would reflect the biological activity during and after lengthening procedures. Unfortunately, no relation between growth rate and scintigraphic activity of the growth plates could be shown. Several possibly explanations are discussed, but no definitive cause for the findings could be found. In chapter 6, the lower limb reconstruction of 52 patients with post-traumatic deformities was analyzed. The treatment failed in only 3 patients. As described in chapter 2, the analysis showed that the relative limb length discrepancy was the sole factor influencing the complication rate. Again a graph was constructed, showing the relation between complication risk and relative limb length discrepancy/bone loss. This profile shows that the 50% risk threshold for 1 or more complications is 8% limb length discrepancy, for 2 or more complications it is 16%, for 3 or more complications 31%. In chapter 7, arthrodesis of the knee after failed arthrodesis for infected knee arthroplasty was analyzed. The concepts of Ilizarov’s method were well illustrated with the union of 14 out of 15 patients and total resolution of the infection in all 15 patients. The success rate of union and infection control has not been reported before. In chapter 8, the findings of all investigations are discussed and put in a context for daily practice.