Functional outcome following treatment of segmental skeletal defects of the forearm bones by Ilizarov application

Abstract

Managing a segmental skeletal defect is a challenge, even more so if the combination of local infection with bone defect exacerbates the problem and provides an even more negative prognosis. Several techniques have been tried, among which skeletal allografts, autologous cortical or cancellous bone graft and vascularised bone graft, each with its limitation and success. In this study, we report our results with the Ilizarov method of bone transport to overcome bone defects of forearm bones due to infection. This series included 16 patients with bone defects of forearm bones, following either debridement of osteomylitis or infected nonunion. The mean time from injury to the Ilizarov procedure was 11.7 months. The mean number of operative procedures before application of the Ilizarov device was 3.4. The mean length of the defects after debridement was 6.4 cm. Monofocal osteotomy was performed. The mean external fixation index, distraction index and maturation index were 41.5 days/cm, 19.8 days/ cm, and 21.7 days/cm respectively. The mean time in the frame was 8.9 months. The mean total duration of treatment was 11.4 months. There were 14 complications in 11 patients including pin-track infection, premature consolidation, delayed union at the docking site and refracture. Ilizarov's technique of bone transport is an ideal solution for a large skeletal defect in spite of the high incidence of associated complications.