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1. NON UNIONS FOLLOWING PATHOLOGICAL FRACTURES
IN CHRONIC HAEMATOGENOUS OSTEOMYELITIS IN
CHILDREN-A COMPREHENSIVE APPROACH BY ILIZAROV
METHOD
Dr. C. Vinay Kumar
Presenter- Post graduate
Dr. N. Srinivas Reddy
Associate Professor
Dr. M. Nagendra Babu, HOD
Prathima Institute of Medical Sciences,
Karimnagar.

2. HAEMATOGENOUS OSTEOMYELITIS
• Primary osteomyelitis – nonunions – rare condition*
• Treatment – different and difficulty.
*

3. WHY DIFFERENT / WHY DIFFICULTY
• Associated with infection – large cavities / sequestrum.
• Limb length discrepancy.*
• Deformities
• Adjacent joint / soft tissue contractures.
*

4. EVALUATION
• Clinical examination
• X-Ray
• Haematological
• MRI / CT
• Physeal damage assessment
• Pus for C/S
• Fitness for anaesthesia / surgery

5. PATIENTS & METHODS
Retrospective clinical study 2006-2018
• Mean age- 5.06 years
– min 1½ year
– max 11 years
• Mean age of nonunion- 3 years
• Limb length discrepancy -3 patients
• Wound exploration – 7 patients but
active infection – 4 patients
• Bone transport – 1 patient
• Free fibular graft + cancellous bone
graft(CBG) – 3 patients,
• CBG – 2 – Iliac crest , 1 – upper tibia
• Average number of surgeries
(Primary) 1.75 / patient.
4 4
0
1
2
3
4
5
MALE FEMALE
NO. PATIENTS
3 3
2
0
0.5
1
1.5
2
2.5
3
3.5
Femur Radius Tibia
BONE SEGMENT

6. TREATMENT
Surgical treatment – Ilizarov fixation
Counseling
Infection control Osteosynthesis Deformity
correction
Limb length
discrepancy
Late reconstruction
Basic function restoration Total function restoration
Priority
of
treatment
PRIORITIZATION OF TREATMENT

7. ILIZAROV APPLICATION
• Single / two stage procedure
• Wound exploration /
debridement
• Mounting the fixator
• Deformity correction
• Corticotomy
• Bone grafting
• Antibiotic protocol.

8. POST OPERATIVE PHASE
• Intensive physiotherapy
• Fixator education- compression / distraction protocol
• Pin tract care / infections
• Bone transport
• Regular followup

9. LONG TERM FOLLOWUP
AND TREATMENT
• Progression of the
deformity
• Limb length discrepancy.
• Deformity correction and
bone transport.

10. COMPLICATIONS & OUTCOME
• Pin tract infection
• Failed osteosynthesis
• Flareup of infection
• Malunion
• Limitation of forearm rotation
Despite complications osteosynthesis
obtained in all the cases.

11. CASE – 1

13. CASE – 2

15. CASE – 3

16. CASE 3

17. CASE – 4

18. CASE – 5

20. DISCUSSION
• Nonunions – treated at the
earliest.
• Counseling of the patient /
parents. Explanation of the
clinical situation / treatment
methodology /duration of
treatment / inherent
complications/ multiple surgeries.
• Long term followup.
• Late treatment - progressive limb
length discrepancy / angular
deformities.
• Nutritional status.
• Socio-economic aspects of the
family.
• Psychological status of the child.

21. CONCLUSION
• Ilizarov method is very reliable and effective in
these difficult clinical situations, not only because
of its efficacy in osteosynthesis but also because
of its comprehensive approach to address the
associated conditions.

22. REFERENCES
• Tachdjian’s paediatric orthopaedics, 5th Edition
• S Robert Rozbruch & Svetlana ilizarov, Limb
lengthening and reconstruction surgery, 2007
• Vladimir golyakhobsky, Text book of Ilizarov
Surgical techniques-bone correction &
lengthening
• Dror paley, Principles of deformaty correction
• Dianchi maiocci A, Aronson J, Operative principles
of Ilizarov fracture treatment, non union
osteomyelitis. Baltimore, Williams and wilkins,
1991.

23. CONFLICT OF INTEREST
• Informed consent taken from the patient
for inclusion in the study
• Ethical principles of research followed

24. MASTER CHART
Serial
no.
Na
me
Age
Gen
der
Age of
nonunion
Segment
involved
Limb length
discrepancy.
Deformity
No.Of
surgeries
Wound
debridement
Bone
transport
Bone
grafting
Fixator
time in
days
Result Comments
1 Xxx 5 yrs M 4 years Tibia 7cm. Tibia vara 2 Not done
Done. Distal
tibial.
Not
done
218
Union+/bone
transport+
Varus+
2 Xxx 6 yrs M 6 months Femur 3cm. Nil 1 Done Not done
Not
done
222 Union failed
Ilizarov redone
united
3 Xxx
11
yrs
F 8 years Tibia Nil
Procurvatu
m tibia
1 Not done Nil
Not
done
268
Union+/defor
mity
Satisfied
patient.
4 Xxx 3 yrs M 2 years Femur Nil Nil 1 Done Not done
Not
done
192 Successful LLD persisted
5 Xxx 4 yrs M 3 years Radius Nil
Manus
valgus
2 Done. No inf. Not done Fg+cbg 177
Union +
deformity-
Min. Stiffness
6 Xxx 6 yrs F 3 years Radius Nil
Manus
valgus
2 Done.No inf. Not done Fg+cbg 224
Union+
defomity-
Stiffness min.
7 Xxx
1½
yrs
F 6 months Radius Nil
Manus
valgus
2 Done.No inf. Not done Fg+cbg 118
Union+
deformity-
Lost for
followup
8 Xxx 4 yrs F 3 years Femur Nil Deformity+ 3
Done.
Infection+
Not done
Not
done
168 Successful
Deformity
persisted.
• LLD-Limb Length Discrepancy
• FG- Fibular Graft
•CBG- Cancellous Bone Graft