Ilizarov technique for treatment of distal radius deformity and bone defect after trauma_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 LI Meng ^1,2 , LIU Rui ¹ , GAO Jie ¹ , LAN Xu ¹ , WANG Zhenjun ³ , GAO Qiuming ¹ , ZENG Ping ¹

1. Department of Orthopaedic Trauma, Lanzhou General Hospital of Lanzhou Military District, Lanzhou Gansu, 730050, P.R.China;
2. Department of Trauma Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou Guangdong, 510000, P.R.China;
3. Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China;

Corresponding?author：

LI Meng, Email: lilionli@126.com

Keywords：

Distal radius fracture; deformity; bone defect; Ilizarov external fixatoin

DOI：

10.7507/1002-1892.201804088

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ObjectiveTo investigate the effectiveness on the distal radius deformity and bone defect after trauma by using Ilizarov external fixator.MethodsThe clinical data of 9 patients of post-traumatic distal radius deformity with bone defect treated by Ilizarov technique between January 2012 and December 2016 were retrospectively analyzed. There were 7 males and 2 females with an average age of 25.6 years (range, 11-46 years). Of the 9 cases, 4 were radial baseball hand deformity with large bone defect, 4 were short deformity of distal radius, 1 was distal radius deformity with radial deflection and pronation deformity, all with distal dislocation of the distant radial-ulnar joint. The time from injury to operation was 6 months to 6.2 years (mean, 1.5 years). The bone defect was 1.4-6.8 cm (mean, 3.6 cm). After complete debridement, the forearm was fixed with Ilizarov external fixator. At 7 days after operation, bone transport or bone lengthening was performed at the rate of 0.8-1 mm/d, 4 times a day, the deformity was slowly corrected and the bone defect was repaired. According to the loss of palmar tilt angle and ulnar tilt angle measured before operation, the position of distal radial articular surface was gradually adjusted in the course of moving or prolonging, so as to restore palmar tilt angle and ulnar tilt angle as far as possible.ResultsAll wounds healed by first intention and no leakage or rupture occurred. All the 9 patients were followed up 15-36 months (mean, 23 months). All the radius defects healed and the distal deformity was corrected, the healing time was 92.4-138.6 days (mean, 104.7 days); the external fixation index was 32.6-51.1 days/cm (mean, 40.2 days/cm). After 2 months of external fixator removal, the wrist joint flexion was (42.6±3.1)°, the wrist dorsum extension was (48.5±4.7)°, the palm inclination angle was (11.5±1.3)°, and the ulnar deviation angle was (21.2±3.7)°; the elbow flexion was (128.2±6.4)°, the elbow extension was (3.2±2.1)°, the forearm pronation was (71.5±4.3)°, and the forearm rotation was (38.2±6.5)°; the wrist and elbow joint extension and forearm rotation were significantly improved when compared with preoperative values (P<0.05). At last follow-up, wrist function was assessed according to Gartland-Werley standard, the results were excellent in 3 cases, good in 5 cases, and fair in 1 case. Four cases had pinhole infection, and were cured after anti inflammatory dressing change or replacement of needles; 3 cases did not heal at the bone junction, and were healed after bone grafting; 4 cases deviated from the radial force line, and the deformity was corrected after adjusting the needle.ConclusionIlizarov technique can correct deformity and reconstruct bone defect of the post-traumatic distal radius simultaneously, so it is a good method to treat this kind of disease.

Citation： LI Meng, LIU Rui, GAO Jie, LAN Xu, WANG Zhenjun, GAO Qiuming, ZENG Ping. Ilizarov technique for treatment of distal radius deformity and bone defect after trauma. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1275-1280. doi: 10.7507/1002-1892.201804088 Copy

1.	Jupiter JB, Fernandez DL. Complicatons following distal radial fractures. J Bone Joint Surg (Am), 2001, 83(8): 1244-1265.
2.	Mahmoud M, El Shafie S, Kamal M. Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting. J Bone Joint Surg (Br), 2012, 94(8): 1090-1096.
3.	Marti RK, van Heerwaarden RJ. 創傷后畸形截骨治療. 羅從風, 阮志勇, 譯. 濟南: 山東科學技術出版社, 2010: 157-191.
4.	Zalavras CG, Femino D, Triche R, et al. Reconstruction of large skeletal defects due to osteomyelitis with the vascularized fibular graft in children. J Bone Joint Surg (Am), 2007, 89(10): 2233-2240.
5.	Hosny GA, Kandel WA. Treatment of posttraumatic radial club hand with distraction lengthening. Ann Plast Surg, 2013, 71(5): 489-492.
6.	Page WT, Szabo RM. Distraction osteogenesis for correction of distal radius deformity after physeal arrest. J Hand Surg (Am), 2009, 34(4): 617-626.
7.	殷渠東, 孫振中, 顧三軍, 等. 骨搬運與骨短縮-延長治療脛骨骨缺損合并軟組織缺損的療效比較. 中國修復重建外科雜志, 2014, 28(7): 818-822.
8.	劉會仁, 王立新, 張艷茂, 等. 組織移植結合骨滑移治療小腿皮膚軟組織伴大段脛骨缺損. 中國修復重建外科雜志, 2013, 27(3): 295-298.
9.	Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am, 1951, 33-A(4): 895-907.
10.	Trumnle TE, Budoff JE, Cornwall R. 肩肘手外科學. 邵新中, 于亞東, 譯. 北京: 人民衛生出版社, 2009: 76-87.
11.	Harley BJ, Pereria ML, Werner FW, et al. Force variations in the distal radius and ulna: effect of ulnar variance and forearm motion. J Hand Surg (Am), 2015, 40(2): 211-216.
12.	于金河, 李增炎, 彭阿欽, 等. 橈骨短縮對橈腕關節影響的生物力學研究. 中國臨床解剖學雜志, 2005, 23(1): 103-105.
13.	Ring D, Prommersberger K, Jupiter JB. Posttraumatic radial club hand. J Surg Orthop Adv, 2004, 13(3): 161-165.
14.	McBeath R, Katolik LI, Shin EK. Ulnar shortening osteotomy for ulnar impaction syndrome. J Hand Surg (Am), 2013, 38(2): 379-381.
15.	Malki A, Wong-Chung J, Hariharan V. Centralization of ulna for infected nonunion of radius with extensive bone loss: a modified Hey-Groves procedure. Injury, 2000, 31(5): 345-349.
16.	Kasashima T, Minami A, Kutsumi K. Late fracture of vascularized fibular grafts. Microsurgery, 1998, 18(5): 337-343.
17.	Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg (Am), 1996, 78(2): 204-211.
18.	董長紅, 秦泗河, 彭愛民, 等. Ilizarov 肢體延長技術治療橈骨遠端損傷骨骺早閉短縮畸形. 中國矯形外科雜志, 2017, 25(4): 365-367.
19.	Sabharwal S. Treatment of traumatic radial clubhand deformity with bone loss using the Ilizarov apparatus. Clin Orthop Relat Res, 2004, (424): 143-148.
20.	Lee J, Oh SJ, Jung SW, et al. Ilizarov distraction and vascularized fibular osteocutaneous graft for postosteomyelitis skeletal deformity of the forearm. J Reconstr Microsurg, 2012, 28(9): 627-629.
21.	Zhang X, Duan L, Li Z, et al. Callus distraction for the treatment of acquired radial club-hand deformity after osteomyelitis. J Bone Joint Surg (Br), 2007, 89(11): 1515-1518.
22.	El-Mowafi H, Elalfi B, Wasfi K. Functional outcome following treatment of segmental skeletal defects of the forearm bones by Ilizarov application. Acta Orthop Belg, 2005, 71(2): 157-162.
23.	王富明, 陳鴻奮, 陳濱, 等. 牽拉成骨技術治療下肢大段骨缺損. 中華創傷骨科雜志, 2011, 13(6): 530-533.
24.	Ono CM, Albertson KS, Reinker KA, et al. Acquired radial clubhand deformity due to osteomyelitis. J Pediatr Orthop, 1995, 15(2): 161-168.
25.	秦泗河, 范存義, 張群. 外固定與上肢重建. 北京: 人民衛生出版社, 2016: 298-304.

1. Jupiter JB, Fernandez DL. Complicatons following distal radial fractures. J Bone Joint Surg (Am), 2001, 83(8): 1244-1265.
2. Mahmoud M, El Shafie S, Kamal M. Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting. J Bone Joint Surg (Br), 2012, 94(8): 1090-1096.
3. Marti RK, van Heerwaarden RJ. 創傷后畸形截骨治療. 羅從風, 阮志勇, 譯. 濟南: 山東科學技術出版社, 2010: 157-191.
4. Zalavras CG, Femino D, Triche R, et al. Reconstruction of large skeletal defects due to osteomyelitis with the vascularized fibular graft in children. J Bone Joint Surg (Am), 2007, 89(10): 2233-2240.
5. Hosny GA, Kandel WA. Treatment of posttraumatic radial club hand with distraction lengthening. Ann Plast Surg, 2013, 71(5): 489-492.
6. Page WT, Szabo RM. Distraction osteogenesis for correction of distal radius deformity after physeal arrest. J Hand Surg (Am), 2009, 34(4): 617-626.
7. 殷渠東, 孫振中, 顧三軍, 等. 骨搬運與骨短縮-延長治療脛骨骨缺損合并軟組織缺損的療效比較. 中國修復重建外科雜志, 2014, 28(7): 818-822.
8. 劉會仁, 王立新, 張艷茂, 等. 組織移植結合骨滑移治療小腿皮膚軟組織伴大段脛骨缺損. 中國修復重建外科雜志, 2013, 27(3): 295-298.
9. Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am, 1951, 33-A(4): 895-907.
10. Trumnle TE, Budoff JE, Cornwall R. 肩肘手外科學. 邵新中, 于亞東, 譯. 北京: 人民衛生出版社, 2009: 76-87.
11. Harley BJ, Pereria ML, Werner FW, et al. Force variations in the distal radius and ulna: effect of ulnar variance and forearm motion. J Hand Surg (Am), 2015, 40(2): 211-216.
12. 于金河, 李增炎, 彭阿欽, 等. 橈骨短縮對橈腕關節影響的生物力學研究. 中國臨床解剖學雜志, 2005, 23(1): 103-105.
13. Ring D, Prommersberger K, Jupiter JB. Posttraumatic radial club hand. J Surg Orthop Adv, 2004, 13(3): 161-165.
14. McBeath R, Katolik LI, Shin EK. Ulnar shortening osteotomy for ulnar impaction syndrome. J Hand Surg (Am), 2013, 38(2): 379-381.
15. Malki A, Wong-Chung J, Hariharan V. Centralization of ulna for infected nonunion of radius with extensive bone loss: a modified Hey-Groves procedure. Injury, 2000, 31(5): 345-349.
16. Kasashima T, Minami A, Kutsumi K. Late fracture of vascularized fibular grafts. Microsurgery, 1998, 18(5): 337-343.
17. Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg (Am), 1996, 78(2): 204-211.
18. 董長紅, 秦泗河, 彭愛民, 等. Ilizarov 肢體延長技術治療橈骨遠端損傷骨骺早閉短縮畸形. 中國矯形外科雜志, 2017, 25(4): 365-367.
19. Sabharwal S. Treatment of traumatic radial clubhand deformity with bone loss using the Ilizarov apparatus. Clin Orthop Relat Res, 2004, (424): 143-148.
20. Lee J, Oh SJ, Jung SW, et al. Ilizarov distraction and vascularized fibular osteocutaneous graft for postosteomyelitis skeletal deformity of the forearm. J Reconstr Microsurg, 2012, 28(9): 627-629.
21. Zhang X, Duan L, Li Z, et al. Callus distraction for the treatment of acquired radial club-hand deformity after osteomyelitis. J Bone Joint Surg (Br), 2007, 89(11): 1515-1518.
22. El-Mowafi H, Elalfi B, Wasfi K. Functional outcome following treatment of segmental skeletal defects of the forearm bones by Ilizarov application. Acta Orthop Belg, 2005, 71(2): 157-162.
23. 王富明, 陳鴻奮, 陳濱, 等. 牽拉成骨技術治療下肢大段骨缺損. 中華創傷骨科雜志, 2011, 13(6): 530-533.
24. Ono CM, Albertson KS, Reinker KA, et al. Acquired radial clubhand deformity due to osteomyelitis. J Pediatr Orthop, 1995, 15(2): 161-168.
25. 秦泗河, 范存義, 張群. 外固定與上肢重建. 北京: 人民衛生出版社, 2016: 298-304.

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