The 'upside-down' radial head: a diagnostic challenge

The author describes a rare, traumatic dislocation of the radial head in an 8 year old girl. Only four similar cases were found in the literature. The danger of misdiagnosis and the life-long disability can be avoided by careful examination of the post-reduction radiograph.

Arthrodesis with the Ilizarov device after failed knee arthroplasty

Thirteen patients with failed total knee arthroplasty (TKA) due to infection (12 patients) or aseptic loosening (1 patient) underwent arthrodesis using the Ilizarov external fixator. Solid fusion was achieved in all patients with an average healing time of 27.6 weeks. Patients spent an average 18.8 weeks in the fixator followed by an average 8.8 weeks in a plaster cylinder cast. Five patients had a pin tract infection and one a superficial wound infection. One patient had 15 degrees recurvatum after surgery that was gradually corrected by adding a hinge system to the fixator. Average shortening of the affected limb was 3.7 cm (range: 1-6 cm). The Ilizarov fixator for knee arthrodesis after failed TKA produced favorable results and should be considered for use by surgeons familiar with the technique.

[Ilizarov reconstructive surgery--a solution for complex problems of the musculoskeletal system]

The Ilizarov technique is an important modality of reconstructive surgery for limb deformities, such as malunion and nonunion of fractures, persistent osteomyelitis, and bone loss following complex limb injuries, as well as in limb-lengthening procedures. It has received wide recognition in the Western world over the past decade. In MEDLINE we found 537 articles published between 1971-1995 that describe the use of this technique. Of these, only 18 were published between 1971-1975, while 261 were published between 1991-1995. The present paper describes the developments and updates in this method, as a result of the large experience gained by the authors in a number of centers in Israel using this technique. The Ilizarov apparatus is a circular frame that allows accurate control, much more than any other external fixator, during correction of limb deformities and limb-lengthening. It is minimally invasive, and open techniques and use of internal hardware and bone grafts are not needed. Based on our experience, we suggest that this method requires careful preoperative planning and meticulous surgical technique. More important, cooperation between surgeon and patient throughout the lengthy treatment is a prerequisite to ensure complete success, even in the most complicated cases.

Treatment of open tibial fractures with primary suture and Ilizarov fixation

Thirty-two open tibial fractures were treated by irrigation, debridement, antibiotic therapy, primary closure when possible, and fixation with Ilizarov device. In the Gustilo classification, 11 were Grade I, 10 Grade II, 8 Grade IIIA, and 3 were Grade IIIB. No Grade IIIC fractures were treated in the period studied. Fifteen were in patients with multiple trauma, and in 17 patients the fracture was a single injury. All fractures healed with good anatomic alignment, except for 1 with 5 degrees angulation and another with 1-cm shortening. The healing time was 21.9 weeks in the single injury and 25.7 weeks in the patients with multiple trauma. Eleven patients had pin tract infection, and in 4 the pin had to be replaced. One patient had dermatitis near the fracture site. This treatment of open tibial fractures proved to be successful for anatomic restoration of the tibia and had a low complication rate. Primary closure should be considered a possible method of treatment in Types I to IIIA open fractures, together with the Ilizarov external fixator, if the wound edges can be approximated easily with no tension at the suture line.