EXPERIENCE WITH MANAGING COMPLICATED FRACTURES USING ILIZAROV PRINCIPLE IN LAGOS, NIGERIA.

BACKGROUND

Management of complicated bone fractures in our environment is very challenging. The Ilizarov principle has been found to be a viable management option worldwide, but the use of this method in our environment has been sparsely reported.

AIM: To document our use of Ilizarov method to manage patients with complicated long bone fractures and the outcome.

DESIGN OF STUDY: Prospective observational study.

SETTING

Lagos State University Teaching Hospital, Ikeja, Nigeria.

METHODOLOGY: All the patients were treated between June 2009 and December 2012 using the Linear Rail-fixator System (LRS) according to Ilizarov principle. They were followed up for at least two years and data on demography, indications, procedure and outcome were collected and subjected to statistical analysis.

RESULTS

Thirty patients whose procedures had been concluded were recruited. The age range was 4 - 57 years with a mean of 38 years ; 17 were male while 13 were female with a male/female ratio of 1.3:1. Specific indications for treatment included infected non-union, failed implant with limb length discrepancy and mal-union. They all had bone defects ranging from 4cm to 12cm and the pre-operative period of morbidity ranged from 2 months to 8 years. Seventeen patients had acute docking and lengthening, 10 had bone transport while 3 had simple limb lengthening. Using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria, bone outcome was excellent in 7 patients, good in 20 and poor in 3. Functional outcome was excellent in 8, good in 19 and poor in 3. Complications included pin site infection (grades I & II) in 14 patients, knee stiffness in 6 and regenerate fracture in 1.

CONCLUSION

Ilizarov surgery is a good method of limb reconstruction in our environment. Our major complications are the high rate of pin site infection and knee stiffness. Good pin site care and early physiotherapy is essential.