Introduction: The management of Gustilo-Anderson type-Ⅲ open tibial fracture is complex due to neurovascular damage and soft tissue loss. Combined orthopedics, plastic and vascular surgery provides better result for reconstructing the injuries of limb. The prevalence of tibial shaft fractures is estimated about 67%.1,2 Tibial shaft fractures are approximately 15% of all adult fracture and open tibial fractures are about 23.5%.1 Rigid fixation and good soft tissue coverage are essential for management of the fracture. Ilizarov external fixator, provide multi-disciplinary management of type Ⅲ open tibial fractures with sever contamination and comminution. Purpose of the study: To evaluate the clinical efficacy of Ilizarov external fixator with or without fascio-cutaneous flap transplantation in the management of Gustilo-Anderson type-Ⅲ open tibial fracture. Methodology: In the period of 2020 -2021, we manage 5 cases of Gustilo- type-Ⅲ open tibial fracture by Ilizarov. 2 patients were type-ⅢA and 3 type-ⅢB with severely contaminated and comminution. No neurovascular damage. All are male, age 30 -65 years and caused by RTA. There was 1 diabetic and 1 hypertensive patient. Surgical toileting, debridement and posterior slab apply as immediate management. All patients managed by Ilizarov on 5th and 7th day with secondary closure of type-ⅢA and vascularized fascio-cutaneous flap with skin grafting in type-ⅢB cases by orthopedic and flap surgeon. Summary: Full weight bearing was allowed on 3rd Soft tissue was healed within 3-6 weeks. In 1 case found skin infection, treated by antibiotic and dressing, also 1 case occurred flap edge necrosis, managed by debridement and 2nd time skin graft. Bone union time was 5-6 months, RUST scores 10. According to ASAMI score all were excellent results. Conclusion: RTA is the main cause of type Ⅲ open tibial fractures. Combined multi-disciplinary managements by Ilizarov provide excellent outcomes, early mobilization and infection control. It is a single stage definite management, which reduce treatment cost, patient`s mortality and morbidity.

Introduction: Aim of this study to evaluate the clinical efficacy and highlight their relevance in present orthopedics practice where multiple newer choices have been become famous. Accordion maneuver design with modified Ilizarov apparatus, a single stage procedure in femoral shaft non-union and re-fracture with quiescent infection place dynamic compression plate (DCP) in situ. Femoral shaft fractures (FSFs) are frequently occurring injury due to RTA. Infection (0.4%) and non-union (1.1 - 14%) are the morbid complications of femur fractures. The healing rate for femora shaft non-unions is too high (90%).1 Accordion Maneuver (AM) is the “Bloodless Stimulation” of bone healing described by Professor G. A. Ilizarov. It comprises of alternate compression and distraction which produce stress in living tissue and also convert biologically inactive scar tissue at non-union site into tissue capable of neo-osteogenesis.2 The suggested treatment for quiescent type of infected non-union is a single stage procedure with minimal or no debridement and if implant is provide sufficient stability it placed in situ.3 Case Report: In the case, a 26 years man treated by DCP with MIPO for his Gustilo type – Ⅰ open, comminuted fracture of mid femoral shaft (Left) following RTA. Post-operative infection occurred within 2 weeks of operation. Infection controlled by exploration and surgical toileting with antibiotic. After four (4) months later he was sustained re-fractured with bending plate due to fall again. Finally he was diagnosed as H. Rosen`s type 3 Quiescent infected non-union (Oligotrophic) and Romano stage -1 post-implant infection with re-fracture mid shaft of left femur. Then he was treated following accordion principles with modified Ilizarov frame. AM was applied according to protocol of Baruah and Patowary of non-union treatment. Result: After complete union and consolidation, substantiated by radiological evidence Ilizarov apparatus was dispelled six (6) months later of installation without removal of plate and four (4) months of that finally plate was removed. After one (1) year and four (4) months of mounted Ilizarov frame, the patient was in full free movement of knee and hip. He had no problem during walking even running. Conclusion: We pursue for the treatment, accordion maneuver with Ilizarov apparatus, a single stage procedure in femoral shaft non-union and re-fracture with quiescent infection kept plate in situ. Few authors reported, Accordion Maneuver (AM) techniques with Ilizarov apply over intramedullary nail (IMN) in situ for aseptic non-union of femur. In this study, we discussed the role of this tool (AM) for the treatment of femoral shaft non-union and re-fracture with quiescent infection place plate (DCP) in situ.

Introduction: Accordion Maneuver is the “Bloodless Stimulation” of bone healing described by Professor G. A. Ilizarov. It converts biologically inactive tissue into tissue capable of neo-osteogenesis. The suggested management of non-union, hypo-regeneration and infection with implant failure by a single stage procedure with minimal or no debridement and if implant is provide sufficient stability it placed in situ. Purpose of the study: Purpose of this study to evaluates the clinical efficacy and highlights their relevance of AM with Ilizarov in present and future orthopedics practice. Methodology: This is a retrospective study of 3 years from 2019 to 2021. Apply AM with Ilizarov in the patient’s management of non-union, hypo-regeneration and infection with implant failure. Patients included ≥18 years, intra-articular fractures are excluded. Total patient 7. Patient`s age from 19-62 years. There were 5 male and 2 female patients. Affected bones were tibia-3, femur-2, humerus-1 and radius & ulna-1. Causes were fall and infection. Final diagnosis was broken implant-2, bending implant with quiescent type infected non-union-1, poly-trauma with broken implant -1 and infection -3. Primary fixation was done by ILIMN in 3 and DCP in 4 cases. We follow Baruah and Patowary suggested protocol of AM in all cases. Summary: After 3-7 months follow up, according to ASAMI score, there were 4 excellent and 3 good outcomes. As per Paley`s classification, in 3 cases found shortening and angulation deformity. We were successfully managed all cases by AM with Ilizarov, kept failure implant in situ. Conclusion: We pursue AM with Ilizarov kept failure implant in situ, as a single stage procedure for the treatment of the patients and found very good results. So, in future it may an ultimate procedure for the management of those helpless conditions.