This is a comparative study to evaluate the outcome of forty patients with bone loss in tibia using conventional external fixation device for group A while for group B using Ilizarov external fixator device each group consists of 20 patients, based on principles of distractive osteogenesis. Patients and methods: Forty patients with bone loss of 4 to 14 centimeters in tibia between April 2011 and April 2016 were treated, ages (15-65 years); female to male ratio was 6:34. The cause of defects in tibia was fracture due to road traffic accident (20 cases), bullet injury to leg (8 cases), gap nonunion (8 cases) and infected non unions(4 cases). They were divided into two groups each consists of 20 patients, conventional external fixator used for group A while for group B Ilizarov external fixator device was used with performing transverse corticotomy proximal or distal to the gap for both groups. Results: Evaluation of results was done according to Association for Study and Application of Methods of Ilizarov (A.S.A.M.I.) scoring system and it revealed that both functional and bony results were better in group B than group A. Conclusions: Fixation of the bone by Ilizarov frame gives more rapid union of the bone, less chance of pin tract infection and cosmetically more preferable because of smaller scar tissue of entry of K wires than Schanz pins. Prevention and treatment of equinus deformity and clawing of the toes can be done by extending the Ilizarov frame to correct them. In cases of severe soft tissue loss it is better to apply conventional external fixator as a provisional fixator till the soft tissue loss and swelling will be diminished.

Background  Humerus is the long bone of the arm, radial nerve which is branch from the posterior cord of the brachial plexus commonly injured by fracture shaft of humerus because of close relation to the bone during it’s course in the arm, and the average incidence of radial nerve palsy with fracture of humerus in the literature is 12%. Objective To study incidence, types and nature of radial nerve injury associated with humeral shaft fracture. Subjects and Methods This is prospective study conducted at the Sulaimani Teaching Hospital and Causality Hospital during the period of June 2009 – June 2010. The study included sixty-eight patients with fracture shaft of hummers (21 females, 47 males), with an age ranging from 6 to 75 years (mean ±SE = 40± 0.67 years). Among the 68 patients 14 of them presented with neurological deficit of radial nerve dysfunction with an age ranging from 6 to 44 years (mean ±SE = 25 ± 0.67 years) (6 female and 8 male). The entire subjects met certain inclusion and exclusion criteria. Nerve Conduction Study and needle electromyography examinations were performed for those patients with radial nerve Dysfunction. The following biochemical parameter were measured complete blood count, serum calcium, serum alkaline phosphatase also X ray examination were performed in more than one view (anterior-posterior and lateral view). Results Among 68 patients with fractured humeral shaft 14 of them presented with feature of radial nerve palsy, nerve conduction study and electromyographic result showed that 10 patients (72%) have only focal demyelinating lesion (neuropraxia), (21%) 3 patients with severe radial nerve injury (neurotmesis) and 1 patient (7%) with partial radial nerve injury (axonotmesis) with the over all prevalence of about 20.6%. Among those patients with radial nerve palsy 3 of them was presented with compound fracture and associated severe radial nerve injury (neurotmesis), the remaining 11 patients presented with closed fracture.. Conclusions The incidence of radial nerve palsy with fractureed shaft humerus was 20.6%, transection of radial nerve is associated with open fractures of the humerus, nerve palsies that are part of closed fracture nearly always recovered.

This is a prospective study performed from December 2005 to November 2007 on 25 children with closed traumatic femoral shaft fractures admitted to the orthopedic department of Sulemani Teaching and Causality Hospital. Their ages ranged from 3 to 13 years with male to female ratio of 17:8. All cases were treated by gentle fracture reduction and application of monolateral external fixation by the closed method. The average time needed for the fracture to unite was 72.6 days (ranged from 45 -121 days). The complications reported in the study were: 12 % pin tract infection, 8% of temporary knee joint stiffness and 4% of heterotopic ossification at the site of pin insertion. Neither bone refracture or clinical shortening of the injured limb were reported. The study concluded that unilateral external fixation is a good method of holding femoral shaft fractures in children. The treatment is associated with minimum morbidity and will result in satisfactory bony union, low rates of complications, and early return to school.

This is a prospective study was done on one hundred patients with late complications of the amputated stump between may 2001-2004 in Vincent Orthopedic center in Sulaimanya. There were eighty men and twenty women, their age range from seventeen to sixty years. Fifty patients with infected stump range from abscess formation in fifteen cases, infected epidermoid cysts in five cases to fissuring and ulceration of stump in thirty cases. Fifteen patients with painful neuromas attached to the scar tissue. Ten patients with below knee amputation had knee flexion deformity. Nine patients with below knee amputation with prominent bones compressing the skin of the stumps the fibula were long and the anterior edge of the tibia compressing the skin. Fifteen patients with loose cushion of muscles. One patient with recurrent infected above ankle amputation stump superadded by squamous cell carcinoma. All patients were treated by refashioning of the amputation stump, except one with squamous cell carcinoma.

Background and objectives: Distraction osteogenesis is one of the discoveries of Ilizarov which can be used to fill the gap in long bones, control infection, stimulate osteogenesis and equalize the limb. A nonunion is said to have occurred once there is clinical and/or radiological evidence of cessation of fracture healing, usually after 6-8 months. A septic nonunion is defined as a nonunion complicated by local infection at the fracture site and in the surrounding tissues. The aim of this study was to evaluate the effectiveness of treating infected nonunion of femoral shaft by using Ilizarov method. Methods: in this prospective case series study, 13 patients with infected gap nonunion of femoral shaft were treated surgically with meticulous debridement and bone transport through application of Ilizarov ring fixator. Results: The mean age was 30.2 years. The mean length of bone loss was 6.1 centimeters. All patients achieved bony union with eradication of infection. The mean external fixation time was 5.9 months with a mean healing index of 1.1 month/ cm. The bone and functional results were evaluated by using Association for the study and application of the methods of Ilizarov (ASAMI) scoring system. The bone results were excellent and good in 84.6%, fair in 15.4% and poor in 0%. The functional results were excellent and good in 77%, fair in 15.4%, poor in 7.7% and failure in 0%. Conclusions:Treatment of infected gap nonunion of femoral shaft by Ilizarov method provides an excellent result if conducted properly with a good patient education, preparation, surgical techniques and patient follow up.