Predictors of Postoperative Complications of Ilizarov External Ring Fixators in the Foot and Ankle

Rogers, Lee C.; Bevilacqua, Nicholas J.; Frykberg, Robert G.; Armstrong, David G.

doi:10.1053/j.jfas.2007.06.004

Cited by 69 publications

(45 citation statements)

References 33 publications

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“…The major complications specially related to pin/wire site infec tion (only 2) are on lower side as compared with litera ture. 3,7,8,1014 Overall results in terms of radiological and clinical outcomes are also comparable with other similar studies.…”

supporting

confidence: 85%

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Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

Shrivastava¹,

Khan²,

Rathi³

et al. 2017

The Journal of Medical Sciences

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Introduction:In the developing world, there is still lack of accessibility and availability of adequate health care. In rural population this further gets limited, due to meager immediate resource at disposition and lack of availability of transports to adequate set ups. This cross-sectional study is undertaken among our rural patients who had undergone this treatment to understand what difficulties they had faced during such treatments and their acceptability toward such treatment. This study was undertaken with the aim to find out the acceptability and adaptability among the rural population for Ilizarov ring fixators. Materials and methods:The study consisted of 88 consecutive cases (91 lower limbs) of all age groups, who completed the treatment by Ilizarov methodology between July 2005 and July 2012. A retrospective analysis of the procedure was done through the medical records in terms of preoperative, intra operative, and after the complete treatment. These were analyzed for limb lengthening in centimeters, correction of deformities, total wearing duration, and final outcome. Subsequently, these patients/parents were interviewed with a questionnaire to assess the self-accessibility (ease) toward self-care; selfdistraction; self-adaptability-comfort during wearing time and the difficulties faced. Results:Overall the functional outcome was excellent in 18, good in 50, fair in 8, and poor in 4. Out of 91 patients, 67 (73.6%) followed up and could be evaluated for adaptability toward Ilizarov fixator. Overall, 91.04% were satisfied with the treatment by Ilizarov fixator. In the remaining the main reason for not accepting the Ilizarov method was difficulty in commuting in the public transport, ugly and threatening looks of fixator with so many wires crossing the leg. Conclusion:Ilizarov method is a very effective tool for managing the complex lower limb problems, especially among the population with low resources. It will ensure delivery of a very low-cost solution offered to the needy patients, wherein otherwise due to multiplicity of problems, integral solution is difficult to achieve within their resources.

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supporting

confidence: 85%

“…7,1014 In addition, the cosmetic ugliness of fixator where in several wires going across the limb and hardware tends to dissuade it as the primary choice of treatment. Also the patients' movement in public, including going to school, traveling in transport system like buses, is also a social taboo.…”

mentioning

confidence: 99%

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

Shrivastava¹,

Khan²,

Rathi³

et al. 2017

The Journal of Medical Sciences

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“…Older patients also spent longer time in the apparatus and required a greater number of antibiotics. Many factors could have accounted for these findings, including medical indication for external fixation, goal(s) of treatment, knowledge of and adherence to postoperative care, and developmental stage as it impacts physical growth, cooperation, and postoperative self-care [33,41,57]. Appropriate education regarding these findings will establish reasonable expectations of treatment duration and potential challenges.…”

Section: Background and Rationalementioning

confidence: 99%

“…As such, a poor support system and familial and/or environmental problems may compromise postoperative self-care, rehabilitation, and outcome [36,47,52]. Undergoing limb lengthening and reconstruction also requires mental stability, resilience, and good coping skills to manage increasing pain, limited mobility, and treatment fatigue [10,11,15,19,35,41,58]. This is crucial, because unaddressed psychological, emotional, and behavioral disturbances have been shown to complicate rehabilitation [2,20,38,40].…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Richard

Nguyen

Birch

et al. 2015

Clin Orthop Relat Res

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Background Pediatric limb reconstruction using circular external fixation is a prolonged treatment that interrupts patients' daily function. Patient personality characteristics and expectations may interfere with planned treatment, making complicated medical procedures more challenging. The aims of this study are to identify factors impacting treatment outcome and recommendations for preoperative evaluation and planning. Questions/purposes (1) Are there group differences between patients with and without a preexisting mental health condition(s) in terms of unplanned reoperations? (2) Does the number of surgical procedures before current external fixator placement correlate with the number of unplanned readmissions, unplanned reoperations, and days spent in circular external fixation? (3) Are there group differences between single-compared with two-parent households in terms of inpatient narcotic doses, length of inpatient stay, number of unplanned readmissions, length of readmission(s), and/or unplanned outpatient clinic visits? (4) Does patient age at the time of surgery have an impact on treatment duration, postoperative complications, and treatment outcome? Methods This is a retrospective chart review of pediatric patients who underwent limb reconstruction between 2008 and 2012. Patients with limb length discrepancy [ 4 cm or severe angular deformity and who agreed to intervention were treated with circular external fixation. Sixty-seven patients were included; 16 patients were excluded. Statistical analyses included Pearson r correlation and t-test. Results Patients who reported preexisting mental health diagnosis (13%) had more unplanned reoperations than patients who did not (no mental health diagnosis; 87%) (mental health diagnosis 3.4 ± 10.3 versus no mental health diagnosis 0.2 ± 0.5 reoperation[s], p = 0.022). Number of previous surgical procedures correlated with number of unplanned reoperations (r = 0.448, p \ 0.001), number of unplanned readmissions (r = 0.375, p \ 0.001), and number of days in an apparatus (r = 0.275, p = 0.018). Compared with patients from two-parent households, patients from single-parent households received a greater number of inpatient narcotic doses (singleparent 129 ± 118 versus two-parent 73 ± 109 doses, p = 0.039), longer length of inpatient stay (single-parent 73 ± 63 versus two-parent 40 ± 65 days, p = 0.036), more unplanned readmissions (single-parent 0.4 ± 0.1 versus two-parent 0.2 ± 0.2 readmission, p = 0.024), longer hospitalization when readmitted (single-parent 5 ± 11 versus two-parent 1 ± 3 day(s), p = 0.025), and fewer unplanned outpatient visits (single-parent 0.2 ± 0.8 versus two-parent 0.9 ± 1.1 visit, p = 0.005). Apparatus applications with successful outcome had higher average age than those with poor outcome (successful outcome 16 ± 3 versus poor outcome 13 ± 4 years old, p = 0.011). Age at time of apparatus application correlated with One or more of the authors (JGB, MKS, AMC), or a member of his or her immediate family, has or may receive payments ...

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“…Advantages given [47] for the use of external frame fi xators include the ability to operate on infected or possibly infected bone (by placing the pins away from the infected bone), fi xation away from the CN bone, greater tolerance for weight-bearing immediately after the surgery [48] (which although not advised is expected), access to the soft tissues while maintaining rigid stabilization, less invasive surgery than is needed for internal fi xation, and the ability to perform staged procedures. However, the use of external fi xation in patients with diabetes is associated with increased complications compared with nondiabetic patients [49,50]. We were unable to locate any studies that compared various methods of fi xation, and consequently the current literature cannot support one form of fi xation over others.…”

Section: Surgical Therapymentioning

confidence: 99%

The charcot foot: Medical and surgical therapy

Ulbrecht

Wukich²

2008

Curr Diab Rep

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Charcot neuro-osteoarthropathy (CN) is among the most devastating complications of neuropathy and now most commonly occurs in the feet of diabetic patients. Because it is relatively rare and because most patients and practitioners do not expect major bone pathology in the absence of significant pain, CN is often misdiagnosed as cellulitis, deep venous thrombosis, or gout. Also, radiographs early in the process are often relatively unremarkable. Although MRI findings are characteristic, treatment should not wait for the MRI result. The hot swollen erythematous neuropathic foot suspected to be CN should be emergently mechanically protected, usually in an irremovable total contact cast. Mechanical protection is the mainstay of conservative therapy, but surgical reconstruction of a deformed foot can usually also be successful. Unless diagnosed very early, significant decrements in quality of life result. Controlled studies are urgently needed to identify best practices.

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Predictors of Postoperative Complications of Ilizarov External Ring Fixators in the Foot and Ankle

Cited by 69 publications

References 33 publications

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

Study on Outcome of Complex Lower Limb Problems treated by Ring External Fixator and Evolvement of Practices toward its Acceptability

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

The charcot foot: Medical and surgical therapy

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