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Abstract
Management of bone defects had been represented one of the most difficult challenges in orthopaedic practices. Bone grafts with different types and techniques remained for long time the gold standard for treatment of bone gaps. The use of Ilizarov principles of distraction osteogenesis offered orthopedic surgeons a new option in dealing with such problems.
In the current study, a group of 50 patients (40 male and 10 females) with bone defects ( 38 tibial , 10 femoral and 2 ulna ) had been managed using the Ilizarov technique of distraction osteogenesis. The study included defects of variable origin as regards the causative pathological condition such as open injuries, bone resection during the course of treatment of chronic bone infections, bone tumors and congenital defects.
In this thesis we used 2 techniques which were bone transport and shortening distraction techniques; the former technique depended on sliding a healthy segment after corticotomy to close the gap at a rate of 5.0 to 1 mm / day. This technique was used in 25 cases when the possibility of acute shortening was difficult as very bad skin, kinking of the vessels and long defects in which shortening was impossible. Acute shortening or partial shortening and lengthening were used in 25 cases when the situation was reasonable for shortening as small defect and more healthy skin and patency of vessels in spite of kinking. It has the advantage of long contact of the docking site which allowed healing during the course of lengthening with short period of treatment. In this work complete excision of the pathological segment was mandatory to avoid non union and persistence of infection in infected non united cases, recurrence of tumor in cases with neoplasm and non union in pathological segment of congenital pseudoarthrosis tibia.
In this thesis we evaluated the results according to the system described by Paley et al, 1989 into bony and functional results. Bone results were determined according to four criteria which were union, infection, deformity and limb length discrepancy Bone graft was performed in 11 cases, one with application of the frame and 9 cases after reaching the docking site with removal of intervening soft tissue and freshening the bone surfaces and insertion of cancellous bone graft to fasten the process of bone union and one case for augmentation of the regenerated bone. Infection had been eradicated in 29 cases out of 31 cases of infection associated with the problem of debridement without the fear of bone shortening as previously considered and the increase of blood supply in the limb with corticotomy and this was noticed in cases of bone graft in which the bone ends appeared vascular and with minimal or no sclerosis . Bone deformity was associated with the problem of bone defect in 7 cases which were treated simultaneously by fractional lengthening with hinges at the CORA site to overcome this combined problem.
This work had achieved excellent bony result in 33 cases, good result in 14 cases fair result in 2 cases and poor result in are case.