A perspective - Ilizarov Frame as distraction Device- followed by internal fixation.
Neglected- Delayed presentation -8 months post injury
Treated initially by quacks at second covid wave in April 2021
Close fracture shaft Femur Left with 7.5 cm Shortening.
Treatment option :
• Open reduction - Osteoclasis- acute attempt at reduction and Antegrade nailing/ LCP. Carries risk of neurovascular stretching.
• Other option is to shorten the limb and do Antegrade nailing.
• Open reduction - Osteoclasis and gradual correction of overriding with LRS/ Ilizarov.
Chose to treat patient with Ilizarov External Fixator.
⁃ Mal-union broke percutaneously with few 3.2 mm drill holes - drill bit with sleeve inserted through stab incision, followed by Osteoclasis with 5 mm Osteotome.
⁃ Confirmed with C arm images.
• Frame applied with adequate stability to withstand distraction forces.
• Overriding addressed with 1cm gradual distraction done on table under spinal anaesthesia four times. Post 4 cm distraction Distal pulse volume diminished.
• So further distraction discontinued and 1 cm compressed, effectively 3cm distraction done on table.
In post operative period overriding gradually corrected with 1.5 mm distraction at four times a day and on 7th day-length almost achieved. Residual translation corrected with biplanner hinges and washer.
• On Eighth day chose to remove frame and do Antegrade nailing.
• Raw area due to pin cut through of soft tissue at rapid distraction pace.
• None of pin tract infected.
• One half pin kept in distal fragment to manipulate
• Callus broken with 5 mm osteotome inserted through raw area of R2 Half pin, Canal reamed with solid reamer.
Discharged on 4th post op day.
At 4 weeks follow up- pin tracts almost healed, union in progress, full knee motion, no residual shortening and patient walking unaided.
Have done similar case in past in delayed presentation - used Distal femur LCP in that case.