ΑΝΤΙΜΕΤΩΠΙΣΗ ΤΡΑΥΜΑΤΩΝ ΑΠΟ ΠΥΡΟΒΟΛΟ
ΟΠΛΟ ΜΕ ΤΗ ΜΕΘΟΔΟ ILIZAROV
Δημητριάδη Ε, Σαρίδης Α, Μπούγας Π,
Τζελτζές Β, Σδράλης Η,Κουζέλης Α
Ορθοπαιδική Κλινική Πανεπιστημίου Πατρών
Χειρουρκική Κλινική Πανεπιστημίου Πατρών
www.orthopatras.gr
ΕΠΙΠΛΟΚΕΣ-ΠΡΟΒΛΗΜΑΤΑ
In shotgun wound extensive destruction of soft
tissues and bone, leads to high complication rate
and the end result may be poor.
Significant risk of infection
Bone loss
Nonunion
Limb-length discrepancy
Deformity
often require multiple additional surgical procedures
ΣΤΟΧΟΙ ΘΕΡΑΠΕΙΑΣ
Restoration of the lower extremities
continuity,
axis, original length and near – original function
is the primary aim of salvage therapy.
Because of the wide of the wide variety of gunshot injuries,
treatment plans must be personalized;
no single protocol can be established.
E. Craintz J. Orthop. Science - 2002
The standard care in the management of
acute gunshot fractures includes:
Wound care
Fracture stabilization
Repair of neuro-vascular injury
I.V. antibiotics
Repeat surgical debridement
Closure by secondary intention
External circular fixation with the Ilizarov
method allows simultaneous treatment of bone
loss, infection, nonunion, and deformities.
MATERIAL-METHOD
17 Patients – 17 Shotgun fractures
17 fractures were open high-energy
type III C, and displaced severely
comminuted - type C3 (Α.Ο.)
17 patients were male
average age
42,6 y (range 18 – 52 y)
MATERIAL-METHOD
In 17 patients the monolateral external fixator
were used for initial fracture stabilization.
2 of the fractures was aseptic and
15 of the fractures were infected.
 Time to index
3,6 m. (1-15)
 Average No of previous operations 2,4
 Average size of bone defect
5,7 cm. (2- 15)
The additional plastic surgery were applied
in 9 cases for coverage of the skin and soft tissue defect.
Osteosynthesis technique
Monofocal compression osteosynthesis
( bone defect < 2 cm )
2 PT
Monofocal compression – distraction
osteosynthesis (bone defect 2-4 cm)
1 PT
Initial monofocal compression osteosynthesis
( delayed corticotomy )
Extensive soft –tissue and bone defect
3 PT
Osteosynthesis technique
Bifocal combined
compression - distraction osteosynthesis
4 PT
Bifocal consecutive
distraction – compression osteosynthesis
7 PT
Results
Mean external fixation time was
281,4 days (range 90 –450 d)
ASAMI criteria
Results
BONE
FUNCTIONAL
Excellent :
11
6
Good
:
3
5
Fair
:
2
3
Poor
:
1
3
Complications
Axial deformity in the nonunion site
3 p
Joint stiffness ( ankle )
6 p
Complications
Delayed union at the docking site
4 p.
Secondary locked intramedullary nailing in 5 p. ( 29,4%)
PK-55
9 months
bone defect 7 cm
PK-55
PK-55
proximal corticotomy
1 month after
6 months post. op.
PK-55
11 months post. op.
PK-55
18 months post. op.
KS-40
III C quadriceps interruption
KS-40
4 months
removal of ex-fix => 3cm defect
KS-40
10 days
2 months post. op.
KS-40
3 months post. op.
KS-40
2 years post. op.
DA-24
# III C
4 months
DA-24
4 months
DA-24
2 months post. op.
DA-24
1 years post. op.
DA-24
DN-35
DN-35
2 months post. op.
6 months post. op.
KN-44
# III C
KN-44
KN-44
KN-44
11 months post. op.
20 months post. op.
KN-44
The Ilizarov method allows simultaneous
correction and restoration of all accompanied
orthopaedic pathology caused of shotgun
injuries of the lower extremity.
The Ilizarov method is the treatment of choice for
high – energy gunshot injuries of long bones.
ΕΥΧΑΡΙΣΤΩ