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Lower limb deformity due to failed trauma treatment corrected with the Ilizarov technique: factors affecting the complication rate in 52 patients.

Oostenbroek HJ, Brand R, van Roermund PM - Acta Orthop (2009)

Bottom Line: The results were analyzed by using logistic regression in a polytomous universal mode (PLUM) logistic regression model.In 2 patients treatment failed, which resulted in amputation.In all other patients healing of nonunion could be established, malunion could be corrected, and infections were successfully treated.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, University Medical Centre, Utrecht, The Netherlands. hj@oostenbroek.nl

ABSTRACT

Background and purpose: Failed treatment of fractures may be corrected by the Ilizarov technique but complications are common. In 52 patients with compromised healing of femoral and tibial fractures, the results of secondary reconstruction with Ilizarov treatment were investigated retrospectively in order to identify the factors that contribute to the risk of complications.

Methods: 52 consecutive patients was analyzed. The median interval between injury and secondary reconstruction was 3 (0.1-27) years. The patients had failed fracture treatment resulting in bone defects, pseudarthrosis, infection, limb length discrepancy (LLD) caused by bone consolidation after bone loss, malunion, soft-tissue loss, and stiff joints. Most patients had a combination of these deformities. The results were analyzed by using logistic regression in a polytomous universal mode (PLUM) logistic regression model.

Results: The median treatment time was 9 (4-30) months, and the obstacle and complication rate was 105% per corrected bone segment. In 2 patients treatment failed, which resulted in amputation. In all other patients healing of nonunion could be established, malunion could be corrected, and infections were successfully treated. The statistical analysis revealed that relative bone loss of the affected bone was the only predictor for occurrence of complications. From these data, we constructed a simple graph that shows the relationship between relative bone loss of the affected bone and risk of complications.

Interpretation: Relative bone loss of the affected bone segment is the main predictor of complications after Ilizarov treatment of previously failed fracture treatment. The visualization of the analysis in a simple graph may assist comparison of the complication rates in the literature.

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Related in: MedlinePlus

Population estimates of the relation between the percentage bone loss and number of complications in a univariate logistic regression model. The standard errors of the estimates that play a role in the graph are represented in Table 3. The y-axis represents the estimated risk for the amount of complications at a certain relative loss of the affected bone (%) as represented on the x-axis. For example, the risk of having 1 or more complications is 50% for a loss of the affected bone of 8%.
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Figure 0001: Population estimates of the relation between the percentage bone loss and number of complications in a univariate logistic regression model. The standard errors of the estimates that play a role in the graph are represented in Table 3. The y-axis represents the estimated risk for the amount of complications at a certain relative loss of the affected bone (%) as represented on the x-axis. For example, the risk of having 1 or more complications is 50% for a loss of the affected bone of 8%.


Lower limb deformity due to failed trauma treatment corrected with the Ilizarov technique: factors affecting the complication rate in 52 patients.

Oostenbroek HJ, Brand R, van Roermund PM - Acta Orthop (2009)

Population estimates of the relation between the percentage bone loss and number of complications in a univariate logistic regression model. The standard errors of the estimates that play a role in the graph are represented in Table 3. The y-axis represents the estimated risk for the amount of complications at a certain relative loss of the affected bone (%) as represented on the x-axis. For example, the risk of having 1 or more complications is 50% for a loss of the affected bone of 8%.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823189&req=5

Figure 0001: Population estimates of the relation between the percentage bone loss and number of complications in a univariate logistic regression model. The standard errors of the estimates that play a role in the graph are represented in Table 3. The y-axis represents the estimated risk for the amount of complications at a certain relative loss of the affected bone (%) as represented on the x-axis. For example, the risk of having 1 or more complications is 50% for a loss of the affected bone of 8%.
Bottom Line: The results were analyzed by using logistic regression in a polytomous universal mode (PLUM) logistic regression model.In 2 patients treatment failed, which resulted in amputation.In all other patients healing of nonunion could be established, malunion could be corrected, and infections were successfully treated.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, University Medical Centre, Utrecht, The Netherlands. hj@oostenbroek.nl

ABSTRACT

Background and purpose: Failed treatment of fractures may be corrected by the Ilizarov technique but complications are common. In 52 patients with compromised healing of femoral and tibial fractures, the results of secondary reconstruction with Ilizarov treatment were investigated retrospectively in order to identify the factors that contribute to the risk of complications.

Methods: 52 consecutive patients was analyzed. The median interval between injury and secondary reconstruction was 3 (0.1-27) years. The patients had failed fracture treatment resulting in bone defects, pseudarthrosis, infection, limb length discrepancy (LLD) caused by bone consolidation after bone loss, malunion, soft-tissue loss, and stiff joints. Most patients had a combination of these deformities. The results were analyzed by using logistic regression in a polytomous universal mode (PLUM) logistic regression model.

Results: The median treatment time was 9 (4-30) months, and the obstacle and complication rate was 105% per corrected bone segment. In 2 patients treatment failed, which resulted in amputation. In all other patients healing of nonunion could be established, malunion could be corrected, and infections were successfully treated. The statistical analysis revealed that relative bone loss of the affected bone was the only predictor for occurrence of complications. From these data, we constructed a simple graph that shows the relationship between relative bone loss of the affected bone and risk of complications.

Interpretation: Relative bone loss of the affected bone segment is the main predictor of complications after Ilizarov treatment of previously failed fracture treatment. The visualization of the analysis in a simple graph may assist comparison of the complication rates in the literature.

Show MeSH
Related in: MedlinePlus