TREATMENT OF POST POLIO PARALYSIS WITH THE ILIZAROV EXTERNAL

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					            The Journal of Pakistan Orthopaedic Association




TREATMENT OF POST POLIO PARALYSIS WITH THE ILIZAROV
                EXTERNAL FIXATOR
                                      Farmanullah and Khushnood Ali Baz


ABSTRACT:

Introduction: Illizarov external fixator is the most versatile form of an external
fixators and can be used easily, dealing with many Qrthopaedic problems including
correction of deformities & leg length discrepancy in patients of post polio paralysis.
Study Design: Descriptive case series.
Patient and methods: 28 patients of post polio paralysis were treated by Illizarov
external fixator. It was carried out at multiple centers in Peshawer from January
2004 to December 2005.
Results: Among them 12 were males & 16 females. Age was between 10-18 years.
Different deformities of lower limbs were treated. Results were better than patients
treated by other conventional methods i.e. (splints surgery calipers etc). In our series
we got 23 good results 4 satisfactory results & one unsatisfactory result.
Key Words: Illizarov external fixator, postpolio deformities,

                    ......................................................................................


INTRODUCTION:                                                     fixator2,3 It uses multiple rings, small diameter
                                                                  K-wires & connecting rods, which provides
The beginnings of external fixation are                           very firm fixation of tissue & bone at
associated to the name of Malgaigne,                              different levels of the limb & at the same
followed by the authors of Western European,                      time have the provision of the rings in all
German and American school of external                            planes & hence giving the ability to correct
fixation. This apparatus was invented by                          flexion,Valgus, varus deformities & of course
Professor Ilizarov of Kurgan in 1951 in the                       the ability to contract & distract fragments.
                                                                                    4,5
former USSR. In the U.S.A., this method                           Poliomyelitis is the largest cause of
was accepted as late as in 1950s; being                           disability in our part of the world. Though
                                                 1
accepted in Russia through Ilizarov.                              polio is almost eradicated in our country,
Illizarov external fixator is a versatile external                but there are thousands of peoples affected

Correspondence: Dr Khushnood All Baz, Al-Shifa Surgical Centre, Dabgari Gardens Peshawar
Phone: 091-2569586 Email: kabaz@pes.comsats.pk
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                        The Journal of Pakistan Orthopaedic Association



by this disease with different forms and         PROCEDURE:
severity of residual disability which needs
orthopaedic help.                                We applied two rings to the femoral shaft
                                                 and through lateral 5 cm incision osteotomy
Conventional methods such as orthosis,           at the distal femur was done. While for tibia
calipers, surgery etc have certain drawbacks     3 rings were applied and lengthening
such as incomplete correction of deformities,    achieved by metaphyeal osteotomy. In the
very long rehabilitation period & inability      foot we have done triple arthodesis and
                                                                                             8
to correct joint deformities at one stage due    applied single half ring to the calcaneus.
to fear of neurovascuclar compromise.            one half ring to the fore foot and connected
                                                 to the distal tibial ring. For equino valgus
The beauty of this surgery is that it is         we transferred the peroneus brevis to the
minimally invasive. It involves rings & small    cuneiform, while for equino valgus we
diameter K-wires , which are placed under        transferred the anterior tibial tendon to the
tension in the rings & rings are held together   lateral cuniform to achieve straight & planti
                                                                                             9
with the help of threaded rods for allowing      grade foot, followed by triple arthodesis.
the rings to move in all directions.6,7          For calceneus deformity we have done
                                                 subtalar fusion & calcaneus lengthening with
The Ilizarov apparatus achieve                   Ilizarov apparatus.
comprehensive correction in a short
time(3,4,5 months). It restore muscle            RESULTS:
imbalance & lengthen the limbs. It improves
gait (when used in lower extremity) & reduce     Deformities which we corrected: In 4 patients
the amount of energy spent on walking. It        flexion abduction contracture of the hip joint.
helps the patient to avoid aids such as          We did soft tissue release i.e. tensor fascia
crutches, calipers etc.                          lata, sartorius iliopsoas, gluteus minimus &
                                                 medius, with knee joint contracture & equino
MATERIAL & METHODS:                              varus deformity of the foot & tibial
                                                 shortening. 12 patients were with knee joint
The study is a descriptive case series. It was   contractures tibial shortening equinovarus
carried out at multiple centers in Peshawer      deformity of the foot, remaining were with
from January 2004 to December 2005. All          equinovalgus and calcaneus deformity of the
the patients presenting with post polio          foot.
deformities and requiring major surgical
corrections were included. In our series there   Below 14 years of age we have done soft
were 28 patients, out of 28, 16 were female,     tissue distraction of the knee with Ilizarov
                                                            10
12 were male. Age was between 10-18 years.       apparatus. Where angulations was more
All the patients were with lower limb            than 30 degree and above 14 years old we
deformities.                                     have done supracondylar extension


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                         The Journal of Pakistan Orthopaedic Association



osteotomy.11 and posterior translation of the     of deformity). Paley has emphasized the
distal fragment12 which ensures mechanical        importance of planning before proceeding
alignment in sagittal plane.                      Illizarov.13

We assessed knee flexion angle, range of          In our series we have an average follow up
motion, stability, presence of pain, and          of 10 months ranging 6 to 18 months. In
healing index. 13 Results show a higher           another study Hosney14 a series of 50 patients
success rate in patients with Ilizarov external   (71 knees) between 1994 and 2002 with the
fixator. 28 patients were treated with Ilizarov   Ilizarov external fixator. Of the 50 patients,
fixator. Out of 28, in 21 were had good results   29 were affected unilaterally and 21
4 were satisfactory and one was                   bilaterally. In 15 patients, there were
unsatisfactory.                                   associated deformities. All patients were
                                                  assessed clinically and radiographically. After
Complications: four patients suffered pin         a minimum follow up of 1 year (mean 3.7
tract infections, which was treated with          years; range, 1-8 years), 18 of 20 of the
antibiotics, and daily dressing and one had       preoperatively nonambulatory patients having
neuro vascular injury.                            bilateral surgery could walk at last followup.
                                                  Complications included pin tract infection
DISCUSSION:                                       in all patients, knee subluxation in three
                                                  patients, and fracture related to treatment in
Polio has still not been eradicated from our      seven patients. We believe gradual correction
country we still have a huge number of            using a circular frame an effective method
patients who have extensive disabilities, apart   to treat Postpolio contractures.
from the physical disabilities; these patients
have tremendous. psychological problems.          CONCLUSION:
It takes a lot of time and money to treat these
patients.                                         The illizarov technique is a versatile system
                                                  external fixator which allows firm fixation
The conventional methods are very time            at- multiple levels in limb and it is suitable.
intensive & cannot address all the aspects        for performing multiple tasks like limb
of the problem i.e. muscle imbalance              lengthening deformity correction contracture
deformities and shortening at one stage. We       release and performing arthodesis at the same
used the Ilizarov apparatus as a one stage        time. Comprehensive correction can be
procedure. These patients did not have a          achieved giving maximum benefit to the
need for wearing any calipers & orthosis &        patient with minimum intervention and
weight bearing was allowed from the second        duration of treatment.
day of surgery (depending upon the severity

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           The Journal of Pakistan Orthopaedic Association



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