Bone loss can result from accident, post-operative bone infection and from excision of bone tumors. In our environment, it is mostly the result of fracture mismanagement. The commonest site of missing bone segment is the tibia. A bone loss in excess of 6cm will surely result to a non-union and limb shortening.
The conventional method of plating and bone grafting or use of unilateral fixators in grade III open fractures, is in the main, for fragment stabilization and wound closure, while bone replacement is attempted later by multiple operations, involving extensive bone grafting, which take a long time to incorporate, with increased morbidity.
Hopeville Hospital usage of the Ilizarov bone transport technique is a guarantee for bone segment replacement, no matter the size of bone loss. Ilizarov frames can be used to achieve replacement of missing bone segment at the time of treating bone and wound infection.
Limb length inequality may result from trauma, infection, poliomyelitis, cerebral palsy, tumours that affect growth or congenital deformities. The goals of treatment are a balanced spine and pelvis, equal limb lengths, and a correct mechanical weight bearing axis.
Hopeville Hospitals uses four types of treatment for limb length equalization:
- Shoe lift
- Shortening of the long leg
- Reducing growth of the long leg
- Lengthening of the short leg.
For small discrepancies of 1.5cm or less, no treatment is necessary, inside the shoe lift is sufficient. For discrepancies of 2-4cm, an outside shoe lift is accepted. Discrepancies of 1-4cm are regarded as minor while 5cm and above are regarded as major.
Limb lengthening of major short limbs is the preferred method of treatment. However, a major limb lengthening program requires a patient and family fully committed to maximal participation in an extended project.
Ilizarov technique is the most effective treatment method for major limb discrepancies. The Ilizarov monofocal, bifocal or trifocal method osteosynthesis has replaced the highly traumatic and unpredictable fibular bone transfer in major tibia bone loss.