orthopatras.gr

1. 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

2. 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

3. 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

4. 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

5. External circular fixation with the Ilizarov method allows simultaneous treatment of bone loss, infection, nonunion, and deformities.

6. MATERIAL-METHOD 1990-2008 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)

7. MATERIAL-METHOD In 17 patients the monolateral external fixator were used for initial fracture stabilization. 2 of the fractures was asepticand 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.

8. 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

9. Osteosynthesis technique Bifocal combined compression - distraction osteosynthesis 4 PT Bifocal consecutive distraction – compression osteosynthesis 7 PT

10. Results Mean external fixation time was 281,4 days (range 90 –450 d) ASAMI criteria

11. Results BONE FUNCTIONAL Excellent : Good : Fair : Poor : 11 6 3 5 2 3 1 3

12. Complications Axial deformity in the nonunion site 3 p Joint stiffness ( ankle ) 6 p

13. Complications Delayed union at the docking site 4 p. Secondarylocked intramedullary nailing in 5 p. ( 29,4%)

14. PK-55 bone defect 7 cm 9 months

15. PK-55

16. PK-55 6 months post. op. proximal corticotomy 1 month after

17. PK-55 11 months post. op.

18. PK-55 18 months post. op.

19. KS-40 III C quadriceps interruption

20. removal of ex-fix => 3cm defect KS-40 4 months

21. KS-40 10 days 2 months post. op.

22. 3 months post. op. KS-40

23. 2 years post. op. KS-40

24. DA-24 # III C 4 months

25. 4 months DA-24

26. 2 months post. op. DA-24

27. DA-24 1 years post. op.

28. DA-24

29. DN-35

30. DN-35 2 months post. op. 6 months post. op.

31. KN-44 # III C

32. KN-44

33. KN-44

34. KN-44 11 months post. op. 20 months post. op.

35. KN-44

43. 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.

44. ΕΥΧΑΡΙΣΤΩ