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The Ilizarov method

The Ilizarov method, in which the Orthopedic Surgeon Traumatologist Ioannis Kontolatis has been trained in the largest center in the world in this method in Kurgan, Russia, is a very effective method of treating difficult orthopedic problems such as chronic osteomyelitis, bone deformities, bone loss and bone lengthening. The following is a brief presentation of cases encountered by the doctor and presented at the Panhellenic orthopedic conference.

Incident 1

A 40-year-old patient with a previous open fracture osteosynthesis that has healed and the osteosynthesis materials (plate screws) have been removed , seven years later and while doing heavy manual work suffers a fracture after a minor injury with the following x-rays

After 5 years and 6 surgeries involving external osteosynthesis of various types, intramedullary nailing and Ilizarov application the patient has septic deformity of the bone and a forgotten screw in the metaphysis of the tibia and was advised by his treating physician to have an amputation. At that time he presented in the clinic of Mr. Kontolatis with the following images:

After receiving information from the previous surgeon, we devised a treatment plan involving orthopaedic surgeon, plastic surgeon infectious disease and hyperbaric medicine specialist consisting of
1.determination of responsible infectious agents and initiation of appropriate antibiotic treatment of a pseudoarthrosis tissue, correction of deformity and fixation with Ilizarov device
3.covering the pseudoathrosis area with vascularized flap
4. Removal of the foreign body
5. Hyperbaric oxygen therapy Initial X-rays after surgery

One year after the bone healed and after another 4 months the fistulas of chronic osteomyelitis closed. The patient goes up and down stairs on three floors in his apartment. The following is an axial image showing the bone union of the septic pseudoarthrosis for which amputation had been adviced.

Incident 2

A 45-year-old patient was transported to the emergency department of the Attica Hospital after an accident in which he suffered self-injury from a shotgun in the tibia with a cross section of arteries and a bone deficit of more than 10 cm. The tibia was immobilized with external osteosynthesis and the arterial damage was successfully repaired by the orthopedic and vascular surgery clinic of the Attica Hospital and then transferred to the supervision of Dr. Kontolatis for the restoration of the significant bone and tissue loss. Original images from the patient`s leg:

From the assessment of the case, the treatment plan was determined, which included initial cleaning and stabilization of the tibia , osteotomy of the lower third of the tibia and bone transport to cover the bone deficit with use of Ilizarov device, prescribing antibiotic treatment, covering the skin deficit of the involved area. Initial postoperative radiographs: Final X-rays after restoring the bone deficit and successful union of the tibia . this case is a good example of appropriate initial treatment by the medical teams of the Attica Hospital and the efforts of Mr. Kontolatis and his team. The patient has returned to all activities he had before the injury including hunting despite the approximately 11 cm initial bone deficit

Incident 3

A 35-year-old woman suffered an open tibial fracture and was treated in a prefectural hospital with osteosynthesis with a plate and screws that became infected and led the treating surgeon to remove the osteosynthesis materials. This patient was referred a few months later by her gynecologist to Mr. Kontolatis' office with difficulty walking, septic pseudoarthrosis with fistula, shortening of the tibia and prominence of fibular head. Original pictures in the doctor's office: Debridment of the pseudoarthrosis tissue, stabilization with an Ilizarov device with simultaneous osteotomy in the upper part of the tibia, so that in addition to the fight against septic pseudoarthrosis, an elongation procedure was performed for complete restoration of the limb length, with simultaneous antibiotic treatment: Final x-rays, the patient has returned to all her activities (work, hobbies) without restrictions