Aim

The purpose of this study was to quantify the number of children treated with ESIN (elastic stable intra-medullary nails) at our institution and to determine what proportion of these nails have been removed and the time and difficulty taken to do so.

Background: The Ilizarov Method is well established for lower limb trauma and reconstruction. However, although the same principles apply, its use in the upper limb is less well described.

Aims of Study: To review indications and outcomes of all Ilizarov arm fixators applied by the two limb reconstruction surgeons in our unit.

Methods and Results: All patients treated using an upper limb Ilizarov frame were identified and reviewed. Demographic data, indications and durations of frames collected. Fifty-one cases identified. Average age 43 (17–81). Tertiary referrals in 63%. Previous surgery in 78%. Mechanism of injury included: 37% RTA, 40% simple falls. Reasons for frame usually multifactorial including 22 for non-unions. 43% of fixators applied acutely (< 6 weeks). Average frame time was 152 days (34–343). Over 80% achieved expected outcome –obtaining good function or fracture union. 14 needed further frame surgery including 5 for frame removal, 3 adjustments and 2 corticotomies. Most frames removed in clinic.

Complications: 30% superficial pin site infection. No deep wire infections. 1 wrist malunion requiring delayed correction. 2 patients had neurological complications from frame surgery. One radial palsy possibly from humeral plate removal. One median palsy due to pressure from wire. One patient had an above-elbow amputation for persistent infection.

Conclusions: The Ilizarov technique appears well tolerated and successful despite often infected or deformed tissues. Indication and intended purpose of arm frames very varied. This technique allows stabilization (with/without bone loss), treatment of non-unions and lengthening/bone transport. The Ilizarov Method is valuable for limb salvage/reconstruction.

To review indications and outcomes of all Ilizarov arm fixators applied by the two limb reconstruction surgeons. All patients treated with an upper limb Ilizarov frame were identified. Casenotes were reviewed. Demographic data, indications and duration of frames collected. Forty-seven patients had application of an arm frame. Average age 43 (17–81). Tertiary referrals in 72%. Previous surgery in 79%. Mechanism of injury included: 37% RTA, 40% simple falls. Reasons for frame usually multifactorial. Half of fixators applied acutely (< 6 weeks), 17 for non-unions. Two patients had neurological complications from frame surgery. One radial palsy possibly from humeral plate removal. One median palsy due to pressure from wire. Average frame time was 152 days (34–343). Over 80% achieved expected outcome -obtaining good function or fracture union. One patient had an above elbow amputation for persistent infection. Fourteen needed further frame surgery including 5 for frame removal, 3 adjustments and 2 corticotomies for lengthening. Most frames removed in clinic. The Ilizarov technique appears well tolerated and successful despite often infected or deformed tissues. Indications and intended function of arm frames very varied. This technique allows stabilisation (with/without bone loss), treatment of non-unions and lengthening/ bone transport. The Ilizarov technique is valuable for limb salvage/ reconstruction.