In this study of secondary reconstruction for post-traumatic deformities, the treatment goal could be achieved in 50 out of 52 patients. In 5 of these 50 patients, the limb length inequality was intentionally undercorrected—because of patient factors. These patients had problems that should be addressed by limb reconstruction, but at the same time they had problems that would be a contraindication for limb reconstruction, such as AIDS, severe alcohol abuse, and severe behavioral or psychiatric disorders.
Sometimes combined soft tissue, bone, and joint problems cannot all be solved by limb reconstruction or any other treatment. The main goal for these patients should be a stable leg to stand on, without pain, and fit for the application of an orthosis to compensate for the residual deformity.
Adapted treatment goals indicated by concomitant deformities or conditions have rarely been reported (Morandi et al. 1989
, Garcia-Cimbrelo and Marti-Gonzalez 2004
). There must be an under-reporting, because it is unlikely that this type of patient is not represented in other reconstruction centers. It is undesirable not to report on these patients, because the limitations of treatment or realistic treatment goals of limb reconstruction must be made clear in order not to harm the patient unnecessarily.
The treatment resulted in 59 “obstacles” and “real complications”, which represented complication rate of 105% for 56 treated bone segments. This rate is similar to the results reported for limb reconstruction after failed trauma treatment (ranging from 57% to 232%) (Paley et al. 1990
, Tucker et al. 1990
, Green et al. 1992
, Cattaneo et al. 1992
, Dendrinos et al. 1995
, Marsh et al. 1997
, Song et al. 1998
, Maini et al. 2000
, Paley and Maar 2000
, Garcia-Cimbrelo and Marti-Gonzalez 2004
, Mahaluxmivala et al. 2005
). However, the variation in patient groups is large, making comparison of results in the literature difficult. The value of complication rates is limited unless the deformities are classified. To make comparison of treatment outcomes easier, Dahl et al. (1994)
introduced a classification of the severity of the deformity.
Evaluation of our patient group with logistic regression analysis in a PLUM logistic regression model revealed that neither the severity classification nor the type of the deformity (malunion or (infected) nonunion) was related to the risk of complications. The percentage or proportionate bone loss of the affected bone was the only significant statistical factor that we could identify for the risk of complications. Resultant graphic representations of such analyses have can been constructed by other investigators, which makes comparison between authors possible.
When we break down the complications, the (re)fracture rate was 5 in 56 treated bone segments (9%), which is similar to the results of O'Carrigan et al. (2005)
in a report on 986 lengthenings (8%). Also, all other local types of complications in our series were similar to those in most of the relevant literature (Antoci et al. 2006
Besides the type of deformity, the complication rate of the Ilizarov treatment is notoriously influenced by many other factors. It is known that surgeon's experience of more than 30 operations is needed to overcome the learning curve problems (Dahl et al 1994
). This was not an issue in this study. Smoking was not evaluated as a determinant, because we had no information.
In conclusion, our study shows that the Ilizarov method is a valuable tool in treating severe types of bone loss and limb deformity with or without active infections. Reconstructive surgery using the Ilizarov method should always be considered as a treatment modality when amputation is imminent, though it is still difficult to judge when this type of reconstructive surgery is indicated (Bosse et al. 2002
). Our analysis shows that the relative amount of bone loss from the affected bone or the relative amount of bone to be reconstructed dictates the complication rate. This is represented in a graph, which may be helpful for comparisons with published material involving similar reconstruction procedures.