The duration of follow up for clinicoradiological assessment for the study was shorter compared to other similar studies due to the limited time period of the study. After rehabilitation, regular physiotherapy and return to work, functional outcome is expected for further improvement.Pin site infection occurred in 11 out of 17 patients.
All pin site infection ranged from grade 1 to 3. All pin site infection healed with standard pin site care by cleaning with saline and minimal pin site debridement. None of the patients required removal of a pin or systemic antibiotic. Soft tissue contracture with equinus was present in 3 patients for which stretching exercise advice. Regenerate fracture of femur occurred in one patient which united after 2 months of continuation of Ilizarov fixator. There was no incidence of pin breakage, neurovascular injury sympathetic dystrophy, revision surgery. The present study suggests that distraction osteogenesis with Ilizarov have lesser morbidity and can be managed by proper counseling and follow up for physiotherapy and care for fixator and pin site. The disadvantage of Ilizarov fixator is poor patient tolerance compared to other fixators or implants and need of frequent follow-up but Ilizarov is more suitable for stiff nonunion, nonunion with a deformity in more than one planes, shortening, nonunion around joints.
Also, regular follow up ensures proper management of complications, physiotherapy, and patient satisfaction.This study suggests that hypertrophic non-union has an intrinsic capacity to form bone and consolidate and compression is not required for healing as all cases united after distraction 9 months.The union can be achieved by distraction osteogenesis of hypertrophic nonunion with Ilizarov fixator by new bone formation and consolidation correcting deformity and shortening with favorable function outcome.Abolition of shear forces while retaining the axial distraction and compression has been proved to stimulate consolidation of hypertrophic nonunion.(14)The study is prospective and surgery was done by the same surgeon which eliminates the difference in surgical skill and decision.The limitations of my study are: · Small sample size· The study population was not randomized due to low volumes of cases. · There was no control group to compare outcomes of distraction osteogenesis to patients who have not received distraction and with other treatment modalities. · The follow-up period was shorter to due to a limitation in study period therefore long-term outcome could not be assessed.