The Ilizarov technique for treatment of sequelae of childhood-acquired bone and joint infection.

Bone and joint infections in childhood can result in various sequelae including deformity and limb length discrepancy (LLD). Management of these sequelae is difficult and must be individualized. In this study, we retrospectively examined the efficacy of treatment with Ilizarov techniques in 30 patients suffering from sequelae of bone and joint infections in childhood, treated from 1989 to 1994. These cases comprised 17 hip infections, two septic shoulders, and 11 cases of osteomyelitis (4 femurs, 5 tibiae, 1 humerus, and 1 forearm). All patients had some evidence of LLD. There were 13 cases of hip deformity and 10 cases of unstable hips. There were also 10 cases of angular deformity and five of nonunion of bone. The mean age at treatment was 21 years. Twenty-eight patients underwent Ilizarov lengthening procedures and 18 of them underwent deformity or instability correction simultaneously. Two patients underwent Ilizarov deformity correction only. Various techniques were used, including Schanz osteotomy plus mid-shaft femoral lengthening and distraction callotasis with and without an intramedullary nail. Postoperative complications included stiffness of joints in six patients, pin tract infection in six, fracture in five, malunion in five, nonunion in four, callus shortening in four, nerve palsy in two, and over-lengthening in one. The mean duration of follow-up was 72 months. The average length gain was 6.6 cm in shortened bones, with a mean external fixator index of 40.5 days/cm. All patients were satisfied with the functional and cosmetic results. We conclude that Ilizarov techniques are effective in treating sequelae of childhood infections of bones and joints.