Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2017; 8(1): 42-48
Published online Jan 18, 2017. doi: 10.5312/wjo.v8.i1.42
Unhappy triad in limb reconstruction: Management by Ilizarov method
Barakat Sayed El-Alfy
Barakat Sayed El-Alfy, Orthopedic Department, Mansoura University Hospital, Mansoura City 35516, Egypt
Author contributions: El-Alfy BS performed the surgery in all cases, designed the study and wrote the paper.
Institutional review board statement: The study was approved by the ethical committee in our institution.
Informed consent statement: All patients gave their informed consent before being included in the study.
Conflict-of-interest statement: The author has no conflict of interest.
Data sharing statement: No available data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Barakat Sayed El-Alfy, MD, Assistant Professor, Orthopedic Department, Mansoura University Hospital, Elgomhorya Street, Mansoura City 35516, Egypt.
Telephone: +20-50-233480
Received: April 25, 2016
Peer-review started: April 26, 2016
First decision: July 5, 2016
Revised: August 8, 2016
Accepted: August 27, 2016
Article in press: August 29, 2016
Published online: January 18, 2017

To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.


Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo (range 27-56 mo).


The infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases.


Distraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.

Keywords: Ilizarov methods, Bone defect, Soft tissue reconstruction, Open bone transport

Core tip: Bone and soft tissue loss represent a true challenge for both the orthopedic and plastic surgeons. The presence of bone and soft tissue infection further complicates limb reconstruction. In this study a series of 28 patients with severe lower limb trauma were managed by the Ilizarov method without the need for major plastic surgery. The results were encouraging.