Sample Report: Ilizarov Frame Removal

Preoperative Diagnosis: Hypertrophic nonunion, right tibia.

Postoperative Diagnoses

1. Hypertrophic nonunion, right tibia.

2. Status post Ilizarov frame application for nonunion treatment.

Procedures Performed

1. Removal of circular external fixator from right tibia.

2. Debridement of pin tracks, right tibia.

3. Application of long leg cast.

Clinical History: The patient is a 12-year-old boy with a hypertrophic nonunion of the right tibia, following an open tibia fracture, with angulation. Five months ago, I applied a halo fracture frame and gradually distracted the nonunion. Recent x-rays show that he is radiographically united, and he now presents for removal. The x-rays also show some osteolysis around the near cortex of several of the half pins.

Description of Procedure: Having induced satisfactory anesthesia, the patient was placed supine on the OR table. I sequentially disassembled the components of the frame. The wires were painted with iodine, Betadine, and extracted. The half pins were all removed and noted to be fixed tightly within the bone. The leg was then painted with Betadine, and I then took a sterile curette and curetted out the subcutaneous tissue and a bit of the near cortex of each of the pin sites that showed osteolysis on the x-ray. There really was not much in the way of granulation tissue or debris. I used a syringe with sterile saline to irrigate each of the pin sites, and then applied a dry, sterile dressing and well-molded, well-padded, long leg cast with the ankle in neutral position and the knee then approximately 30 degrees. We plan to have this child come back in seven to ten days for a cast change.