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Author Topic: A Rare Fatal Complication of Ilizarov Procedure  (Read 708 times)

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Android

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A Rare Fatal Complication of Ilizarov Procedure
« on: March 12, 2018, 03:04:15 AM »

Abstract

Ilizarov process is used for the management of multiple fractures, polytrauma conditions, cosmetic limb lengthening, and fracture malunion. Complications associated with the process are nerve palsy, joint contracture, premature or delayed osseous consolidation, a nonunion and permanent stiffness of the joint, pin tract infection, edema, and transient paresthesia, etc. In our case, there was a fatal complication. A 25-year-old African lady underwent the Ilizarov procedure for femur lengthening in a hospital in New Delhi, India. During her first distraction process, she suddenly collapsed at the hospital and could not be revived. At postmortem, a small hematoma was seen around the surgically fractured area. On histopathology of internal organs, fat globules were present in the vasculature of brain and lungs. Cause of death was opined as due to fat embolism. This is the first case reported of a fatal fat embolism following Ilizarov procedure for limb lengthening in a healthy adult.

Source
First page of case report
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5'4" and 1/4" (163.2 cm) | United States | early 30s | Cross-lengthening with Dr. Solomin & Dr. Kulesh

lucindaris

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #1 on: March 12, 2018, 04:29:45 AM »

That's interesting.
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7231

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #2 on: March 12, 2018, 06:35:58 AM »

Abstract

Ilizarov process is used for the management of multiple fractures, polytrauma conditions, cosmetic limb lengthening, and fracture malunion. Complications associated with the process are nerve palsy, joint contracture, premature or delayed osseous consolidation, a nonunion and permanent stiffness of the joint, pin tract infection, edema, and transient paresthesia, etc. In our case, there was a fatal complication. A 25-year-old African lady underwent the Ilizarov procedure for femur lengthening in a hospital in New Delhi, India. During her first distraction process, she suddenly collapsed at the hospital and could not be revived. At postmortem, a small hematoma was seen around the surgically fractured area. On histopathology of internal organs, fat globules were present in the vasculature of brain and lungs. Cause of death was opined as due to fat embolism. This is the first case reported of a fatal fat embolism following Ilizarov procedure for limb lengthening in a healthy adult.

Source
First page of case report

Is the possibility of fat embolism higher in fatter people compared to slimmer people? thanks
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KiloKAHN

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #3 on: March 12, 2018, 06:52:18 AM »

Is the possibility of fat embolism higher in fatter people compared to slimmer people? thanks

Yes, as well as deep vein thrombosis.
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Surgery performed by Dr Mangal Parihar at Mangal Anand Center for Limb Lengthening & Reconstruction. http://www.limblengtheningforum.com/index.php?topic=634.0
Pre-surgery height:  164 cm (Surgery on 6/25/2014)
Post-surgery height: 170 cm (Frames removed 6/29/2015)

myloginacct

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #4 on: March 12, 2018, 03:04:21 PM »

Is that the first confirmed death from a purely CLL procedure?

I know Catagni had an achondroplastic (i.e. dwarf) patient die due to an ATL surgery, but it wasn't any of the CLL surgeries themselves. More like a consequence of them.
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myloginacct

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #5 on: March 12, 2018, 03:07:22 PM »

Too bad I can't seem to read the full article, either. I'd like to know what her risk factors were.

What I can tell from the abstract: female, peforming CLL in India.
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Android

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #6 on: March 12, 2018, 07:40:37 PM »

I read the entire case report, no further information was shared about the patient. Goes into detail about typical complications, citing doctors Paley and Catagni, then discusses how fat embolism works but you can learn about that elsewhere.

It cites a paper which notes that fat embolism occurs 90% of the time for long bone and hip fractures, and of those only 1-3.5% develop into fat embolism syndrome (FES). This is not cited in the case report, but I want to add that most patients facing FES recover fully.

All in all the abstract pretty much tells the whole story, though it does mention one more fatal case via femoral lengthening, a 12 year-old dwarf. Excessive lengthening and the subsequent attempt to shorten the limbs released a massive fat emboli.

Don't want to scare anybody since fatal cases are extremely rare for LL, but it is a possibility.
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5'4" and 1/4" (163.2 cm) | United States | early 30s | Cross-lengthening with Dr. Solomin & Dr. Kulesh

myloginacct

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #7 on: March 12, 2018, 10:56:17 PM »

Both fatalities seem to have involved external femurs. So that's something to keep in mind. The other one involved ATL.

We probably need a thread listing all confirmed deaths related to LL.
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0184946

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #8 on: March 15, 2018, 11:58:38 PM »

I wonder what was her weight. So sad to die over something like this. Its why some doctors may require their patients to lose some weight. How many known fatal cases of cosmetic LL is known?
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Android

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #9 on: March 16, 2018, 01:08:22 AM »

I wonder what was her weight. So sad to die over something like this. Its why some doctors may require their patients to lose some weight. How many known fatal cases of cosmetic LL is known?

She wasn't overweight. While not listed, the photo of her is of average weight; I would guess somewhere around or under 130 lb (59 kg).

I wondered why the previous post assumed she was overweight as well, unless it was an unrelated question.

As for number of fatal cases due to fat embolism (I would guess the biggest risk for LL), as per case report:

Quote
This is the first case reported of a fatal fat embolism following Ilizarov procedure for limb lengthening in a healthy adult. However, Ganel et al. reported a case of fatal fat embolism in a case of an achondroplastic dwarf from Israel.

While the risk of death is real, it's much safer compared to popular procedures like liposuction or a tummy tuck.
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5'4" and 1/4" (163.2 cm) | United States | early 30s | Cross-lengthening with Dr. Solomin & Dr. Kulesh

MirinHeight

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Re: A Rare Fatal Complication of Ilizarov Procedure
« Reply #10 on: March 16, 2018, 03:57:22 AM »

its pretty crazy that the surgery was only done on one leg via external fixator and she died from FES

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currently 179 cm with a 6'2 wingspan
Goal: 182.5-184 cm
top 5 LL surgeons: Paley, Rozbruch, Mahboubian, Parihar, Birkholtz
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