Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis

Introduction Many different methods and variations have been employed to perform osteotomy for deformity correction, bone lengthening, and segmental bone transport. Currently, multiple drill-hole (MDH) and Gigli saw osteotomies are the two most preferred ones, being favoured over other techniques. Our objective is to compare the modified healing index (mHI) of these two commonly used procedures. Methodology This retrospective study was conducted at the department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. The study population consisted of all skeletally mature patients who underwent tibial bone osteotomy for bone lengthening or bone transport using Ilizarov circular fixator from June 2016 to September 2018. We excluded patients with metabolic bone disease and patients who underwent osteotomy for deformity correction. Preoperative and operative patients’ demographics and clinical data were gathered through a review of medical record and mHI was calculated to compare the effectiveness of osteotomy techniques. Results A total of 50 patients, 74% males and 26% females 26% with a mean age of 33.14 ± 12 years were included in the study. Of the 50 patients, 23 (27 osteotomies) had undergone MDH osteotomy (group I), whereas 27 patients (37 osteotomies) had a Gigli saw osteotomy (group II). The overall mHI of both groups was 1.60 ± 0.34 month/cm (range 1.0-2.5 month/cm). When we compared the mHI of both techniques, the mean mHI was 1.72 ± 0.33 month/cm (range 1.2 - 2.5 months/cm) in MDH group and 1.54 ± 0.36 month/cm (range 1.0-2.5 month/cm) in the Gigli saw group. The healing index was significantly lower in the Gigli saw group. None of our patients showed nonunion at the osteotomy site. However, the problems of incomplete osteotomy in two cases and bone fractures in four cases were seen in MDH osteotomy. Conclusion According to our results, percutaneous Gigli saw osteotomy technique by two small incisions minimizes the local soft tissue trauma and periosteal disruption around the osteotomy more than the multiple drill holes osteotomy, resulting in better consolidation following distraction osteogenesis.