Accordion maneuver: A bloodless tool in ilizarov

Purpose: Accordion maneuver (AM) is a “Bloodless Tool” to stimulate bone healing as described by Professor Ilizarov by a mechanism called transformation osteogenesis. It has been underdescribed in literature. Furthermore, there is lack of standard protocol for AM. We report our cases where this Bloodless Tool was used and discuss the strategies for its use in various conditions. Materials and Methods: We reviewed our cases that underwent AM during 1994−2015, through this retrospective study. In nonunion, initial compression or distraction was decided by the status of nonunion. In hypertrophic (stiff) nonunion, the first maneuver was distraction followed by compression in one cycle and the sequence was reversed in atrophic (mobile) nonunion. In hyporegenerate, distraction was discontinued, stability restored, and AM was performed with compression first. Results: Twenty-three patients were included. In 15 cases monofocal, 7 cases bifocal, and in 1 case trifocal osteosynthesis was done with Ilizarov. AM was done for hypertrophic nonunion in 6 cases, atrophic nonunion in 15 cases, and hyporegenerate in 5 cases. In 3 cases, AM was done for both hyporegenerate and docking site nonunion. In all the cases of nonunion, union was achieved and in all the cases of hyporegenerate, bone formation improved. Conclusions: Transformation osteogenesis with AM is a bloodless tool in Ilizarov. To achieve desired results, protocol for the maneuver should be based on type of pathology between the fragments