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Castro CRADP, Kakihata AM, Barros CBFD, Gonçalves M, de Souza BC, da Silva LS, Braga DM. Aquatic therapy in congenital malformation during the use of external fixator for bone lengthening: It is possible? Clinics (Sao Paulo) 2024; 79:100416. [PMID: 38897100 PMCID: PMC11237682 DOI: 10.1016/j.clinsp.2024.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/13/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES The objective of this study is to describe the rehabilitation of individuals with Congenital Malformations (CMF) during the use of an External Fixator (EF) in Aquatic Therapy (AT) and to analyze the association between diagnosis, EF type and location with rehabilitation process outcomes, surgical intervention, and adverse effects. METHODS This retrospective study included 29 medical records from which the personal and rehabilitation data of the patient were collected. The AT used was described and the outcome variables were associated. The medical records were selected by screening the database of the CMF clinic at the AACD. The inclusion criteria were participants with CMF who used EF treated between 2011 and 2019 of both genders and without age restriction. The exclusion criteria were incomplete medical record data or not undergoing AT while using EF. The extracted data included diagnosis, gender, age, EF type and location, objective of the surgery, adverse events, surgical interventions, time of rehabilitation in AT, physiotherapeutic objectives, and rehabilitation process outcomes in AT. RESULTS The mean age of the participants was 12.1 ± 3.99 years, with male predominance (55 %) and hemimelia cases (37 %). The most used EF was circular (51 %), located in the femur (37 %), and the main objective of surgery was bone lengthening (52 %). The most recurrent adverse effect was infection (62 %) and 76 % completed AT. There was no association between the variables analyzed. CONCLUSIONS It was possible to describe CMF rehabilitation with EF in AT. There was no association between the variables analyzed.
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Affiliation(s)
| | - Alessandra Mitie Kakihata
- Setor de Fisioterapia Aquática da Associação de Assistência à Criança Deficiente (AACD), São Paulo, SP, Brasil
| | | | - Monica Gonçalves
- Setor de Fisioterapia Aquática da Associação de Assistência à Criança Deficiente (AACD), São Paulo, SP, Brasil
| | - Beatriz Carvalho de Souza
- Setor de Fisioterapia Aquática da Associação de Assistência à Criança Deficiente (AACD), São Paulo, SP, Brasil
| | - Larissa Soares da Silva
- Setor de Fisioterapia Aquática da Associação de Assistência à Criança Deficiente (AACD), São Paulo, SP, Brasil
| | - Douglas Martins Braga
- Setor de Fisioterapia Aquática da Associação de Assistência à Criança Deficiente (AACD), São Paulo, SP, Brasil
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Danişman M, Yilmaz ET, Özdemir E, Tuncay O, Yilmaz G. Accuracy of the hexapod external fixator in treating tibial angular deformities with or without limb length discrepancy: a retrospective study. J Pediatr Orthop B 2023; 32:611-616. [PMID: 37278281 PMCID: PMC10529806 DOI: 10.1097/bpb.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Hexapod external fixator systems allow simultaneous deformity correction in multiple planes as well as limb lengthening. The aim of this study is to evaluate the accuracy of a hexapod frame (smart correction frame) in different types of tibial deformities requiring correction with or without lengthening. METHODS A total of 54 tibial angular deformities and limb length discrepancies operated with a hexapod frame between January 2015 and January 2021 were classified into four groups: "Group A ( n = 13): only lengthening," "Group B ( n = 14): lengthening and uniplanar correction," "Group C ( n = 16): only uniplanar correction," and "Group D ( n = 11): biplanar correction." The accuracy of angular deformity correction/lengthening was calculated by dividing the actual correction/lengthening achieved after frame removal by the preoperative planned lengthening/correction. RESULTS The lengthening accuracy in Group A and Group B was 96.3 ± 7.1% and 95.7 ± 5.9%, respectively ( P = 0.685). The angular deformity correction accuracy was 85.1 ± 9.9% for Group B, 85.2 ± 13.9% for Group C, and 80.2 ± 18.4% for Group D ( P = 0.852). A revision program was performed in six cases (1 in Group B, 1 in Group C, and 4 in Group D) for full correction of the deformities. CONCLUSION The accuracy of tibial lengthening is high with the hexapod frame and is minimally affected by simultaneous deformity correction; however, the accuracy of angular correction slightly reduces as the deformity becomes more complex. Surgeons should be aware that reprogramming may be required after complex deformity correction.
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Affiliation(s)
- Murat Danişman
- Department of Orthopaedics and Traumatalogy, Giresun University Faculty of Medicine, Giresun
| | - Engin Türkay Yilmaz
- Department of Orthopaedics and Traumatalogy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdi Özdemir
- Department of Orthopaedics & Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ozan Tuncay
- Department of Orthopaedics and Traumatalogy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güney Yilmaz
- Department of Orthopaedics and Traumatalogy, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Laliotis N, Konstantinidis P, Chrysanthou C, Giannakopoulou L, Papadopoulou E. Restoration of Limb Length Discrepancy and Alignment With the Ilizarov Device After Management of an Aneurysmal Bone Cyst Crossing the Distal Femoral Physis. Cureus 2023; 15:e46259. [PMID: 37908925 PMCID: PMC10615118 DOI: 10.7759/cureus.46259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
An aneurysmal bone cyst (ABC), when located juxta-physeal, may rarely penetrate the growth plate and extend into the epiphysis. The recurrence rate is considered higher when ABC is in contact with the active growth plate. Treatment methods usually focus on cyst healing and the rate of cyst recurrence. We present the method of treatment used for addressing the lesion of the growth plate following the surgical management and healing of a juxta-physeal ABC. A seven-year-old girl had an aggressive ABC in the juxta-physeal area of the distal femur, penetrating the growth plate and extending in the epiphysis. Surgical treatment was performed, including curettage and autologous bone grafting, avoiding the growth plate. The cyst healed; however, physis presented an obliteration. The affected limb developed valgus deformity and severe leg length discrepancy (LLD). To address this issue, once our patient completed her growth, we proceeded with distraction osteogenesis, using the Ilizarov device, with asymmetrical lengthening of the rods. We achieved the correction of the limb alignment and resolved the LLD. ABCs in the juxta-physeal area of a growing child are benign metaphyseal tumors that exceptionally may penetrate the physis and extend into the epiphysis. Our report highlights that the growth plate's lesion, despite the cyst's healing, may compromise the final result. The use of the Ilizarov device is an effective method for correcting the malalignment and the LLD that may emerge.
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Affiliation(s)
| | | | - Chrysanthos Chrysanthou
- Orthopaedics, Interbalkan Medical Center, Thessaloniki, GRC
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Motta DP, Faria JLR, Couto A, Aguiar DP, Amaral MVG, Kropf LL, Motta GAVA, Cerqueira FS, Leonetti BD. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023; 18:123-132. [PMID: 37942429 PMCID: PMC10628620 DOI: 10.5005/jp-journals-10080-1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To present a review of patients subjected to gradual correction of a valgus deformity of the tibia using a monolateral external fixator. Method This retrospective review included patients from January 2012 to May 2022 who met the following inclusion criteria: deviation of mechanical axis of the limb due to valgus deformity of the tibia; tibial deformity in the coronal plane on radiographic examination; a documented outpatient pre-operative evaluation by an orthopaedic surgeon and age between 10 and 70 years. The following exclusion criteria were applied: the presence of another tibia deformity preventing gradual correction using the proposed assembly; skin conditions incompatible with the surgical procedure; inadequate pre- or post-operative radiological evaluation; and insufficient information in the medical records. Results The mean age of patients with a valgus deformity of the tibia was 30.8 ± 15.9 years. These patients had a body mass index (BMI) of 26.1 ± 5.5 kg/m2. A congenital or developmental aetiology was attributed to 58.3% of the cases. Most commonly, the deformity was found in the middle third of the tibia with a mean deformity of 14.7 ± 6.6 degrees. The total external fixator time ranged from 73 to 229 days (average 149.7 ± 36.1 days). The mean medial proximal and lateral distal tibial angles differed significantly for pre- and post-operative measurements (p ≤ 0.05). There were complications in eight cases; five cases of pin site infections, two cases of medial cortical fracture and one case of peroneal nerve neuropraxia. Conclusion The proposed correction technique produces a satisfactory angular correction and with similar outcomes as described in the literature. How to cite this article Motta DP, Faria JLR, Couto A, et al. Gradual Correction of Valgus Deformities of the Tibia Using a Monolateral External Fixator. Strategies Trauma Limb Reconstr 2023;18(2):123-132.
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Affiliation(s)
- DP Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - JLR Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - A Couto
- National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - DP Aguiar
- Biophysics Chair, State University of Rio de Janeiro, Brazil
| | - MVG Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - LL Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - GAVA Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - FS Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - BD Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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Hydrotherapy for Patients With External Fixation: Effect on Infectious Events. J Pediatr Orthop 2023; 43:187-191. [PMID: 36728393 DOI: 10.1097/bpo.0000000000002341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgery to achieve long bone lengthening and deformity correction in skeletally immature patients is traditionally performed through external fixators. The incidence of infection during treatment is high. Hydrotherapy is highly beneficial during external fixation management, but the infection rates may impact its utilization. The objective of this paper is to document the incidence and duration of infection in patients who participated in a full hydrotherapy program when performed under medical supervision and in accordance with strict follow-up protocols. METHODS In this retrospective study, we documented the key characteristics of patients who participated in hydrotherapy after lower limb external fixation surgery including age, sex, diagnosis and surgery site, the incidence and duration of pin site infections, and the percentage of cases, which were able to comply with a full hydrotherapy protocol. RESULTS The hydrotherapy pool met all daily water quality metrics. Thirty-four children (19 males and 15 females) had a mean±SD age of 10.9±4.6 years. Of the cases, 80% were unilateral and 20% were bilateral. Diagnoses included congenital hereditary (eg, achondroplasia), congenital nonhereditary conditions (eg, fibular hemimelia), and acquired conditions (eg, traumatic). The location of osteotomy site was quite evenly spread between the femur and the tibia/fibula. Three out of the 34 patients were unable to receive hydrotherapy due to continuous secretions; 2 patients did not miss any sessions. The mean number of treatments was 3 per week. During the entire period, a total of 1200 treatments were performed for these patients with only 32 cancellations (about 3%) due to secretions or other signs of infection. Spearman correlation coefficients showed significantly high correlations between the duration of external fixation and the duration of hydrotherapy. There are no significant correlations between infections and other factors (sex, age segment, whether the problem is unilateral or /bilateral, diagnosis, and duration of treatment). CONCLUSIONS This is the first report, to our knowledge, that documents the low prevalence of infectious events during hydrotherapy treatment and demonstrates its feasibility. LEVEL OF EVIDENCE Level III; retrospective, comparative study.
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Salimi M, Sarallah R, Javanshir S, Mirghaderi SP, Salimi A, Khanzadeh S. Complication of lengthening and the role of post-operative care, physical and psychological rehabilitation among fibula hemimelia. World J Clin Cases 2022; 10:8482-8489. [PMID: 36157817 PMCID: PMC9453342 DOI: 10.12998/wjcc.v10.i24.8482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects. Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care. Muscle contractures are typically a consequence of the generated tension on the distracted muscle. It can be managed by physiotherapy initially and surgically in later severe stages. Furthermore, it is essential to avoid muscle contracture development, which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation. The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability. Joint stiffness is the other possible unfavorable effect of lengthening. It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening. Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness. Likewise, the effect of mental and physical rehabilitation programs should not be overlooked.
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Affiliation(s)
- Maryam Salimi
- Department of Orthopaedic Surgery, Shiraz University of Medical Sciences, Shiraz 71936-13311, Iran
| | - Rojin Sarallah
- Department of Medicine, Islamic Azad University Medical Branch of Tehran, Tehran 713843809, Iran
| | - Salar Javanshir
- Department of Medicine, Islamic Azad University Medical Branch of Tehran, Tehran 713843809, Iran
| | - Seyed Peyman Mirghaderi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 7138433608, Iran
| | - Amirhossein Salimi
- Department of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 7156893040, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz Sadoughi University of Medical Sciences, Tabriz 716534908, Iran
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Cheng K, Peng Y, Yan X, Wen X, Ding H. Feasibility of Computer-Aided Design in Limb Lengthening Surgery: Surgical Simulation and Guide Plates. Orthop Surg 2022; 14:2073-2084. [PMID: 35924698 PMCID: PMC9483076 DOI: 10.1111/os.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the feasibility and utility of computer‐aided design (CAD) in surgical treatment of leg length discrepancy (LLD) using monorail external fixators. Methods In the present case series, we retrospectively analyzed seven patients diagnosed with LLD who were surgically treated using a monorail external fixator between June 2018 and August 2020. A personalized surgical emulation of each patient was designed using CAD based on preoperative CT scans to measure limb parameters. Through reverse engineering, a surgical guide plate was then designed to assist with correcting the limb deformity. Patient general information and clinical history, leg length, mechanical lateral distal femoral angle (mLDFA), anatomical anterior distal tibial angle (aADTA), and surgical parameters were recorded during the perioperative period. Three months after external fixator removal, distraction‐consolidation time (DCT), healing index (HI), and lower extremity function score (LEFS) were calculated, and statistically analyzed by paired T‐test. Results The mean limb lengthening achieved was 6.41 ± 2.54 (range, 3.30–10.54) cm with either varus or valgus correction. The mean operative duration was 151 ± 41.87 (84–217) minutes and mean blood loss was 53.58 ± 22.51(25–87) ml. The mean distraction‐consolidation time was 3.67 ± 1.13 (range, 2.5–6.0) months and mean external fixator duration was 11 ± 2.45 (range, 8–14) months. The mean healing index (HI) was 18.11 ± 3.58 (range, 12.8–22.7) days/cm. Mean LEFS scores improved postoperatively from 32.17 ± 8.57 (range, 24–45) to 61.17 ± 6.68 (range, 50–67) with a significant difference (T = –14.26,P < 0.001). Conclusions Simultaneous length and angular correction can be achieved by incorporating CAD into the surgical treatment of patients with LLD, without compromising postoperative lower limb function. CAD demonstrates utility in the surgical treatment of LLD by improving the functionality of monorail external fixators.
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Affiliation(s)
- Kai Cheng
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou, China
| | - Yuanhao Peng
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaonan Yan
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Xinghua Wen
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
| | - Huanwen Ding
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Orthopedic Surgery, Guangzhou First People's Hospital, Guangzhou, China
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Ganse B, Orth M, Roland M, Diebels S, Motzki P, Seelecke S, Kirsch SM, Welsch F, Andres A, Wickert K, Braun BJ, Pohlemann T. Concepts and clinical aspects of active implants for the treatment of bone fractures. Acta Biomater 2022; 146:1-9. [PMID: 35537678 DOI: 10.1016/j.actbio.2022.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/24/2022] [Accepted: 05/02/2022] [Indexed: 12/17/2022]
Abstract
Nonunion is a complication of long bone fractures that leads to disability, morbidity and high costs. Early detection is difficult and treatment through external stimulation and revision surgery is often a lengthy process. Therefore, alternative diagnostic and therapeutic options are currently being explored, including the use of external and internal sensors. Apart from monitoring fracture stiffness and displacement directly at the fracture site, it would be desirable if an implant could also vary its stiffness and apply an intervention to promote healing, if needed. This could be achieved either by a predetermined protocol, by remote control, or even by processing data and triggering the intervention itself (self-regulated 'intelligent' or 'smart' implant). So-called active or smart materials like shape memory alloys (SMA) have opened up opportunities to build active implants. For example, implants could stimulate fracture healing by active shortening and lengthening via SMA actuator wires; by emitting pulses, waves, or electromagnetic fields. However, it remains undefined which modes of application, forces, frequencies, force directions, time durations and periods, or other stimuli such implants should ideally deliver for the best result. The present paper reviews the literature on active implants and interventions for nonunion, discusses possible mechanisms of active implants and points out where further research and development are needed to build an active implant that applies the most ideal intervention. STATEMENT OF SIGNIFICANCE: Early detection of delays during fracture healing and timely intervention are difficult due to limitations of the current diagnostic strategies. New diagnostic options are under evaluation, including the use of external and internal sensors. In addition, it would be desirable if an implant could actively facilitate healing ('Intelligent' or 'smart' implant). Implants could stimulate fracture healing via active shortening and lengthening; by emitting pulses, waves, or electromagnetic fields. No such implants exist to date, but new composite materials and alloys have opened up opportunities to build such active implants, and several groups across the globe are currently working on their development. The present paper is the first review on this topic to date.
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Shu W, Yue C, Zhong H, Tang X. Case report: Single-session double-Ilizarov lengthening technique in the treatment of a child with congenital fibular deficiency. Front Pediatr 2022; 10:952591. [PMID: 35967573 PMCID: PMC9372609 DOI: 10.3389/fped.2022.952591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Congenital fibular deficiency is a rare disease with a broad spectrum of deformities. Associated anomalies complicate the symptoms of patients and, consequently, individualized treatments that aim at normal function and acceptable appearance. CASE PRESENTATION We present a case of congenital femoral and fibular shortening in the right lower limb with foot anomaly at school age. The patient underwent limb lengthening procedure in a single session on the right femur and tibia at the same time using a double-Ilizarov frame. The functional and cosmetic of his right lower extremity achieved a good outcome. Complications were minimal except for the superficial infection. Treatment lasted for 9.2 months, allowing for returning the patient to functional activity as soon as possible. CONCLUSION A satisfactory result was obtained with limb lengthening in a single session using double Ilizarov external fixators in a school-aged patient with congenital fibular deficiency.
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Affiliation(s)
- Wen Shu
- Department of Trauma Orthopedics, Liuzhou People's Hospital, Liuzhou, China
| | - Changjie Yue
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haobo Zhong
- Department of Orthopedics, Huizhou First Hospital, Huizhou, China
| | - Xin Tang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kirienko A, Malagoli E. Ilizarov Technique in Severe Pediatric Foot Disorders. Foot Ankle Clin 2021; 26:829-849. [PMID: 34752240 DOI: 10.1016/j.fcl.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The treatment of foot disorders in pediatric age with Ilizarov method is reserved for complex cases, cases in which it is not possible to perform acute corrections or cases that need bone and soft-tissue lengthening. Ilizarov method permits to correct any deformity. Correction can be achieved progressively with a closed procedure or combining the external fixator with a treatment involving soft or bone tissues. Complications are frequent; however, most of them do not affect the outcome of the treatment.
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Affiliation(s)
- Alexander Kirienko
- External Fixation Unit, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Emiliano Malagoli
- External Fixation Unit, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, Rozzano, Milan 20089, Italy.
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Masci G, Palmacci O, Vitiello R, Bonfiglio N, Bocchi MB, Cipolloni V, Maccauro G, Pola E. Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review. World J Orthop 2021; 12:575-583. [PMID: 34485104 PMCID: PMC8384613 DOI: 10.5312/wjo.v12.i8.575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Limb lengthening techniques play an increasingly important role in the pediatric orthopedic field. The principles of the osteogenesis distraction bonded traditionally with external fixators; however, the recent deployment of fully implantable systems has been able to overcome severities related to external fixators. The PRECICE® is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven.
AIM To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening.
METHODS Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs. The clinical and radiological outcomes of interest were: the main lengthening obtained, the distraction rate, the period of time to full weight bearing, the consolidation index, and the Association for the Study and Application of Methods of Ilizarov score.
RESULTS In conclusion, data collected from the articles under investigation were comparable with the exception of the consolidation index. Unfortunately, the study population was too small and the patients’ follow-up was too short to make definitive conclusions.
CONCLUSION This review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons; however, careful pre-operative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.
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Affiliation(s)
- Giulia Masci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Osvaldo Palmacci
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Nadia Bonfiglio
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Maria Beatrice Bocchi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Valerio Cipolloni
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Pola
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
- Policlinico di Napoli University Hospital, Università della Campania Luigi Vanvitelli School of Medicine, Napoli 80100, Italy
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Malkova TA, Borzunov DY. International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100 th birthday of G. A. Ilizarov). World J Orthop 2021; 12:515-533. [PMID: 34485099 PMCID: PMC8384611 DOI: 10.5312/wjo.v12.i8.515] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/08/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
The Ilizarov method is one of the current methods used in bone reconstruction. It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA. Its main merits are viable new bone formation through distraction osteogenesis, high union rates and functional use of the limb throughout the course of treatment. The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery. Since then, the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails. They gave rise to a relatively new orthopedic subspecialty termed “limb lengthening and reconstruction surgery”. Based on a comprehensive literature search, we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community. The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating. The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents. It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
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Affiliation(s)
- Tatiana A Malkova
- Department of Medical Information and Analysis, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan 640014, Russia
| | - Dmitry Y Borzunov
- Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
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