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Scholl Schell M, Xavier de Araujo F, Silva MF. Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review. Disabil Rehabil 2024; 46:1673-1684. [PMID: 37118977 DOI: 10.1080/09638288.2023.2202419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DA.
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Affiliation(s)
- Mauricio Scholl Schell
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Marcelo Faria Silva
- Physiotherapy Department, Post Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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2
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Tremblay JO, Bernstein JM, Schoenleber SJ. Lower Extremity Malformations. Pediatr Rev 2022; 43:704-713. [PMID: 36450641 DOI: 10.1542/pir.2020-001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | - Jessica M Bernstein
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
| | - Scott J Schoenleber
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR
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Proximal Femoral Focal Deficiency/Congenital Femoral Deficiency: Evaluation and Management. J Am Acad Orthop Surg 2022; 30:e899-e910. [PMID: 35486897 DOI: 10.5435/jaaos-d-21-01186] [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] [Received: 12/01/2021] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Proximal focal femoral deficiency is a congenital transverse deficiency in which the femur is globally smaller with a typical proximal deformity at the hip that may include distal involvement of knees, leg, and feet. Congenital femoral deficiency (CFD) describes a broader spectrum of longitudinal deficiency inclusive of proximal focal femoral deficiency. CFD may also include lateral distal femoral hypoplasia, knee cruciate ligament deficiency, rotational instability, patellar dislocation, fibular hemimelia, ray absence, and contralateral limb involvement. Treatment intends to maximize function by limb equalization and deformity correction ranging from nonsurgical management using prosthetics to amputation and may include lengthening, shortening, and complex limb reconstruction. Management decisions depend on overall severity and the patient and family's preferences and priorities. Owing to its complexity, CFD is best treated by clinicians with considerable deformity treatment experience who can help guide decision making and embark on a treatment course that will maximize the functional outcome.
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Femoral Lengthening in Children: A Comparison of Motorized Intramedullary Nailing Versus External Fixation Techniques. J Pediatr Orthop 2022; 42:253-259. [PMID: 35180729 DOI: 10.1097/bpo.0000000000002120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoral lengthening is associated with high complication rates often related to the type of surgical device used to perform the lengthening. The advent of intramedullary lengthening devices has promised a reduction in complications when compared with external fixation systems. The purpose of this study was to compare the clinical outcomes of femoral lengthening in children using a motorized intramedullary nail (Precice) versus an external fixation system (Taylor Spatial Frame-TSF; or Monolateral Rail System-MRS) at a single institution, single surgeon practice. METHODS This study is a retrospective comparison of pediatric patients who had previously undergone femoral lengthening (±deformity correction). Patients ages 8 to 18 years of age were included and grouped based on whether they had undergone Precice nailing or external fixation (TSF or MRS) between 2010 and 2019. RESULTS Twenty-seven patients (32 femurs) were included. Thirteen patients (15 femurs) had undergone Precice nailing and 14 patients (17 femurs) had undergone external fixation. The Precice group had significantly fewer problems, obstacles, and complications than the external fixation group, Precice 6.6%, 0%, 0%, respectively, and external fixation 47.1%, 29.4%, 0% respectively (P<0.01). Unplanned return to the operating room occurred in 4 cases, solely in the external fixation group. There were no differences in percentage of goal length achieved, Precice (mean 93.6%, range: 66.7% to 114.3%), external fixation (mean 96%, range: 76.9% to 117.5%) P=0.31 and total length achieved, Precice (mean: 44 mm, range: 20 to 80 mm), external fixation (mean: 46 mm, range: 10 to 70 mm) P=0.72. There was no difference in consolidation index, Precice (24.1 d/cm), external fixation (28.5 d/cm) P=0.36. The Precice group had a significantly shorter length of stay (mean: 2.2 d, range: 1 to 4 d), compared with the external fixation group (mean: 3.7 d, range: 2 to 8), P=0.01. CONCLUSIONS Femoral lengthening in children using a motorized intramedullary nail was associated with a markedly reduced rate of complications and shorter length of stay compared with external fixation. LEVEL OF EVIDENCE Level III.
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Hafez M, Nicolaou N, Offiah A, Offorha B, Giles S, Madan S, Fernandes JA. Quality of life of children during distraction osteogenesis: a comparison between intramedullary magnetic lengthening nails and external fixators. INTERNATIONAL ORTHOPAEDICS 2022; 46:1367-1373. [PMID: 35385976 PMCID: PMC9117380 DOI: 10.1007/s00264-022-05399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
Background Distraction osteogenesis is a very demanding process. For decades, external fixation was the only reliable option for gradual deformity correction. Recently, intramedullary magnetic nails have gained popularity. This research aimed to assess the quality of life in children during gradual deformity correction using intramedullary lengthening nails compared to external fixation. Method Prospective analysis included children who had gradual lower limb deformity correction between 2017 and 2019. Group A included children who had magnetic lengthening nails; patients in group B had external fixation devices. Child health utility 9D (CHU- 9D) and EuroQol 5D youth (EQ- 5D-Y) were used to measure the quality of life at fixed points during the distraction osteogenesis process. The results were used to calculate the utility at each milestone and the overall quality of life adjusted years (QALYs). Results Thirty-four children were recruited, group A had 16 patients, whilst group B had 18 patients. The average ages were 16.0 years and 14.7 years for groups A and B, respectively. Group A patients reported significantly better utility compared to group B. This was observed during all stages of treatment (P = 0.00016). QALYs were better for group A (0.44) compared to group B (0.34) (P < 0.0001). Conclusion The quality of life was generally better in group A compared to group B. In most patients, the health utility progressively improved throughout treatment. In the same way, QALYs were better with the lengthening nails compared to external fixators. The magnetic lengthening devices (PRECICE nails) which were used in this research were recently relabelled to restrict their applications in children; this study was conducted before these restrictions.
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Affiliation(s)
- Mohamed Hafez
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK. .,Oncology and Metabolism Department, Medical School, Sheffield University, Sheffield, UK.
| | - Nicolas Nicolaou
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - Amaka Offiah
- Oncology and Metabolism Department, Medical School, Sheffield University, Sheffield, UK
| | - Bright Offorha
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Stephen Giles
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - Sanjeev Madan
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
| | - James A Fernandes
- Paediatric Limb Reconstruction Unit, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.,Sheffield University, Sheffield, UK
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Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction. Arch Orthop Trauma Surg 2022; 142:1511-1522. [PMID: 33674962 PMCID: PMC9217775 DOI: 10.1007/s00402-021-03831-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/08/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION In absence of deformity or injury of the contralateral leg, the contralateral leg length is used to plan limb lengthening. Length variability on long-leg weight-bearing radiographs (LLR) can lead to inaccurate deformity correction. The aim of the study was to (1) examine the variability of the measured limb length on LLR and (2) to examine the influence of the position of the magnification device. MATERIALS AND METHODS The limb lengths of 38 patients during deformity correction with a taylor-spatial-frame were measured retrospectively on 7.3 ± 2.6 (4-13) LLR per patient. The measured length of the untreated limb between LLR were used to determine length variability between LLR in each patient. To answer the secondary aim, we took LLR from a 90 cm validation distance. A magnification device was placed in different positions: at the middle of the 90 cm distance (z-position), 5 cm anterior and 5 cm posterior from the z-position, at the bottom and top of the validation distance as well as 5 cm medial and 15 cm lateral from the z-position. RESULTS The measured length variability ranged within a patient from 10 to 50 mm. 76% of patients had a measured limb length difference of ≥ 2 cm between taken LLR. Compared to length measurement of the 90 cm test object with the magnification device in the z-position (90.1 cm), positioning the device 5 cm anterior led to smaller (88.6 cm) and 5 cm posterior led to larger measurements (91.7 cm). The measured length with the magnification device at the bottom, top, medial or lateral (90.4; 89.9; 90.2; 89.8 cm) to the object differed not relevantly. CONCLUSIONS High variability of limb length between different LLR within one patient was observed. This can result from different positions of the magnification device in the sagittal plane. These small changes in positioning the device should be avoided to achieve accurate deformity correction and bone lengthening. This should be considered for all length and size measurements on radiographs.
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Patients With Lower Limb Deformity Report Worse Quality of Life Than Control Subjects Regardless of Degree of Deformity. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202108000-00005. [PMID: 35103625 PMCID: PMC8357251 DOI: 10.5435/jaaosglobal-d-21-00182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to determine how Limb Deformity Modified Scoliosis Research Society (LD-SRS) scores differ between patients with different types and degrees of limb deformity compared with control subjects.
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Popkov A, Pietrzak S, Antonov A, Parol T, Lazović M, Podeszwa D, Popkov D. Limb Lengthening for Congenital Deficiencies Using External Fixation Combined With Flexible Intramedullary Nailing: A Multicenter Study. J Pediatr Orthop 2021; 41:e439-e447. [PMID: 33782369 DOI: 10.1097/bpo.0000000000001816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hydroxyapatite (HA) coated flexible intramedullary nailing (FIN) stimulates osteogenic activity. The role of HA-coated intramedullary nails remains unclear in normal bone lengthening. The goal of this study was to quantify the influence of FIN on the External Fixation Index (EFI) in patients with congenital lower limb discrepancy. METHODS Patients with femoral deficiency and fibular hemimelia underwent lengthening by the combined technique of external fixation with titanium (Ti) FIN or HA coated FIN and returned for follow-up at least 12 months after frame removal. RESULTS Seventy patients (mean age of 12.6 y) were included: 19 monofocal femoral lengthenings, 35 tibial monofocal lengthenings, 16 tibial bifocal lengthenings. The mean EFI's for those treated with and without HA-coated nails were not significantly different. The Conover posthoc analysis did not reveal a significant influence of the type of FIN on EFI in any subgroup. However, 2-way analysis of variance revealed simultaneous effects of nail types and age on the EFI in tibial bifocal lengthening.Significant positive correlation between the ratio "nail diameter/medullary shaft diameter" and EFI in tibial bifocal non-HA-coated FIN lengthening, and a significant positive correlation between age and EFI for femoral non-HA-coated FIN lengthening, tibial monofocal and bifocal HA-coated FIN lengthening were revealed.There were 4 cases of fracture at lengthening site required unscheduled surgery. In the non-HA-coated group, there was a statistically significant negative correlation between nail diameter and fracture occurrence at the lengthening site after frame removal. A ratio of <0.15 likely does not ensure required mechanical stability and support. CONCLUSIONS Both Ti-nail and HA-coated nail lengthening provide good and excellent outcomes for femoral and tibial monosegmental lengthening procedures and ensure reduced EFI. In congenital disorders which were not associated with abnormal bone, there are no differences with regard to EFI using HA-coated or non-HA-coated FIN. The ratio of "elastic Ti-nail diameter/medullary canal diameter at narrowest site" <0.15 seems to be associated with higher risk of fracture at the lengthening site after frame removal.
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Affiliation(s)
- Arnold Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Szymon Pietrzak
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Alexander Antonov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Tomasz Parol
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Mikan Lazović
- Orthopaedic Department, Children's University Hospital, Belgrade, Serbia
| | - David Podeszwa
- Department of Orthopaedics, Scottish Rite Hospital for Children, Dallas, TX
| | - Dmitry Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
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Pawik Ł, Pawik M, Wrzosek Z, Fink-Lwow F, Morasiewicz P. Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method. J Orthop Surg Res 2021; 16:62. [PMID: 33468173 PMCID: PMC7814564 DOI: 10.1186/s13018-021-02202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group. METHODS Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy. RESULTS Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used. CONCLUSIONS After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.
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Affiliation(s)
- Łukasz Pawik
- Department of Physiotherapy of Motor Disorders and Dysfunctions, University School of Physical Education, al. Paderewskiego 35, 51-612, Wrocław, Poland.
| | - Malwina Pawik
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Zdzisława Wrzosek
- Department of Physiotherapy of Motor Disorders and Dysfunctions, University School of Physical Education, al. Paderewskiego 35, 51-612, Wrocław, Poland
| | - Felicja Fink-Lwow
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education, Wrocław, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, Opole, Poland
- Department and Clinic of Orthopedic and Traumatological Surgery, Wrocław Medical University, Wrocław, Poland
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Frommer A, Rödl R, Gosheger G, Vogt B. [Application of motorized intramedullary lengthening nails in skeletally immature patients : Indications and limitations]. Unfallchirurg 2019; 121:860-867. [PMID: 30203390 DOI: 10.1007/s00113-018-0541-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Limb lengthening and deformity correction with motorized intramedullary lengthening nails is a more comfortable and equally safe procedure than the use of external fixators. While this treatment is a well-established method in adults, intramedullary nailing for skeletally immature patients remains a challenge and is the focus of current clinical investigations. OBJECTIVE Elucidation of the indications for the application of femoral and tibial lengthening nails in skeletally immature patients, presentation of essential characteristics and limitations of the treatment. MATERIAL AND METHODS Treatment of skeletally immature patients up to 16 years old who had a lengthening nail inserted was retrospectively clinically and radiologically evaluated (2016-2018). RESULTS A total of 60 procedures were performed on 54 patients. Mean age at the time of surgery was 13.6 years and the mean follow-up time was 10 months. Different nailing approaches were used: antegrade femoral (n = 42), retrograde femoral (n = 10) and antegrade tibial (n = 8). The average amount of lengthening was 45 mm. In 58 of the 60 cases (96.7%) the desired amount of lengthening was achieved, while 2 patients experienced complications that required interruption of the treatment. None of the patients developed growth disorders associated with the nailing approach. CONCLUSION Different approaches for intramedullary lengthening nails can be used in children and adolescents to correct leg length discrepancy with or without concomitant deformities. The treatment is limited by the size of the available nails, the residual growth and extent of the deformity. Larger trials will be needed to further validate the application of lengthening nails in skeletally immature patients.
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Affiliation(s)
- A Frommer
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
| | - R Rödl
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - G Gosheger
- Klinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Münster, Deutschland
| | - B Vogt
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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Veilleux LN, AlOtaibi M, Dahan-Oliel N, Hamdy RC. Incidence of knee height asymmetry in a paediatric population of corrected leg length discrepancy: a retrospective chart review study. INTERNATIONAL ORTHOPAEDICS 2018; 42:1979-1985. [PMID: 29387916 DOI: 10.1007/s00264-018-3794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of the study is to provide a methodology to quantify knee height asymmetry (KHA) and to establish the incidence of knee height asymmetry in a patient population visiting the limb length discrepancy clinic in a paediatric-orthopaedic hospital centre. METHOD A retrospective chart review was performed on all patients who attended the limb length discrepancy clinic and underwent corrective surgery at the Shriners Hospital for Children-Canada from December 2009 to December 2015. Full-standing anteroposterior radiographs were used to measure pre- and post-surgery limb length discrepancy and knee height asymmetry for 52 individuals included in the study. RESULTS Sixty-seven percent of the studied population had a KHA of 20 mm or less, 25% had a KHA between 20 and 40 mm, and 8% had a KHA of over 40 mm. The average KHA preoperatively for all 52 individuals was 17 ± 14 mm (range 0-59 mm), which represents roughly 2.5% of total limb length. There was a 3-mm non-significant reduction in KHA size between pre-and post-operative states (p = 0.22). CONCLUSION The current study provides a method to quantify knee height asymmetry. Using this method, it was shown that knee height asymmetry is frequent in youth with limb length discrepancy in both pre- and post-corrective surgery states. The relatively high incidence of knee height asymmetry highlights the importance to investigate the impact of knee height asymmetry in youth living with a limb length discrepancy.
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Affiliation(s)
- Louis-Nicolas Veilleux
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada. .,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada.
| | - Mohammed AlOtaibi
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Graduate Studies, McGill University, 845 Sherbrooke Street West, Montreal, Quebec, H3A 0G4, Canada.,King Fahad Medical City, Al Mukarramah Branch Rd, As Sulimaniyah, Riyadh, Makkah, 11525, Saudi Arabia
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada
| | - Reggie C Hamdy
- Shriners Hospital for Children, 1003, Boulevard Décarie, Montréal, Quebec, H4A 0A9, Canada.,Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, H3G 2M1, Canada
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The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect. Injury 2017; 48:2842-2846. [PMID: 29122280 DOI: 10.1016/j.injury.2017.10.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.
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13
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Kaastad TS, Tveter AT, Steen H, Holm I. Physical function and health-related quality of life in young adults with unilateral congenital lower-limb deficiencies. J Child Orthop 2017; 11:348-357. [PMID: 29081849 PMCID: PMC5643928 DOI: 10.1302/1863-2548.11.170026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The primary aim was to examine if there were differences in physical function and health-related quality of life (HRQoL) between young adults (18 to 35 years) with unilateral congenital lower-limb deficiency (CLLD) who had been surgically lengthened (Surg) and those using lengthening prostheses (Pros). Second, we wanted to compare their health status with an age- and gender-matched reference group (Ref) without CLLD. METHODS Cross-sectional study including a study-specific questionnaire, clinical examination, two field tests evaluating physical function (the six-minute walk test and the Stair test) and HRQoL questionnaires (Short Form (SF)-36 and EuroQol (EQ)-5D-3L). RESULTS Physical function and HRQoL did not differ between the two treatment groups. The odds for having painful or disfiguring scars were 18 times higher in the Surg group (n = 16) compared with the Pros group (n = 14). The CLLD group showed significantly reduced physical function compared with the Ref group. HRQoL, measured by the EQ-5D-3L visual rating scale, was significantly reduced in the CLLD group compared with the Ref group, as was the SF-36 physical function domain in both genders. Men with CLLD also showed increased bodily pain and reduced general health (SF-36), while we found a reduction in the emotional role domain in women compared with Ref. CONCLUSION There were no significant differences in physical function and quality of life in young adults with CLLD treated with surgical lengthening compared with those using lengthening prostheses. Compared with the general Norwegian population, young adults with CLLD had significantly lower physical function and reduced HRQoL in some domains.
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Affiliation(s)
- T. S. Kaastad
- Division of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Post Office Box 4956 Nydalen, 0424 Oslo, Norway,Correspondence should be sent to: T. S. Kaastad, Division of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Post Office Box 4956 Nydalen, 0424 Oslo, Norway. E-mail:
| | - A. T. Tveter
- Division of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Post Office Box 4956 Nydalen, 0424 Oslo, Norway and Institute of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, 0130 Oslo, Norway
| | - H. Steen
- Division of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Post Office Box 4956 Nydalen, 0424 Oslo, Norway and Institute of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, 0130 Oslo, Norway
| | - I. Holm
- Division of Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, Post Office Box 4956 Nydalen, 0424 Oslo, Norway and Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway
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Abstract
Successful limb reconstruction surgery not only relies on surgical skill but probably more on assessment and planning before intervention. A clear appreciation of the child as a whole, an understanding of natural history and the ability to carefully evaluate the patient clinically are key to successful treatment. The appropriate use of investigations and the ability to analyze, plan and execute a treatment plan is challenging and requires experience and training. This paper outlines some of the steps required to assess the patient with a complex limb deformity.
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15
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Popkov A, Foster P, Gubin A, Borzunov D, Popkov D. The use of flexible intramedullary nails in limb lengthening. Expert Rev Med Devices 2017; 14:741-753. [DOI: 10.1080/17434440.2017.1367284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Arnold Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russian Federation
| | | | - Alexander Gubin
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Dmitry Borzunov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Dmitry Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Kurgan, Russian Federation
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16
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Popkov D, Lascombes P, Journeau P, Popkov A. Current approaches to flexible intramedullary nailing for bone lengthening in children. J Child Orthop 2016; 10:499-509. [PMID: 27826905 PMCID: PMC5145831 DOI: 10.1007/s11832-016-0781-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Limb-length discrepancies and extremity deformities are among the most common non-traumatic orthopaedic conditions for which children are hospitalised. There is a need to develop new treatment options for lower-limb length discrepancy in order to ameliorate treatment outcomes, avoid or reduce rates of complication and provide early rehabilitation. The authors report on the basic principles, experimental and clinical data, advantages, problems and complications of a combined technique associating the Ilizarov method and flexible intramedullary nailing (FIN) in limb lengthening and deformity correction in children. They describe features of the use of hydroxyapatite-coated intramedullary nails in patients with certain metabolic bone disorders and in cases where bone consolidation has been compromised. The advantages of bone lengthening using a combined technique (circular fixator plus FIN) are a lower healing index, quicker distraction-consolidation, a reduced rate of septic and bone complications, the ability to correct deformities gradually and the increased stability of bone fragments during the external fixation period and after frame removal.
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Affiliation(s)
- Dmitry Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6 M. Ulyanova Street, Kurgan, 640014, Russian Federation.
| | - Pierre Lascombes
- Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, rue Willy Donzé 6, 1211, Geneva 14, Switzerland
| | - Pierre Journeau
- CHU Brabois, Hôpital d'Enfants, Chirurgie Infantile Orthopédique, Rue du Morvan, 54500, Vandoeuvre, France
| | - Arnold Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6 M. Ulyanova Street, Kurgan, 640014, Russian Federation
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17
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Schiedel F, Rödl R. [Spectrum of indications for intramedullary or external fixators for axis correction and limb lengthening]. DER ORTHOPADE 2014; 42:1018-29. [PMID: 24201831 DOI: 10.1007/s00132-012-2051-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Corrective osteotomy is a well established operative option for correction of predominantly congenital skeletal deformities on the growing skeleton. The indications for the use of a suitable corrective instrument result partly from the location, severity of the deformity and the presence of concomitant leg length discrepancies. External fixators are predominantly used for correction of combined deformities. For isolated leg length differences limb lengthening nails can be implanted but only after growth plates have become closed; however, only a few combined deformities can be addressed in this way. Often several surgical steps are necessary. A careful treatment plan can only be created if the analysis of the deformity is carried out with appropriate parameters and a correct prognosis of the further development. The aim of this paper is to describe the indications for the corrective instruments, the planning of corrections and the presentation of typical indications for axis correction and limb lengthening.
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Affiliation(s)
- F Schiedel
- Abteilung für Kinderorthopädie, Deformitätenrekonstruktion und Fußchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland,
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18
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Abstract
Limb deformity can occur in the pediatric and adolescent populations from multiple etiologies: congenital, traumatic, posttraumatic sequelae, oncologic, and infection. Correcting these deformities is important for many reasons. Ilizarov popularized external fixation to accomplish this task. Taylor expanded on this by designing an external fixator in 1994 with 6 telescoping struts that can be sequentially manipulated to achieve multiaxial correction of deformity without the need for hinges or operative frame alterations. This frame can be used to correct deformities in children and has shown good anatomic correction with minimal morbidity. The nature of the construct and length of treatment affects psychosocial factors that the surgeon and family must be aware of prior to treatment. An understanding of applications of the Taylor Spatial Frame gives orthopedic surgeons an extra tool to correct simple and complex deformities in pediatric and adolescent patients.
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Affiliation(s)
- Michael Paloski
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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19
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Dheensa S, Thomas S. Investigating the relationship between coping, quality of life and depression/anxiety in patients with external fixation devices. Int J Orthop Trauma Nurs 2012. [DOI: 10.1016/j.ijotn.2011.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Sabharwal S, Green S, McCarthy J, Hamdy RC. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2011; 93:213-21. [PMID: 21248221 DOI: 10.2106/jbjs.j.01420] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopaedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA.
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21
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Koster M, Minnaert AEMG, Nakken H, Jan Pijl S, van Houten EJ. Assessing Social Participation of Students With Special Needs in Inclusive Education: Validation of the Social Participation Questionnaire. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2010. [DOI: 10.1177/0734282910384065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study addresses the convergent validity of a new teacher questionnaire to assess the social participation of students with special needs in regular primary schools. The Social Participation Questionnaire (SPQ) consists of four subscales representing four key themes of social participation: friendships/relationships, contacts/interactions, student’s social self-perception, and acceptance by classmates. The study took place in Grades 1 to 3 of regular Dutch primary schools that had at least one student with an official special-needs statement. A confirmatory factor analysis using the LISREL program provided evidence for the SPQ’s convergent validity. The outcomes support the model of social participation distinguishing four key themes. The fit indexes suggest that our model is theoretically viable for Grades 1 and 2 but only partly viable for Grade 3.
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Affiliation(s)
| | | | - Han Nakken
- University of Groningen, Groningen, The Netherlands
| | - Sip Jan Pijl
- University of Groningen, Groningen, The Netherlands, Norwegian University of Science and Technology, Trondheim, Norway
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