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Wang Q, Ma T, Li Z, Zhang K, Huang Q. Semi-focal bone transport versus traditional bone transport technique for the management of large tibial bone defects after trauma. Sci Rep 2024; 14:7982. [PMID: 38575734 PMCID: PMC10994901 DOI: 10.1038/s41598-024-58548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
How to deal with large tibial bone defects is still controversial. The purpose of this research was to compare the semi-focal bone transport (SFBT) technique with traditional bone transport (TBT) technique for treating such patients. Sixty-two patients were included and retrospectively analyzed. In all cases, after radical debridement large tibial bone defects remained. Patients were treated by the SFBT or TBT technique. The distraction, consolidation duration and complications were recorded by the patients' medical files. Based on the Association for the Study and Application of Methods of Ilizarov (ASAMI) standard, the bone and functional results were evaluated. The mean bone defect size was 7.7 ± 1.6 cm and 7.5 ± 2.1 cm for SFBT and TBT patients. The mean external fixation index (EFI) was 1.51 ± 0.14 months/cm and 1.89 ± 0.25 months/cm for SFBT and TBT patients (p < 0.05), respectively. With respect to bone and function results, there was no significant differences between the two groups (p > 0.05). The mean number of complications per patient was 1.1 ± 0.6 and 1.6 ± 0.7 for SFBT and TBT patients (p < 0.05). Compared to the traditional bone transport technique, patients using the semi-focal bone transport technique achieved better clinical effects, including shorter EFI and less complications. Therefore, the SFBT technique could be a new option for patients with large tibial bone defects.
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Affiliation(s)
- Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
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Cibura C, Ull C, Rosteius T, Lotzien S, Godolias P, Rausch V, Schildhauer T, Kruppa C. The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases. Z Orthop Unfall 2024; 162:166-178. [PMID: 36167325 DOI: 10.1055/a-1910-3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. MATERIALS AND METHODS Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. RESULTS The mean time of fixator treatment was 29 (range 15-65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2-186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. CONCLUSION The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.
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Affiliation(s)
- Charlotte Cibura
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Christopher Ull
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Thomas Rosteius
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Sebastian Lotzien
- Unfallchirurgie, Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil, Bochum, Deutschland
| | - Periklis Godolias
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Valentin Rausch
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Thomas Schildhauer
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - Christiane Kruppa
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
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Seng DWR, Oh CW. Critical size bone defects managed with modern techniques of bone transport: An update. Injury 2024; 55:111341. [PMID: 38244250 DOI: 10.1016/j.injury.2024.111341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/10/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Bone transport is one of several techniques that has been proven to be effective in addressing critical bone loss. While it was first described over 100 years ago, modifications to this technique coupled with advances in technology have allowed us to perform bone transport with higher success rates and reduced complication rates. Modern techniques of bone transport aim to shorten the duration of time an external fixator is utilized to reduce its associated complications and burden to patients. We present an update on modern techniques of bone transport for critical size defects and methods to shorten the external fixation time.
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Affiliation(s)
- Daniel W R Seng
- Department of Orthopaedic Surgery. Woodlands Health. National Health Group, Singapore
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Korea.
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Li Z, Liu J, Li C, Wu M, Li Y, Cui Y, Xiong W, Yang F, Liu B. Advances in the Application of Bone Transport Techniques in the Treatment of Bone Nonunion and Bone Defects. Orthop Surg 2023; 15:3046-3054. [PMID: 37963829 PMCID: PMC10694017 DOI: 10.1111/os.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Bone nonunion and bone defects frequently occur following high-energy open injuries or debridement surgeries, presenting complex challenges to treatment and significantly affecting patients' quality of life. At present, there are three primary treatment options available for addressing bone nonunion and bone defects: vascularized bone grafts, the Masquelet technique, and the Ilizarov technique. The Ilizarov technique, also known as distraction osteogenesis, is widely favored by orthopedic surgeons because of several advantages, including minimal soft tissue requirements, low infection risk, and short consolidation time. However, in recent years, the application of the Masquelet technique has resulted in novel treatment methods for managing post-traumatic bone infections when bone defects are present. Although these new techniques do not constitute a panacea, they continue to be the most commonly employed options for treating complex large bone nonunion and bone defects. This review evaluates the currently available research on the Ilizarov and Masquelet bone transport techniques applied at various anatomical sites. Additionally, it explores treatment durations and associated complications to establish a theoretical foundation that can guide clinical treatment decisions and surgical procedures for the management of bone nonunion and bone defects.
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Affiliation(s)
- Zhenhao Li
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Jiahe Liu
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Chenzhi Li
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Mingjian Wu
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Yancheng Li
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Yan Cui
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Wanqi Xiong
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
| | - Fan Yang
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
- Institute of Metal Research Chinese Academy of SciencesShenyangChina
| | - Baoyi Liu
- Department of OrthopaedicsAffiliated Zhongshan Hospital of Dalian UniversityDalianChina
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Xie L, Huang Y, Zhang L, Si S, Yu Y. Ilizarov method and its combined methods in the treatment of long bone defects of the lower extremity: systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:891. [PMID: 37968675 PMCID: PMC10652567 DOI: 10.1186/s12891-023-07001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Ilizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods. METHODS Studies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique. RESULTS Sixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity. CONCLUSION Our study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.
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Affiliation(s)
- Lijun Xie
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, P. R. China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, P. R. China
| | - Ye Huang
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
| | - Libi Zhang
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
| | - Shuting Si
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China
| | - Yunxian Yu
- Department of Public Health, and Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China.
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China.
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Ghaly HM, El-Rosasy MAM, Marei AE, El-Gebaly OA. Simultaneous femoral and tibial lengthening for severe limb length discrepancy in fibular hemimelia. J Orthop Surg Res 2023; 18:844. [PMID: 37936235 PMCID: PMC10631071 DOI: 10.1186/s13018-023-04229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/22/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Fibular Hemimelia (FH) is the most common longitudinal limb deficiency. Significant limb length discrepancy (LLD) will necessitate long treatment times and multiple settings to compensate for LLD when associated with femoral shortening. This study evaluates the outcome of simultaneous femoral and tibial lengthening using the Ilizarov frame. METHODS This retrospective study included the cases of 12 children with severe limb length discrepancy caused by combined FH and ipsilateral femoral shortening from May 2015 to August 2022. The total LLD ranged from 7 to 14.5 cm. All patients underwent single-session femoral and tibial lengthening using the Ilizarov ring external fixator technique. Additional procedures were performed in the same setting, including Achilles tendon lengthening, fibular anlage excision, peroneal tendons lengthening, and iliotibial band release. Follow-up ranged from 2 to 4 years. RESULTS The planned limb lengthening was achieved in ten cases (83%). No cases of joint subluxation or dislocation were encountered. No neurovascular injury has occurred during the treatment course. In all cases, the bone healing index was better on the femoral side than on the tibia. Poor regeneration and deformity of the tibia occurred in two cases (16.6%). CONCLUSION Simultaneous femoral and tibial lengthening using the Ilizarov fixator is a relatively safe procedure with the result of correction of total LLD in one session in a shorter time and less morbidity.
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Bakircioglu S, Danisman M, Tuncay O, Kolac UC, Bulut MA, Yilmaz G. Complex rigid foot deformity correction with hexapod external fixator system. Int Orthop 2023; 47:2773-2780. [PMID: 37460652 DOI: 10.1007/s00264-023-05897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Complex rigid foot deformities include three-plane deformities and usually presents with poor soft tissue coverage. In the last decades, gradual correction with computer-assisted fixator became an appropriate option for the treatment rigid foot deformities. This study aims to report our experience about treatment of complex foot deformities using Smart Correction fixator system®. METHODS We retrospectively analyzed 13 complex rigid foot deformities of ten consecutive patients treated with Smart Correction fixator system® from 2016 to 2020. Primary outcomes were classified as good, fair, and poor according to previously determined criteria. The outcomes were also assessed with The Manchester-Oxford Foot Questionnaire (MOXFQ). Non-parametric analysis (Wilcoxon test) for continuous variables and the Fisher's exact test for categorical variables were used. RESULTS Plantigrade foot was achieved in all patients after correction program. Supramalleolar osteotomy was applied in nine feet, midfoot osteotomy was applied in two feet, hindfoot osteotomy was required in one foot, and only soft tissue distraction performed in two feet. Two patients had recurrent deformity managed by further acute corrections. The mean MOXFQ scores improved from 72.7 preoperatively to 24.8 at last follow-up. CONCLUSIONS Present study shows that SCF the reliable option for the treatment of complex foot deformities, which also facilitates three-plane correction and concomitant lengthening with gradual soft tissue balance.
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Affiliation(s)
- Sancar Bakircioglu
- Department of Orthopedics and Traumatology, TOBB Economy and Technology University, Ankara, Turkey.
| | - Murat Danisman
- Department of Orthopedics and Traumatology, Giresun University, Giresun, Turkey
| | - Ozan Tuncay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Ulas Can Kolac
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Muhammed Abdulkadir Bulut
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Guney Yilmaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
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Liu Y, Tan Q, Liu K, Yang G, Zhu G, Wu J, Mei H. Is physeal distraction osteogenesis a good choice to treat CPT patients with tibial shortening? J Pediatr Orthop B 2023; 32:617-620. [PMID: 36912081 DOI: 10.1097/bpb.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The purpose of this study was to evaluate the healing index and complications of distraction osteogenesis through the physis in children with Congenital pseudarthrosis of the tibia (CPT) using Ilizarov external fixation device. Nine children with CPT who underwent distraction osteogenesis through the physis surgery with an Ilizarov external fixation device between June 2018 and August 2020 were included in the study. The average follow-up time was 36.1 months. X-ray examination was performed 1 month after physis lengthening, and the callus quality was evaluated using the Li classification. Any complications and the quality of the callus after tibial lengthening were followed up. The average age at the time of operation was 9.4 years, and the average follow-up time was 36.1 months. The average lengthening length of children with CPT was 6.6 cm. The incidence of good callus morphology was 100%, and the healing index was 51.1 d/cm. The average fixation time of the external fixation device was 316 days. Needle tract infection occurred in one case, ankle stiffness occurred in one case, ankle plantar flexion 20° deformity occurred in one case, angular deformity of the tibial lengthening segment occurred in one case (7°) and limited movement of knee joint occurred in one case (0-20°-70°). The osteogenic quality of the patients of distraction osteogenesis through the physis with tibial shortening and small diameter of the proximal tibia is good, which provides a choice of operation for the children with CPT.
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Affiliation(s)
- Yaoxi Liu
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, The School of Pediatrics, Heng Yang Medical School, University of South China, Changsha City, Hunan Province, China
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Kurniawan A, Ivansyah MD, Dilogo IH, Hutami WD. Umbilical cord mesenchymal stem cells combined with secretome for treating congenital pseudarthrosis of the Tibia: a case series. Eur J Orthop Surg Traumatol 2023; 33:2881-2888. [PMID: 36879164 DOI: 10.1007/s00590-023-03511-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Most patients with congenital pseudoarthrosis of tibia (CPT) do not have promising outcomes despite multiple attempts using conventional surgeries. The combination of umbilical cord-derived mesenchymal stem cells and conditioned medium (secretome) contains major components pivotal for the enhancement of fracture healing. The purpose of this study was to address fracture healing in CPT cases that were treated using the combined implantation of umbilical-cord mesenchymal stem cells (UC-MSCs) and secretome. MATERIALS AND METHODS From 2016 to 2017, six patients with CPT who were treated by one senior pediatric orthopedic consultant at a single center (3 girls and 3 boys; mean age of 5.8 years) were included in this case series. A combined procedure including resection of hamartomatous fibrotic tissue, implantation of MSCs and secretome, and fixation using a locking plate and screws was performed. Patients were followed up for a mean of 29 months. Leg-length discrepancy, refracture rate, functional outcome, and radiological outcomes were assessed preoperatively, immediately postoperatively and at the final follow-up. RESULT Five out of 6 (83%) of the patients experienced primary union. One patient experienced refracture; however, 8 months later, after another implantation and reconstruction were performed, union eventually occurred. Significant functional improvement was achieved after at least 1 year of follow-up. CONCLUSION This case series suggests that the combination of secretome and UC-MSCs is a potential treatment for CPT, it highlights the efficacy of the combined procedure in treating CPT and in achieving satisfying results. A larger number of subjects and longer follow-up are required for further study.
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Affiliation(s)
- Aryadi Kurniawan
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Muhammad Deryl Ivansyah
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, 10430, Indonesia.
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Westrick ER, Bernstein M, Little MT, Marecek GS, Scolaro JA. Orthopaedic Advances: Use of Three-Dimensional Metallic Implants for Reconstruction of Critical Bone Defects After Trauma. J Am Acad Orthop Surg 2023; 31:e685-e693. [PMID: 37384878 DOI: 10.5435/jaaos-d-22-00676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/26/2023] [Indexed: 07/01/2023] Open
Abstract
Multiple successful strategies exist for the management of critical-sized bone defects. Depending on the location and etiology of an osseous defect, there are nuances that must be considered by the treating surgeon. The induced membrane technique and various modifications of the Ilizarov method (bone transport by distraction osteogenesis) have been the most common methods for biologic reconstruction. Despite the versatility and high union rates reported, they may not be practical for every patient. The rapid expansion of three-dimensional printing of medical devices has led to an increase in their use within orthopaedic surgery, specifically in the definitive treatment of critical bone defects. This article proposes indications and contraindications for implementation of this technology and reviews the available clinical evidence on the use of custom nonresorbable implants for the treatment of traumatic bone loss. Clinical cases are presented to illustrate the scenarios in which this approach is viable.
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Affiliation(s)
- Edward R Westrick
- From the Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA (Westrick), the Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada (Bernstein), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Little), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Marecek), and the Department of Orthopaedic Surgery, University of California Irvine, Orange, CA (Scolaro)
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Thakeb MF, Kozman MA, ElGebeily MA, Baraka MM, Al Kersh MA. Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial. J Orthop Trauma 2023; 37:462-468. [PMID: 37074808 DOI: 10.1097/bot.0000000000002613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVES To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in the management of infected long-bone defects. DESIGN Prospective, randomized, controlled study. SETTING Tertiary-level center. PARTICIPANTS Thirty patients with infected nonunited long-bone fractures of lower limbs were included. INTERVENTION Fifteen patients were treated by BTM in group A, and 15 patients were treated by BT in group B. OUTCOME MEASUREMENTS The outcome measures were external fixation time, external fixation index, and docking time. Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov scoring system. Postoperative complications were evaluated according to the Paley classification. RESULTS The mean docking time was significantly lower in the BTM group than in the BT group (3.6 ± 0.82 months vs. 4.8 ± 0.86 months, respectively; P value 0.001). Docking site nonunion and infection recurrence were significantly lower in the BTM group than in the BT group (0% vs. 40%; P value 0.02 and 0% vs. 33.3%; P value 0.04, respectively), with no significant difference in the external fixation index ( P value 0.08). CONCLUSIONS This is the first prospective, randomized, controlled study comparing BTM and BT techniques, showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates, and lower number of additional procedures needed at the expense of 2-staged operation in comparison with BT. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mootaz F Thakeb
- Division of Limb Reconstruction Surgery, Department of Orthopedic Surgery, Faculty of Medicine, Ain-Shams University, Abbasia, Cairo, Egypt
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Fidan F, Kılıç F, Lapçin O, Polat A, Kılıç M, Sökücü S. Effect of transported segment size on the new bone formation of the rabbit femur in the Ilizarov bone transport method. Acta Orthop Traumatol Turc 2023; 57:215-220. [PMID: 37850240 PMCID: PMC10724839 DOI: 10.5152/j.aott.2023.22087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/23/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This study aimed to compare histological and radiological union in the bone transport of 3 segments of different sizes to reconstruct the rabbit femur's bone defects. METHODS Thirty rabbits were divided into 3 groups; a 1-cm defect was created in the femur in all rabbits. The length of the segment to be transferred was 10% of the femur length in group 1, 15% in group 2, and 20% in group 3. All defects were reconstructed by applying bone transport. At the end of the consolidation period, the distraction zone was compared radiologically and histologically. RESULTS While there was no radiological difference between the groups, the highest histological scores were obtained from group 3. Osteocalcin staining revealed similar involvement in groups 2 and 3, butless involvement in group 1. CONCLUSION Evidence from this study has shown that as the size of the segment used for bone transport increases, more stable fixation and better histological union tissue can be obtained in the rabbit femoral defect model.
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Affiliation(s)
- Fırat Fidan
- Department of Orthopedic and Traumatology, Istanbul Aydın University, School of Medicine, Istanbul, Turkey
| | - Feyzi Kılıç
- Department of Orthopedic and Traumatology, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Osman Lapçin
- Department of Orthopedic and Traumatology, Istanbul Aydın University, School of Medicine, Istanbul, Turkey
| | - Abdülkadir Polat
- Department of Orthopedic and Traumatology, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kılıç
- Department of Orthopedic and Traumatology, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Sami Sökücü
- Department of Orthopedic and Traumatology, Istanbul Aydın University, School of Medicine, Istanbul, Turkey
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Hamiti Y, Yalikun A, Lu C, Yusufu A, Yushan M. Ilizarov technique in the treatment of bone defects of the radius and ulna: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:642. [PMID: 37649069 PMCID: PMC10469416 DOI: 10.1186/s13018-023-04126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
PURPOSE The objective of this systematic review and meta-analysis was to assess the efficacy of the Ilizarov method in the treatment of radius and ulna bone defects. METHODS The PubMed, Embase, Web of Science, Cochrane Library, Ovid MEDLINE, and Scopus databases were searched for articles published up to May 2023. The quality of the studies was evaluated using a modified version of the Newcastle-Ottawa scale. The effect size and confidence intervals at 95% for the main results were calculated. The heterogeneity was evaluated. The demographic data, defect size (DS), external fixation time (EFT), external fixation index (EFI), and complications were extracted and analyzed using the Stata version 16. RESULTS This meta-analysis identified and included seven studies involving 98 patients. The union rate of 100% was reported in all studies. According to the findings of the single-arm meta-analysis, the pooled DS was 3.42 cm (95% CI [2.64, 4.21], I2 = 53.5%, P = 0.045), EFT was 148.43 days (95% CI [97.49, 199.38], I2 = 91.9%, P = 0.000), and EFI was 41.32 days/cm (95% CI [35.72, 46.91], I2 = 62.2%, P = 0.021). Pin tract infection was the most common complication, as reported in six studies. CONCLUSION The findings of the present meta-analysis indicate that the Ilizarov technique is a successful treatment option for bone defects in the radius and ulna. This method has demonstrated efficacy in achieving expected clinical outcomes.
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Affiliation(s)
- Yimurang Hamiti
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Ainizier Yalikun
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Cheng Lu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China.
| | - Maimaiaili Yushan
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Xinjiang Medical University, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, Ürümqi, Xinjiang, People's Republic of China.
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El-Gammal TA, Ali AES, Kotb MM, Saleh WR, Ragheb YF, Refai OA, Morsy MM, El-Gammal YT. Congenital Pseudarthrosis of the Tibia: Long-term Outcome of Treatment With Intramedullary Vascularized Fibular Graft Combined With Ilizarov Distraction. J Pediatr Orthop 2023; 43:e487-e492. [PMID: 36941117 DOI: 10.1097/bpo.0000000000002399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Late presenting cases of congenital pseudarthrosis of the tibia, are further complicated with severe shortening. Limb length discrepancy (LLD) cannot be corrected by vascularized fibular grafting and the use of Ilizarov distraction is associated with a high rate of complications. The aim of this study was to report the long-term follow-up of a combined technique previously published under the name "telescoping vascularized fibular graft". MATERIALS AND METHODS Eleven patients operated at an average age of 10.2±3.2 years were reviewed. All cases were Crawford type IV affected by neurofibromatosis 1. Nine patients had an average of 4.3 previous operations. Preoperative LLD averaged 7.9±2.5 cm. RESULTS Follow-up averaged 10±5.4 years. Seven cases (63.6%) reached skeletal maturity before final follow-up. Primary union was achieved in all cases after an average of 7.2±1.3 months. Full weightbearing was possible after an average of 10.6±2.2 months. Recurrent stress fractures occurred in 9 cases (81.8%) and healed with casting in 6 cases and required internal fixation in 3 cases. Eight cases (72.8%) developed tibial shaft deformities, mainly procurvatum that required corrective osteotomy in 2 cases. Final LLD averaged 2.7±1.3 cm. Complete tibialization of the graft was achieved after an average of 17.0 ± 3.6 months. Valgus deformity of the ipsilateral ankle averaged 12.4 degrees±7.5. CONCLUSION The presented technique avoids osteotomy of the diseased bone and allows simultaneous treatment of the pseudarthrosis and correction of shortening. Compared with conventional bone transport, it requires shorter time of frame application and therefore better patient tolerability because there is no waiting for consolidation of the regenerate. The dis-impaction of the doweled fibula occurs proximally, allowing the less active site located at the distal aspect of the pseudarthrosis to heal without displacement. A shortcoming of the presented technique is the more propensity for axial deviation and refractures that seldom require surgery. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
- Tarek Abdalla El-Gammal
- Department of Orthopedics and Traumatology, Reconstructive Microsurgery Unit, Assiut University Hospitals and School of Medicine, Assiut, Egypt
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Liu K, Jia Q, Wang X, Bahesutihan Y, Ma C, Ren P, Liu Y, Yusufu A. Complications associated with single-level bone transport for the treatment of tibial bone defects caused by fracture-related infection. BMC Musculoskelet Disord 2023; 24:514. [PMID: 37353801 PMCID: PMC10288666 DOI: 10.1186/s12891-023-06527-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/12/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The purpose of this study was to report the outcomes of single-level bone transport with a unilateral external fixator for treatment of proximal, intermediate and distal tibial bone defects caused by fracture-related infection (FRI) and compare their complications. METHODS The clinical records and consecutive X-ray photographs of patients with tibial bone defects treated by single-level bone transport using a unilateral external fixator (Orthofix Limb Reconstruction System) were analyzed retrospectively, from January 2012 to December 2018. Patients were divided into the proximal group (P, n = 19), intermediate group (I, n = 25), and distal group (D, n = 18) according to the location of the tibial bone defect. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes and postoperative complications evaluated by the Paley classification. RESULTS A total of 62 participants were included in this study, with a median age of 36 ± 7.14 years. Sixty patients with tibial bone defects caused by FRI were successfully treated by single-level bone transport using a unilateral external fixator, with a mean bone union time (BUT) of 7.3 ± 1.71 months. According to the ASAMI criteria, there were statistical differences in bone and function results between the three groups (P vs. I vs. D, P < 0.001). The excellent and good rate of bone result in the intermediate group was higher than the other (P vs. I vs. D, 73.6% vs. 84% vs. 66.7%), and the excellent and good rate of function result in the proximal group was the highest (P vs. I vs. D, 84.2% vs. 80% vs. 73.3%). Complications were observed in 29 out of 62 patients (46.7%), with pin tract infection being the most common (14.8%), followed by axial deviation (14.8%), muscle contractures (12.7%), joint stiffness (12.7%), and soft tissue incarceration (12.7%). Other complications included delayed consolidation (12.7%), delayed union (6.3%), nonunion (4.2%), and neurological injury (8.5%). Two patients (3.2%) required below-knee amputation due to uncontrollable infection and previous surgery failure. CONCLUSIONS Pin tract infection was the most common complication in tibial bone transport using an external fixator. Complications of distal tibial bone transport are more severe and occur at a higher rate than in other parts. Axial deviation mostly occurred in the intermediate tibial bone transport.
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Affiliation(s)
- Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Qiyu Jia
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Xin Wang
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yemenlehan Bahesutihan
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Chuang Ma
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yanshi Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 650032, Sichuan, China.
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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El-Adly W, El-Gafary K, Khashaba A, Khaled M. Results of Ilizarov external fixator lengthening compared to lengthening and then plating in management of femoral shortening in children. Acta Orthop Belg 2023; 89:177-182. [PMID: 37924532 DOI: 10.52628/89.2.9675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Femoral shortening in children is a challenging condition with complex functional and psychological implications. We study the results of Ilizarov external fixator (IEF) lengthening compared to lengthening and then plating (LAP) in the management of femoral shortening in children. Forty patients were included in the study and equally divided randomly into 2 groups, in group I LAP was used and in group II lengthening by IEF only was done. The two groups were analyzed for postoperative variables to adjudge the surgical outcomes. The mean follow up time was 24.05 ± 2.99 months, The gained length was 5.60 ± 0.60 cm in group 1 and 5.48 ± 0.64 cm in group II, group I had a shorter external fixator period (3.96 ± 0.22) months, better healing index (24.6 ±2.76) days/cm, earlier complete weight-bearing (5.55 ± 0.78) months than group II. The period of hospitalization for group I was longer more than group II. The complications were less in group I (n=7, 35%) than in group II (n=11, 55%). There was no significant correlation between the healing index with age, also no significant difference was detected between the healing index and gender. There was a significant correlation between the gained length and complete weight-bearing. This study efficiently demonstrates that LAP may be better than lengthening with IEF alone in the management of femoral shortening in children.
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Wang S, Li B, Yu X, Wu H, Liu L. Is Ankle Arthrodesis With an Ilizarov External Fixator an Effective Treatment for Septic Ankle Arthritis? A Study With a Minimum of 6 Years of Follow-up. Clin Orthop Relat Res 2023; 481:717-725. [PMID: 36136051 PMCID: PMC10013661 DOI: 10.1097/corr.0000000000002418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/30/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Septic ankle arthritis is a devastating clinical problem with a high potential for permanent disability and amputation. Successful treatment of septic ankle arthritis remains a challenge for the surgeon and patient. Ankle arthrodesis combined with radical debridement may be an effective option to eradicate infection and salvage the limb. Although numerous fusion methods have been proposed, there is controversy about the most effective technique. QUESTIONS/PURPOSES At a minimum follow-up of 6 years after ankle arthrodesis performed using an Ilizarov external fixator, we asked, (1) In what proportion of patients was bony fusion achieved? (2) What complications were observed, and what reoperations were performed in these patients? (3) How much did patient-reported outcomes improve from before surgery to the most recent follow-up in this group? METHODS Between April 2010 to March 2015, we treated 59 patients for septic ankle arthritis. Of those, we considered patients who were at least 18 years of age with irreversible destruction of the joint as potentially eligible. During that time period, all patients met the prespecified criteria and were treated with ankle arthrodesis using an Ilizarov external fixator. Two percent (one of 59) of patients were excluded because they died in the second year after surgery for reasons unrelated to the procedure, and another 7% (four of 59) of patients were excluded because they were lost before the minimum study follow-up interval of 6 years. Finally, 92% (54 of 59) of patients were analyzed at a mean follow-up time of 9 ± 1 years. A total of 61% (33 of 54) were men, and they had a mean age of 48 ± 12 years. Forty-six percent (25 of 54) of patients were smokers, and 13% (seven of 54) of patients had Type 2 diabetes mellitus. All patients received radical debridement and primary arthrodesis with an Ilizarov external fixator, followed by antibiotic therapy. Postoperatively, patients were instructed to perform lower extremity functional exercises and external fixator care; weightbearing ambulation as tolerated was encouraged as early as possible. Fusion was assessed with a radiographic review that was performed by an individual who was not involved in the surgical care of these patients. We defined bony fusion as continuous trabeculae and complete cortical bridging in the fusion interface achieved before 9 months; delayed union was defined as fusion achieved by 9 to 12 months; and nonunion was defined as patients in whom fusion was not achieved by 12 months. Complications and reoperations were tallied through a record review that was performed by an individual who was not involved in the surgical care of these patients. We defined complications as any deviation from the expected postoperative course. We used the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the VAS active pain score, and the SF-12 questionnaire (including the physical component summary [PCS] score and mental component summary [MCS] score) to assess patient-reported outcomes. The minimum clinically important difference (MCID) for the AOFAS score was 30 points of 100, the MCID for the VAS active pain score was 2 points of 10, and the MCID of PCS and MCS scores was 7 points and 9 points, respectively. RESULTS Primary bony fusion was achieved in 94% (51 of 54) of patients. Delayed union was found in 2% (one of 54) of patients. Nonunion was found in 6% (three of 54); one of these patients underwent autologous bone grafting during revision, and bony fusion was ultimately achieved. Final bony fusion was achieved in 96% (52 of 54) of patients. Recurrent infection was found in 2% (one of 54). The median (range) AOFAS score improved from 28 points (8 to 59) before surgery to 80 points (52 to 86) at the most recent follow-up (median difference 52; p < 0.001). The median (range) VAS active pain score decreased from 8 points (6 to 9) before surgery to 2 points (0 to 5) at the most recent follow-up (median difference -6; p < 0.001). For the Short Form 12-item score, the median (range) PCS score improved from 0 points (0 to 30) before surgery to 70 points (40 to 95) at the most recent follow-up (median difference 70; p < 0.001), and the median (range) MCS score improved from 46 points (21 to 75) before surgery to 75 points (50 to 92) at the most recent follow-up (median difference 29; p < 0.001). CONCLUSION Ankle arthrodesis with Ilizarov external fixation might eradicate an infection and restore foot function in patients with septic ankle arthritis. However, patients should be fully informed of the complications related to the external fixator, such as pin-tract infections, recurrent infection, and nonunion. Standardized and professional pin care is important. Additionally, because Ilizarov external fixators can be inconvenient to the patients' daily lives, future studies should explore how psychologic support affects patients who undergo ankle arthrodesis with these devices. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Bohua Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Lei Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P. R. China
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Hirose C. CORR Insights®: Is Ankle Arthrodesis With an Ilizarov External Fixator an Effective Treatment for Septic Ankle Arthritis? A Study With a Minimum of 6 Years of Follow-up. Clin Orthop Relat Res 2023; 481:726-727. [PMID: 36455100 PMCID: PMC10013648 DOI: 10.1097/corr.0000000000002505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
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Iba K, Teramoto A, Yamashita T. A modified chipping technique for nonunion at the distraction lengthening site in children with radial longitudinal deficit for congenital anomaly. J Hand Surg Eur Vol 2023; 48:281-282. [PMID: 36691287 DOI: 10.1177/17531934221148119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Kousuke Iba
- Department of Musculoskeletal Anti-aging Medicine, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Teramoto
- Departments of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Departments of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Boero S, Marrè Brunenghi G, Riganti S, Torchia S. Role of proximal tibiofibular fixation in leg lengthening with the Ilizarov method in the achondroplastic patient. J Pediatr Orthop B 2023; 32:66-71. [PMID: 35635539 DOI: 10.1097/bpb.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The role of proximal tibiofibular joint (TFJ) transfixion during Ilizarov tibial lengthening is still debated in the literature. The aim of this study was to show that TFJ transfixion can be avoided with no impact on patient outcome. All achondroplastic patients undergoing tibia lengthening from 1999 to 2018 were included. Patients were divided in two groups: group A (11 patients) submitted to proximal TFJ transfixion and group B (22 patients) not submitted to TFJ transfixion. The results showed a statistically significant difference in proximal fibular migration (PFM) between the two groups of patients, with a mean PFM of 9.2 mm (range, 1-20 mm) and of 21 mm (range, 2.7-76 mm) in group A and in group B, respectively. We can state that PFM up to 41 mm in our series did not affect joint function and stability. There are no statistically significant differences in the other radiological parameters. Analysis of functional scores (Knee Society, Tegner-Lhysolm, Association for the Study and Application of Methods of Ilizarov) did not reveal significant differences between the groups. The scores of the Achondroplasia Personal Life Experience Scale were also similar in the two groups, demonstrating a good quality of life. There are no differences between the two groups in terms of clinical-functional outcome of the knee, radiographic results, and quality of life. Transfixion of proximal TFJ may not be necessary, but it is important to avoid premature consolidation of the fibular osteotomy.
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Affiliation(s)
- Silvio Boero
- Department of Pediatric Orthopaedics, IRCCS Istituto 'Giannina Gaslini', Children's Hospital, Genova, Italy
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Yang HQ, Zhang YH, Li Q, Zhang HY, Zhao DZ, Han QH, Yang Y, Yang QC, Qu L. [NRD assisted Ilizarov technique in the treatment of infected bone and soft tissue defect of tibia]. Zhongguo Gu Shang 2022; 35:921-926. [PMID: 36280407 DOI: 10.12200/j.issn.1003-0034.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the clinical effect of NRD assisted Ilizarov technique in the treatment of infected bone and soft tissue defect of tibia. METHODS All 48 patients with infected bone and soft tissue defect of tibia were randomly divided into study group and control group from March 2013 to December 2020. There were 34 males and 14 females, aged from 24 to 55 years old with an average of (40.54±11.64) years old. There were 25 patients in the study group, including 17 males and 8 females, aged from 31 to 55 years old with an average of (41.36±9.69) years old. The study group were treated with NRD assisted with Ilizarov bone transport technique. There were 23 patients in control group, including 17 males and 6 females, aged from 24 to 53 years old with an average of(38.61±8.76) years old. The control group were treated with traditional bone transport technique. The curative rate, recurrence rate, incidence rate of pin track infection, time of using antibiotics, time of wound healing, time of carrying external fixation, time of bone transport, time of bone healing and postoperative function were used to evaluate the therapeutic effect of the two groups. RESULTS The follow-up period was from 12 to 62 months with an average of (33.0±7.2) months. At the final follow-up, there was no significant difference in the curative rate between the two groups (P>0.05). The recurrence rate in the study group was lower than that in the control group(P<0.05). The incidence of pin track infection in the study group was lower than that in the control group (P<0.05). The time of using antibiotics and wound healing in the study group was shorter than that in the control group(P<0.05). There was no significant difference in the time of bone transport and carrying of external fixation between the two groups(P>0.05). There was no significant difference in bone healing and postoperative function between the two groups(P>0.05). CONCLUSION NRD assisted Ilizarov technique can achieve satisfactory results in the treatment of infected bone and soft tissue defect of tibia and shorten the treatment period and the time of using antibiotics. It is worthy of development in clinic.
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Affiliation(s)
- Hua-Qing Yang
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Yao-Hua Zhang
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Qiang Li
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Hong-Yue Zhang
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Dian-Zhao Zhao
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Qing-Hai Han
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Yun Yang
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Qi-Chang Yang
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Long Qu
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
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Teng X, Huang L, Yang SS, Wang T, Gong MQ, Jiang XY. [Effect of freshening technique on docking site in tibial bone transport management]. Zhongguo Gu Shang 2022; 35:914-920. [PMID: 36280406 DOI: 10.12200/j.issn.1003-0034.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To study the effect of freshening technique on docking site in tibial bone transport management. METHODS Retrospective cohort study was conducted about the effect of freshening technique on docking site in 20 cases(15 males and 5 females) treated with tibial bone transport from January of 2014 to December of 2019. The age of patients ranged from 19 to 62 years old, with an average of (42.3±11.5)years old. Seven patients had infectious bone defect and 13 patients had non-infectious. Application of freshening technique immediately after docking included resection of invaginated skin or soft tissue, removal of closed sclerotic bone, re-apposition, increasing the contact, acute compression of freshened docking site and grafting from adjacent medullary or bone debris, followed by post-operative gradual compression. RESULTS The amount of segmented bone defect ranged from 5 to 15 cm, with an average of(9.2±2.9) cm. Time required from osteotomy to contact of butt end ranged from 26 to 243 days, with an average of(109.1±51.1) days. The duration needed from 3 to 7 months with an average of(3.7±1.1) months before reaching radiological healing criterion in docking site. Fourteen out of 15 concurrent fibular osteotomy were united. Consolidation time for distracted callus ranged from 5 to 28 months, with an average of (15.0±6.5) months. Bone healing index(BHI) ranged from 0.8 to 2.8 months/cm, with an average of (1.6±0.5) months. One surgical site infection (5%) in tibial was noted. No refractures were found in follow-up ranged from 12 to 73 months, with an average of(37.6±20.3) months after fixator removal. CONCLUSION Freshening technique immediately after docking had advantages of the shorter healing time, avoidance of refracture, and independance of necessity for remote autograft harvest.
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Affiliation(s)
- Xing Teng
- Orthopaedic Trauma Department, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Lei Huang
- Orthopaedic Trauma Department, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Sheng-Song Yang
- Orthopaedic Trauma Department, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Tao Wang
- Orthopaedic Trauma Department, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Mao-Qi Gong
- Orthopaedic Trauma Department, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xie-Yuan Jiang
- Orthopaedic Trauma Department, Beijing Jishuitan Hospital, Beijing, 100035, China
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Zhang YL, Liu SB, Wang Y, Wu TH, Sang RZ, Dong JW, Li PF, Wu XR, Peng AQ. [Clinical therapeutic strategies of refracture after bone transport for tibial bone defect]. Zhongguo Gu Shang 2022; 35:927-932. [PMID: 36280408 DOI: 10.12200/j.issn.1003-0034.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore the clinical therapeutic strategies of refracture after Ilizarov bone transport technique in the treatment of tibial bone defect. METHODS A retrospective study was performed on 19 patients with infected tibial bone defect treated by Ilizarov bone transport technique and then refracture from August 2010 to January 2020, including 18 males and 1 female with an average age of (37.7±13.0) years old ranging from 15 to 66 years old. Cause of injury invlved falling injury in 4 cases, crashing injury 1 case, crushing injury in 1 case and without obvious injury history in 13 cases. The ipsilateral distal femoral fracture in 2 cases occurred before the external fixator of tibia was removed, and the other 17 cases had a minimum of 1 day and a maximum of 30 months after the external fixator had been removed. The site of refracture was at regenerative zone in 8 cases, at docking site in 9 cases, at ipsilateral femoral shaft in 2 cases. According to the modified Simpson classification proposed by the author, the refracture was classified. The treatment of refracture include plaster splint, traction or external fixation. Bone healing and function were evaluated according to the standards of the Association for the Study and Application of the Method of Ilizarov(ASAMI). RESULTS All patients were followed up, and the duration ranged from 9 to 17 months with an average of (12.3±3.2) months. According to the modified Simpson classification, there were 3 cases of type Ⅰa, 1 case of type Ⅰb, 3 cases of type Ⅰc, 1 case of type Ⅱ, 9 cases of type Ⅲ and 2 cases of type Ⅴ. All the refractures healed without infection or malunion. The fracture healing time of conservative treatment for 6 cases were 3, 5, 3, 2, 2, 2 months fespectively;and the healing time of fracture treated by surgery for 13 cases was 2 to 6 months, with an average of(4.4±1.4) months. According to ASAMI evaluation criteria, bony results showed all patients obtained excellent results, and functional results showed 6 patients got excellent results, 13 good beacause of ankle or knee stiffness. CONCLUSION The modified Simpson classification could contain most clinical types of refracture after bone transport, and the external fixation is a simple and effective method for refracture.
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Affiliation(s)
- Yan-Long Zhang
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Shi-Bo Liu
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Yong Wang
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Tian-Hao Wu
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Rui-Zheng Sang
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Jian-Wei Dong
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Peng-Fei Li
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - Xi-Rui Wu
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
| | - A-Qin Peng
- Center of Trauma and Emergency, Orthopedic Research Institute of Hebei Province, Hebei Provincial Key Laboratory of Orthopedic Biomechanics, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei, China
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Yang HQ, Qu L. [Ilizarov bone transport technique]. Zhongguo Gu Shang 2022; 35:903-907. [PMID: 36280404 DOI: 10.12200/j.issn.1003-0034.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Hua-Qing Yang
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Long Qu
- Department of Orthopaedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
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Xu YJ, Gao X, Ding H, Bu XM, Wang HB, Wu B. Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report. Medicine (Baltimore) 2022; 101:e30149. [PMID: 35984144 PMCID: PMC9388036 DOI: 10.1097/md.0000000000030149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE To evaluate the clinical effects of 1-stage revascularization, vacuum sealing drainage covering the wound, temporary external fixation and 2-stage Ilizarov bone transport for the treatment limb destruction injury. PATIENT CONCERNS AND DIAGNOSIS Nine patients with limb destruction injury between September 2014 and June 2019 at our institute were evaluated retrospectively. The age of patient was 21 to 51 years with an average of 33 years. The injuries were caused by vehicle accidents in 4 patients, gunshot in 1 patient, and crushing injuries in 4 patients. All of them had vascular injury. The average length of bone defect was 9.5 (8.3-10) cm. Regular follow-up was performed on wound healing, bone transport time, bone healing time, external fixation index, and limb function. INTERVENTIONS All patients underwent 1-stage revascularization and temporary external fixation during emergency surgery, and then gradual bone transport by Ilizarov fixator was performed until the broken fracture site was reunited. OUTCOMES Nine patients were followed up for 12 to 48 months (average 30 months). Six patients were treated with autogenous cancellous bone graft for the second time, and 2 patients healed spontaneously. The mean wound healing time was 86 (73-90) days. The bone transport time was 97 (88.3-105.3) days, and the bone mineralization time was 164.5 (156.8-181.3) days, and the healing time of the docking sites was 6.8 (6.1-8.3) months. The external fixator time was 14.5 (12.5-17) months with the external fixation index was 1.5 (1.4-1.8) m/cm. At the last follow-up, according to the Association for the Study of the Method of Ilizarov functional scores, excellent functional outcomes were obtained in 5 patients, good in 1 patients, moderate in 2 patients. According to the Association for the Study of the Method of Ilizarov Radiological System, excellent functional outcomes were obtained in 6 cases and good in 2 cases. LESSONS One-stage revascularization and temporary external fixation combined with 2-stage Ilizarov bone transport technique for the treatment of bone defects in limb destruction injury have satisfactory clinical effects and few complications, and can be applied under the condition of strict understanding of surgical indications.
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Affiliation(s)
- Ying-Jie Xu
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Xu Gao
- Department of Qingdao Medical College, Qingdao University, Qingdao City
| | - Hao Ding
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Xian-Min Bu
- Department of Pathology, Jining No. 1 People’s Hospital
| | - Hai-Bin Wang
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, China
| | - Bin Wu
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, China
- *Correspondence: Bin Wu, Department of Orthopedic, Affiliated Hospital of Jining Medical University, No. 89, Guhuai Road, Jining City 272029, Shandong Province, China (e-mail: )
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Wu C, Zheng G, Wang D, Paley D, Ning B. Combination Treatment by Cross-Union of the Tibia and Fibula, Autogenic Iliac Bone Grafting, Reliable Fixation and Bone Morphogenetic Proteins for the Treatment of Refractory Congenital Pseudarthrosis of the Tibia. J Pediatr Orthop 2022; 42:e623-e629. [PMID: 35297391 PMCID: PMC9165645 DOI: 10.1097/bpo.0000000000002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The treatment of congenital pseudarthrosis of the tibia (CPT) remains a challenge because of the difficulties of achieving and maintaining bone union, as well as complications of joint deformity and limb-length discrepancy. The purpose of this study was to evaluate the efficacy of cross-union of the tibia and fibula in achieving union and preventing refracture for patients with refractory CPT as a complementary approach to improve upon conventional surgical treatments. METHODS A retrospective study including patients with refractory CPT who attended our department between June 2014 and August 2020. Eighteen CPT patients, who had sustained refracture that required cast immobilization or secondary surgery, and were managed by pseudarthrosis resection, cross-union of the tibia and fibula, bone morphogenetic protein-2 and autogenous iliac bone grafting, were included. Clinical outcomes of the bone union rate and the frequency of refracture after performing cross-union of the tibia and fibula were assessed during the follow-up period. RESULTS The mean follow-up period was 4.3 years (range: 1.5 to 6.25 y). The mean age of the patients at surgery was 5.4 years (range: 2.6 to 10 y), and all 18 (100%) of the 18 patients had final healing at the site of pseudarthrosis. The average time spent to achieve radiologic bone union of the pseudarthrosis after operation was 2.96 months (range: 2.2 to 4.1 mo). Two (11.1%) patients had an average 2.5 cm limb-length discrepancy, none (0%) sustained refracture which needed cast immobilization or secondary surgery. Patients were all pain-free and move actively. CONCLUSIONS Cross-union of the tibia and fibula is a promising complementary procedure for treating refractory CPT patients. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Chunxing Wu
- Department of Pediatric Orthopedics, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai
| | - Guizhou Zheng
- Department of Orthopedics, The Third Affiliated Hospital (The Affiliated Luohu Hospital) of Shenzhen University, Shenzhen, Guangdong, China
| | - Dahui Wang
- Department of Pediatric Orthopedics, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai
| | - Dror Paley
- Paley Orthopedic and Spine Institute, West Palm Beach, FL
| | - Bo Ning
- Department of Pediatric Orthopedics, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai
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Mekki WA, Kliushin NM, Sudnitsyn AS. Calcaneogenesis: the use of tibial bone transport for treatment of massively infected hindfoot defects. Acta Orthop Belg 2022; 88:127-134. [PMID: 35512163 DOI: 10.52628/88.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Massive hindfoot defects which result after se- questrectomy of chronic osteomyelitis (COM) or Trauma or after tumors resection is a real challenge to the treating surgeons with either amputation or other reconstructive plastic procedures as the only available options, Calcaneal osteomyelitis is a major cause with classical surgical management to cure the infection has limited success in preservation of the hindfoot shape, function, and mechanical stability. The surgical procedure reported with the use of the Ilizarov apparatus for partial or total calcaneal OM is aimed to preserve the Hindfoot. Materials and Methods We retrospectively reviewed 10 patients which were treated by radical debridement of the infected area, Ilizarov frame application and arthrodesis with bone reconstruction by the Ilizarov apparatus using tibial transport for Hindfoot salvage. The mean age at presentation was 33.5 years (range; 24-57) and the mean follow-up was 5.1 years (range; 2-12).Patients clinical and radiographic data were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle- Hindfoot score. Results The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was 48.3(range; 38-86) while the mean postoperative (AOFAS) was 58.5 (range; 45-73) , p value < 0.01 . Clinically all patients had anatomically stable feet with deformity correction and no signs of infection recurrence. Conclusion The use of Ilizarov distal tibial bone transport to fill massive hindfoot defects proved to be a reliable method for elimination of infection and reconstruction of large defects without the need for bony or soft tissue plastic procedures. The technique also has the ability to produce a rigid limb fixation following debridement and to fill in massive hindfoot defects due to other etiologies as well.
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Ilyas MS, Sattar A, Zehra U, Aziz A. Management of femoral shaft infected nonunion through customised Ilizarov external fixator assembly in a morbidly obese patient. BMJ Case Rep 2022; 15:e245824. [PMID: 35042732 PMCID: PMC8768492 DOI: 10.1136/bcr-2021-245824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
A 19-year-old morbidly obese man presented with infected nonunion of femoral shaft fracture. Patient had history of 13 failed fixation surgeries, assessment revealed 3-centimetre limb-length discrepancy with 3-centimetre gap nonunion. Wound debridement, primary compression and external fixation using a customised Ilizarov external fixation assembly were planned. A four-ring customised assembly was applied. Partial weight bearing was allowed from first postoperative day on walker. Patient was kept on a monthly follow-up. After complete union at 10 months after surgery, frame was dynamised. After 6 months of dynamisation, frame was removed, at that time patient was full weight bearing. Knee was still stiff with a range of motion of 0°-20°, and there was 6 cm of limb length discrepancy, which was managed with a shoe raise. At 9 months after frame removal, patient is mobile with fully united bone. Ilizarov external fixator can be a good managing option in such difficult and complicated cases.
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Affiliation(s)
- Muhammad Saad Ilyas
- Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Abdul Sattar
- Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Uruj Zehra
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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Zhang J, Li Y, Liu L, Chen L, Liu Z, Duan Q, Pu B. Post-traumatic severe ankle valgus and forefoot supination deformities treated by staged surgery using ilizarov technique and limited osteotomy: A case report. Medicine (Baltimore) 2021; 100:e28385. [PMID: 34941169 PMCID: PMC8701961 DOI: 10.1097/md.0000000000028385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Post-traumatic ankle valgus deformities are relatively rare. Old post-traumatic ankle deformity compounded by abundant scar contracture tissue formation around the joint is a big challenge for orthopedics. Conventional one-stage corrective osteotomy with internal fixation always results in many knotty postoperative complications, such as soft tissue avascular necrosis, implant-related infections, and distinct lower limb discrepancy. Here, we describe a patient with old post-traumatic severe ankle valgus and forefoot supination deformities and obtained satisfactory clinical results following multi-stage surgery using the Ilizarov technique and limited osteotomy. Even more encouraging, any complications of conventional one-stage surgery were successfully avoided through our treatment regimen. PATIENT CONCERNS A 24-year-old healthy man had post-traumatic 90-degree hindfoot valgus and forefoot supination deformities of the right foot for more than 10 years. The complicated issue was the vast, poorly vascularized scar contracture tissues tightly adhered to the bones of the lateral malleolus and dorsum pedis. DIAGNOSES Old post-traumatic severe ankle valgus and forefoot supination deformities and scar contracture of soft tissues of the foot and ankle joint. INTERVENTIONS In the first stage, Ilizarov external fixation was used to stretch the scar contracture tissue of the lateral malleolus. In the second stage, limited osteotomy of the tibiotalar joint and progressive closure of the osteotomy site were performed. In the third stage, Chopart joint osteotomy and slow forefoot pronation by external frame were performed. OUTCOMES Our treatment regimen not only guaranteed soft tissue safety, but also avoided infection and obvious lower limb discrepancy. At the 1-year follow-up, the patient acquired aesthetic and functional right foot. LESSONS Although relatively rare, old post-traumatic severe ankle valgus and forefoot supination deformities can be corrected using Ilizarov external fixation technology combined with limited osteotomy. With a well-designed staged operation scheme, soft tissue avascular necrosis, infection of the wound, obvious lower limb discrepancy, and flap grafting can be avoided.
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Affiliation(s)
- Jie Zhang
- Orthopedics Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yongmei Li
- Rehabilitation Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Luping Liu
- Orthopedics Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Leijie Chen
- Orthopedics Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhou Liu
- Orthopedics Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qihui Duan
- Orthopedics Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Bo Pu
- Orthopedics Department, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Post-traumatic osteomyelitis is one of the most common disorders of bone infection, which is secondary to open fracture caused by machinery injury, traffic accident, and it is also the main manifestation in the postoperative infection of open fracture. After trauma, bacteria invade bone tissue and reproduce rapidly in large quantities, which easily leads to osteomyelitis. Patients are often complaint of pain at the affected limb, loss of function, or even amputation due to deteriorated infection, resulting in loss of labor capability and poor quality of life. Because the diagnosis and treatment are not timely and standard, the treatment for post-traumatic osteomyelitis is often delayed, resulting in the difficulty of clinical cure. It also makes patients and their families bear a serious financial burden. However, the diagnosis and treatment for this disease is difficult for orthopedic physicians. In recent years, imaging methods (such as CT and MRI) combined with immune techniques have significantly improved the diagnostic accuracy and early diagnosis ability. The application of new diagnostic technologies (such as gene chip and second-generation sequencing) also makes the diagnosis more convenient and sensitive. The novel reconstruction and repair surgery (such as Ilizarov technology and Orthofix LRS technology) provides new treatment direction for orthopedic surgeons and patients.
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Affiliation(s)
- Buqi Tang
- Xiangya School of Medicine, Central South University, Changsha 410013.
| | - Weihong Zhu
- Department of Orthopedics, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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Lotzien S, Rosteius T, Reinke C, Behr B, Lehnhardt M, Schildhauer TA, Gessmann J. Reconstruction of Septic Tibial Bone Defects With the Masquelet Technique and External Ring Fixation-A Low Healing Rate and High Complication and Revision Rates. J Orthop Trauma 2021; 35:e328-e336. [PMID: 33993179 DOI: 10.1097/bot.0000000000002065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the results of a series of septic tibial bone defects treated with the Masquelet technique and external ring fixation as a standardized treatment procedure. DESIGN Retrospective study. SETTING Level one trauma center. PATIENTS/PARTICIPANTS All patients 18 years of age or older with septic diaphyseal bone defects of the tibia who underwent induced membrane treatment with ring fixation at our institution between June 1, 2012, and November 31, 2017. INTERVENTION Staged management as described by Masquelet using an external ring fixator for definitive fixation. MAIN OUTCOME MEASUREMENTS Bony healing at the last follow-up and the time to healing in months. Functional results were assessed according to the scoring system of the Association for the Study and Application of Methods of Ilizarov. The secondary outcome measures were treatment failure and complications. RESULTS Thirty-one patients were treated, with a mean follow-up period of 33 months (range, 13-69 months). Overall, among 14 patients assessed as having achieved bone healing, an average of 3.7 surgical revisions were required. The mean healing time was 15.5 months (range, 6-49 months). According to the Association for the Study and Application of Methods of Ilizarov criteria, 7 patients were rated as "excellent" and 6 patients were rated as "good"; one patient showed "poor" functional results. A total of 17 cases of treatment failure and 36 complications were detected. CONCLUSIONS The combination of the Masquelet technique and external fixation yielded a low healing rate and was associated with a significant number of cases of treatment failure. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | | | - Björn Behr
- Plastic Surgery and Hand Surgery; BG University Hospital Bergmannsheil, Bochum, Germany
| | - Marcus Lehnhardt
- Plastic Surgery and Hand Surgery; BG University Hospital Bergmannsheil, Bochum, Germany
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Ganadhiepan G, Miramini S, Mendis P, Patel M, Zhang L. A probabilistic approach for modelling bone fracture healing under Ilizarov circular fixator. Int J Numer Method Biomed Eng 2021; 37:e3466. [PMID: 33864429 DOI: 10.1002/cnm.3466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/27/2020] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
Bone fracture treatments using Ilizarov circular fixator (ICF) involve dealing with uncertainties about a range of critical factors that control the mechanical microenvironment of the fracture site such as ICF configuration, fracture gap size, physiological loading etc. To date, the effects of the uncertainties about these critical factors on the mechanical microenvironment of the fracture site have not been fully understood. The purpose of this study is to tackle this challenge by using computational modelling in conjunction with engineering reliability analysis. Particularly, the effects of uncertainties in fracture gap size (GS), level of weight-bearing (P), ICF wire pretension (T) and wire diameter (WD) on the fracture site mechanical microenvironment at the beginning of the reparative phase of healing was investigated in this study. The results show that the mechanical microenvironment of fracture site stabilised with ICF is very sensitive to the uncertainties in P and GS. For example, an increase in the coefficient of variation of P (COVP ) from 0.1 to 0.9 (i.e., an increase in the uncertainty in P) could reduce the probability of achieving a favourable mechanical microenvironment within the fracture site (i.e., Probability of Success, PoS) by more than 50%, while an increase in the coefficient of variation of GS (COVGS ) from 0.1 to 0.9 could decrease PoS by around 30%. In contrast, an increase in the uncertainties in T and WD (COV increase from 0.1 to 0.9) has little influence on the fracture site mechanical microenvironment (PoS changes <5%).
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Affiliation(s)
- Ganesharajah Ganadhiepan
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Saeed Miramini
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Priyan Mendis
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Minoo Patel
- Centre for Limb Lengthening & Reconstruction, Epworth Hospital Richmond, Richmond, Victoria, Australia
| | - Lihai Zhang
- Department of Infrastructure Engineering, The University of Melbourne, Parkville, Victoria, Australia
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Tilkeridis K, Keskinis A, Paraskevopoulos K, Papadopoulos G, Chatzipapas C, Ververidis AN. Neglected Stiff Equinocavus Foot Deformity Treated with Cole Osteotomy, Combined with External Ilizarov Hinged Frame Fixation, Soft-Tissue Release, and Achilles Tendon Lengthening: A Case Report. J Am Podiatr Med Assoc 2021; 111:466701. [PMID: 34144581 DOI: 10.7547/20-061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Stiff equinocavus foot deformities are challenging clinical entities that may be treated with osteotomies and extensive soft-tissue release. The most common causes of such lesions are neglected trauma and Charcot-Marie-Tooth disease; other causes include burns, neurologic diseases, and compartment leg syndrome. Conventional treatments, including extensive soft-tissue release, osteotomies, and arthrodesis combined with or without internal splinting, may result in severe complications such as neurovascular or soft-tissue damage and shortening of the foot. The Ilizarov technique may be superior to the traditional approach, because it allows surgeons to apply gradual and titrated correction of individual components of complex deformities and results in minimal surgical morbidity without shortening of the foot. This is the first case report in the literature describing the simultaneous use of Cole osteotomy, combined with external Ilizarov hinged frame fixation, soft-tissue release, and Achilles tendon lengthening for the treatment of an extreme neglected stiff equinocavus foot deformity.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Szelerski Ł, Pajchert Kozłowska A, Żarek S, Górski R, Mochocki K, Dejnek M, Urbański W, Reichert P, Morasiewicz P. A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia. Arch Orthop Trauma Surg 2021; 141:879-889. [PMID: 32778920 PMCID: PMC8049889 DOI: 10.1007/s00402-020-03571-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature. MATERIALS AND METHODS This study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008-2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit. RESULTS The mean age at the start of treatment was 46.7 years (11-84 years). The mean follow-up period was 7 years (2-12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8-20.7 months). The rate of union maintained at the last follow-up visit was 95.1%. CONCLUSIONS All patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7-100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.
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Affiliation(s)
- Łukasz Szelerski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Andżelika Pajchert Kozłowska
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland
| | - Sławomir Żarek
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Radosław Górski
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Karol Mochocki
- Department of Orthopedics and Musculoskeletal Traumatology, Medical University of Warsaw, Lindeya 4, 02-005, Warsaw, Poland
| | - Maciej Dejnek
- Division of Sport Medicine, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wrocław, Poland
| | - Wiktor Urbański
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland
| | - Paweł Reichert
- Division of Sport Medicine, Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, 51-618, Wrocław, Poland
| | - Piotr Morasiewicz
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław Medical University, ul. Borowska 213, 50-556, Wrocław, Poland.
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Ma N, Li Z, Li D, Hu Y, Sun N. Clinical evaluation of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis: A retrospective study. Medicine (Baltimore) 2020; 99:e23921. [PMID: 33350796 PMCID: PMC7769368 DOI: 10.1097/md.0000000000023921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
To analyze the efficacy of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis.This retrospective study included 88 patients with end-stage (stage-3) ankle osteoarthritis according to Morrey-Wiedeman classification who underwent arthrodesis with Ilizarov external fixator from January 2016 to January 2019. There were 47 males and 41 females with a mean age of (57.21 ± 7.12) years old (range 49-76). Outcomes were measured by the American Orthopaedic Foot and Ankle society (AOFAS) Ankle Hindfoot Scale, Visual Analog Scale (VAS) pain scores, complications, subjective satisfaction, ankle function, correction of deformity, and complications.With an average follow-up of (13.50 ± 5.41) months (range 10-21), all 88 patients returned for final follow-up. All patients achieved bony healing with a success rate of 100%. Mean postoperative healing time (3.56 ± 1.04) months (range 3-6). Two patients developed sinus tract infection, delayed healing in 1 patient, and 2 patients had pain and swelling again in the ankle joint. No serious complications occurred in other patients. All the patients evaluated with the VAS scores and AOFAS scores at final follow-up showed significant improvement (P < .05). Through imaging analysis, medical tibial talar angle (MTTA) improved from (85.76 ± 6.01) degrees to (88.98 ± 1.35) degrees postoperative. Lateral talar station (LTS) decreased from (5.32 ± 3.81) mm to (2.71 ± 2.62) mm after operation (P < .05). The overall satisfaction of patients is 88.64%.In the treatment of end-stage ankle osteoarthritis, arthrodesis with Ilizarov external fixator can achieve good radiological and clinical outcomes with low prevalence of ankle joint malalignment and high fusion rates and satisfaction.
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Affiliation(s)
- Nan Ma
- Department of Orthopaedic Trauma
| | - Zhi Li
- Department of infection management
| | - Delei Li
- Department of Orthopaedic Trauma
| | - Yehua Hu
- Department of Rehabilitation, General Hospital of Jizhong Energy Xingtai Mining Group Co., Ltd, Xingtai, Hebei, 054000
| | - Ning Sun
- Department of Orthopaedic, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, PR China
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齐 欣, 徐 永, 夏 燊, 赵 泽, 吕 乾, 浦 绍, 朱 跃. [Application of simple Ilizarov ring external fixation technique in treatment of tibial plateau fracture complicated with osteofascial compartment syndrome]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:1248-1252. [PMID: 33063488 PMCID: PMC8171881 DOI: 10.7507/1002-1892.202003135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/05/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of simple Ilizarov ring external fixation technique in treatment of tibial plateau fractures complicated with osteofascial compartment syndrome. METHODS Between September 2013 and March 2017, 30 patients with tibial plateau fractures complicated with osteofascial compartment syndrome were treated with simple Ilizarov ring external fixation technique. There were 23 males and 7 females, with an average age of 34.4 years (range, 23-43 years). The injuries were caused by traffic accident in 12 cases, by falling from height in 4 cases, by falling in 8 cases, and by a crashing object in 6 cases. The time from injury to admission was 1-12 hours (mean, 4.8 hours). According to the Schatzker classification, there was 1 case of type Ⅱ, 3 cases of type Ⅲ, 10 cases of type Ⅳ, 7 cases of type Ⅴ, and 9 cases of type Ⅵ. All patients underwent fasciotomy due to osteofascial compartment syndrome; the interval between fasciotomy and operation was 10-15 days (mean, 12.5 days). Knee Society Score (KSS) and Ilizarov Method Research and Application Association (ASAMI) protocol were used to evaluate knee function. RESULTS The operation time was 110-155 minutes (mean, 123.1 minutes); the intraoperative blood loss was 100-500 mL (mean, 245 mL); the postoperative hospital stay was 3-5 days (mean, 3.8 days). All patients were followed up 20-24 weeks (mean, 22.7 weeks). Except for 2 patients with signs of needle tract infection, no other complication occurred. X-ray films showed that the fractures healed, and the healing time was 10-20 weeks (mean, 14.6 weeks). At last follow-up, the KSS clinical score was 70- 95 with an average of 87.5; the functional score was 70-90 with an average of 79.0. According to ASAMI protocol evaluation, the effectiveness was rated as excellent in 24 cases, good in 3 cases, fair in 2 cases, and poor in 1 case. CONCLUSION For tibial plateau fractures complicated with osteofascial compartment syndrome, simple Ilizarov ring external fixation technique can basically restore joint function and has fewer complications. It is a relatively safe and effective treatment method.
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Affiliation(s)
- 欣 齐
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 永清 徐
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 燊 夏
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 泽雨 赵
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 乾 吕
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 绍全 浦
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 跃良 朱
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
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郭 保, 赵 巍, 吴 鸿, 梁 喜, 徐 执, 任 龙, 秦 泗. [Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:1000-1004. [PMID: 32794669 PMCID: PMC8171897 DOI: 10.7507/1002-1892.201911070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/19/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of the first-stage debridement and Ilizarov metatarsal bone lengthening in treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head. METHODS Between January 2015 and October 2018, 8 cases (9 feet, 11 sites) of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head were treated by first-stage debridement and Ilizarov metatarsal bone lengthening. There were 3 males (4 feet, 5 sites) and 5 females (5 feet, 6 sites), with an average age of 57.5 years (range, 44-65 years). According to diabetic foot Wagner grade, 6 cases (7 feet) were grade 3 and 2 cases (2 feet) were grade 4. The chronic osteomyelitis located at left foot in 4 cases, right foot in 3 cases, and bilateral feet in 1 case. The duration of chronic osteomyelitis was 1-5 years (mean, 3.1 years). The chronic osteomyelitis site was the 1st metatarsal head in 3 feet, the 3rd metatarsal head in 1 foot, the 4th metatarsal head in 1 foot, and the 5th metatarsal head in 6 feet. Two patients had chronic osteomyelitis at 2 sites on 1 foot. The length of lengthened metatarsal bone, lengthening time, and the time of wearing external fixation frame were recorded, and the external fixation frame index was calculated. The healing conditions of foot ulcer and lengthening bone segment were observed, the healing time was recorded, and the healing index of lengthening bone was calculated. The ankle function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) score criteria. RESULTS All patients were followed up 9-26 months with an average of 15.0 months. Except pin tract infection during the bone lengthening period, there was no complications such as skin necrosis and vascular or nerve injury occurred during treatment. The length of lengthened metatarsal bone was 12-35 mm with an average of 20.5 mm; the metatarsal bone lengthening time were 21-84 days with an average of 57.8 days. The average time of wearing external fixation frame was 14.6 weeks (range, 10.4-21.1 weeks) and the external fixation frame index was 54.3 days/cm (range, 42.9-59.2 days/cm). The ulcer wound healed with an average healing time of 30.5 days (range, 19-70 days) and no ulcer recurrence was observed during follow-up. Bone healing was obtained in all bone lengthening segments, and the average healing index was 42.5 days/cm (range, 37-51 days/cm). The average AOFAS score was 91.7 (range, 87-95); 5 feet were excellent and 4 feet were good. The excellent and good rate was 100%. CONCLUSION The metatarsal bone lengthening under Ilizarov law of tension-stress after debridement can promote diabetic foot ulcers healing and reconstructing the length of metatarsal to retain the function of metatarsal load and avoid amputation. This is an effective method for the treatment of diabetic foot ulcer complicated with chronic osteomyelitis of metatarsal head.
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Affiliation(s)
- 保逢 郭
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - 巍 赵
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - 鸿飞 吴
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - 喜斌 梁
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - 执扬 徐
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - 龙喜 任
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - 泗河 秦
- 清华大学附属垂杨柳医院矫形骨科(北京 100022)Department of Orthopaedics, Beijing Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
- 国家康复辅具研究中心附属康复医院矫形外科(北京 100176)Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China
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刘 铮, 许 超, 俞 益, 涂 冬. [Research progress of tibial transverse transport in treatment of chronic ischemic diseases of the lower extremities]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:994-999. [PMID: 32794668 PMCID: PMC8171916 DOI: 10.7507/1002-1892.202004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/22/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the research progress of tibial transverse transport (TTT) in treatment of chronic ischemic diseases of the lower extremities. METHODS The related literature was systematically searched and the mechanisms, clinical treatment methods, clinical efficacy, indications, contraindications, and complications of TTT were discussed. RESULTS Based on the law of tension-stress, TTT is a new method in the treatment of chronic ischemic diseases of the lower extremities. It can relieve the ischemic symptoms, promote the wound healing, and increase the limb salvage rate. The clinical application in recent years has shown good effectiveness, and the scope of application is expanding. CONCLUSION Due to the current limited clinical application, the sample size of the TTT for the chronic ischemic diseases of the lower extremities is relatively small, and the follow-up time is limited. So its validity, long-term effectiveness, and bone transport standards are need further research.
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Affiliation(s)
- 铮 刘
- 浙江中医药大学第二临床医学院(杭州 310053)The Second Clinical College of Zhejiang Traditional Chinese Medical University, Hangzhou Zhejiang, 310053, P.R.China
| | - 超 许
- 浙江中医药大学第二临床医学院(杭州 310053)The Second Clinical College of Zhejiang Traditional Chinese Medical University, Hangzhou Zhejiang, 310053, P.R.China
| | - 益康 俞
- 浙江中医药大学第二临床医学院(杭州 310053)The Second Clinical College of Zhejiang Traditional Chinese Medical University, Hangzhou Zhejiang, 310053, P.R.China
| | - 冬鹏 涂
- 浙江中医药大学第二临床医学院(杭州 310053)The Second Clinical College of Zhejiang Traditional Chinese Medical University, Hangzhou Zhejiang, 310053, P.R.China
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艾尼孜尔· 亚, 阿里木江· 阿, 买买艾力· 玉, 任 鹏, 马 创, 艾合买提江· 玉. [Trifocal bone transport by using monolateral rail system in treatment of bone defects caused by post-traumatic tibial osteomyelitis]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:862-868. [PMID: 32666729 PMCID: PMC8180421 DOI: 10.7507/1002-1892.201912034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the effectiveness of trifocal bone transport by using monolateral rail system in the treatment of bone defects caused by post-traumatic tibial osteomyelitis. METHODS The clinical data of 28 patients with tibial defects caused by post-traumatic osteomyelitis treated with trifocal bone transport technique by using monolateral rail system between January 2012 and June 2017 were retrospectively analyzed. There were 26 males and 2 females, aged 22-59 years (mean, 41.3 years). The causes of injury included 13 cases of traffic accident injury, 9 cases of falling from height, 4 cases of heavy object injury, and 2 cases of crushing injury. The disease duration was 4.5-17.0 months (mean, 7.1 months). The length of bone defect was 6.5-16.8 cm (mean, 10.3 cm). And the range of soft tissue defect ranged from 3.5 cm×2.0 cm to 18.0 cm×11.0 cm. The bone transporting time, external fixation time, duration of regenerate consolidation, and external fixation index were recorded, and the complications were observed. At last follow-up, the bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of the Ilizarov (ASAMI). RESULTS All patients were successfully followed up after removing the external fixator with an average of 35 months (range, 24-65 months). The bone transporting time was 41-136 days (mean, 60.2 days), the external fixation time was 7.5-20.0 months (mean, 13.4 months), the external fixation index was 1.1-1.9 months/cm (mean, 1.4 months/cm), the duration of regenerate consolidation was 6.0-16.5 months (mean, 10.5 months). Pin tract infection occurred in 12 cases, delayed union on docking site was occurred in 9 cases, axial deviation was observed in 2 cases, poor regenerate consolidation was presented in 1 case, and refracture on docking site after fixator removal was occurred in 1 case. There was no recurrence of infection, amputation, vascular and neurologic complications, and osteofascial compartment syndrome. At last follow-up, according to ASAMI criterion, the bone healing results were excellent in 17 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 85.7%; the functional results were excellent in 15 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 89.3%. CONCLUSION Trifocal bone transport by using monolateral rail system is an effective method in the treatment of bone defect caused by post-traumatic osteomyelitis which can reduce bone transport time, external fixation time, and complications.
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Affiliation(s)
- 亚里坤 艾尼孜尔·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 阿不来提 阿里木江·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 玉山 买买艾力·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 鹏 任
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 创 马
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
| | - 玉素甫 艾合买提江·
- 新疆医科大学第一附属医院骨科(乌鲁木齐 830054)Department of Orthopedics, the First Affiliated Hospital to Xinjiang Medical University, Urumuqi Xinjiang, 830054, P.R.China
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El-Rosasy MA, Ayoub MA. Traumatic Composite Bone and Soft Tissue Loss of the Leg: Region-Specific Classification and Treatment Algorithm. Injury 2020; 51:1352-1361. [PMID: 32327233 DOI: 10.1016/j.injury.2020.03.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The management of traumatic composite bone and soft tissue loss (TCBSTL) requires a classification system and decision-making algorithm for the purpose of description, prognosis and choice of treatment method. PATIENTS AND METHODS between the year 2000 and 2017 a series of 254 cases of TCBSTL were treated using distraction histogenesis and external fixation techniques. The tissue loss was due to either the initial injury or debridement of infection. Adjunctive procedures included split thickness skin grafting and ICBG when indicated. A classification system was designed by the author. The classification is based on factors that influence management and prognosis; (1) stability of the host bone (intact tibia or a well-fixed fracture), (2) presence or absence of infection in the fracture site, (3) size of bone defect, and (4) contamination (infection) of the medullary cavity. A flowchart and decision-making algorithm was subsequently developed. RESULTS Ilizarov external fixator was used in all cases. Ten cases (4%) had combined Masquelet - Ilizarov technique. One hundred seventy five cases (68.9%) had gradual distraction-compression (GDC) technique; while 79 cases (31.1%) had acute shortening and re-lengthening (ASRL) technique. Seventy-two cases (28.3%) had autogenous iliac crest bone graft (ICBG). All cases (100%) had complete clinical and radiological fracture union. All patients completed the follow up that ranged from 24 to 118 months (mean 43.3 ± 23). The results were satisfactory in 212 cases (83.5%) and unsatisfactory in 42 (16.5%) cases due to residual leg length discrepancy, joint stiffness, and persistent pain. DISCUSSION the proposed classification is simple, applicable, recallable and includes most scenarios of reconstructable TCBSTL. The classification provides a basis for communication, description and evaluation of such cases. The algorithm, based on our classification, provides a guideline for management without over/under treatment.
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Affiliation(s)
- Mahmoud A El-Rosasy
- Department of Orthopaedic Surgery & Traumatology, Tanta University, Faculty of Medicine, Tanta, Egypt.
| | - Mostafa A Ayoub
- Department of Orthopaedic Surgery & Traumatology, Tanta University, Faculty of Medicine, Tanta, Egypt
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Kocaoğlu M, Eralp L, Bilen FE, Civan M. Congenital pseudarthrosis of the tibia: Results of circular external fixation treatment with intramedullary rodding and periosteal grafting technique. Acta Orthop Traumatol Turc 2020; 54:245-254. [PMID: 32442122 DOI: 10.5152/j.aott.2020.03.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study investigated the clinical and functional results of treating congenital pseudarthrosis of the tibia (CPT) using the combined techniques of hamartoma resection, periosteal grafting, circular external fixator application, and intramedullary rodding. METHODS The clinical and radiological data of 17 patients (mean age at the treatment time: 7.6 months (range: 4.6-9.7 months) with CPT, treated by a single surgeon between 1997 and 2017, were retrospectively analyzed. All data regarding surgical interventions, complications, deformity analysis parameters, limb length discrepancy (LLD), ankle joint range of motion, and residual deformities were reviewed. All the patients were followed up at least two years after the last surgical intervention. The mean follow-up time was 8.5 years (range: 2.2 to 15.7 years). RESULTS Union was achieved with the index treatment in 15 of the 17 cases (88.2%). The mean age of the patients at the last follow-up visit was 14.2 years (range: 7.6 to 22.1). The mean LLD was 2.1 cm. Nine patients had radiological ankle valgus at the last follow-up. In the entire series, eight patients did not display any complications, four cases reported minor complications, and five cases were complicated by refractures. CONCLUSION Circular external fixator application combined with periosteal grafting is a superior method of CPT treatment. This method provides a healthy biological healing environment while correcting the mechanical problems. The combination of periosteal and cancellous bone grafts with intramedullary rods and an external fixator addresses issues that complicate obtaining and maintaining a union during the CPT treatment. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
| | - Levent Eralp
- Department of Orthopaedics and Traumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Fikri Erkal Bilen
- Department of Orthopaedics and Traumatology, Yeni Yüzyıl University, School of Medicine, İstanbul, Turkey
| | - Melih Civan
- Department of Orthopaedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
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Kamruzzaman M, Mahboob AH, Saha MK, Islam MS, Alam MT, Alamgir MK, Asaduzzaman M. Outcome of Ilizarov External Fixator for the Treatment of Gap Non-uniting Mid Shaft Tibia-fibula Fractures: Our Experience. Mymensingh Med J 2020; 29:284-289. [PMID: 32506080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many patients come with open fracture tibia-fibula initially managed by surgical toileting and the application of indigenous uniaxial external fixator in our country. Many of them lead to non-uniting fracture or sometimes signs of union absent within 4 months from the time of initial fracture and become infected also. This quasi experimental study included 40 skeletally matured patients was conducted from 05 February 2014 to 05 February 2018 in the department of Orthopedics, Mymensingh Medical College Hospital, Mymensigh, Bangladesh. The purpose of this study was to evaluate the efficacy of Ilizarov external fixator for treatment of infected gap non-uniting mid shaft tibia-fibula fracture which was initially open fracture Gustilo II to Gustilo III B. Uniaxial external fixators were replaced by to Ilizarov external fixators which multiaxial. Here male 30(75%), female 10(25%) with mean 28 years of age were analyzed in this study based on the inclusion criteria. Twenty eight (70%) fractures had right tibia-fibula while 12(30%) fracture had involved left tibia-fibula. Twelve (30%) patients had a grade II, grade III A- 18(45%), grade IIIB- 10(25%) open fracture tibia-fibula according to the Gustilo and Anderson classification. Initial mode of injury RTA was 28(70%), fall from height 8(20%), physical assault 4(10%). Mean interval between initial trauma and Ilizarov external fixator application was 4.4 months (ranges 4.2-4.8 months).Union or signs of union achieved in all cases in an average time of 17.12 weeks (range 14-20 weeks). The Ilizarov fixator was kept for an average period of 195 days (range 180-210 days). Minimal follow-up was 9 months after complete frame removal (average: 12 months, range: 9-18 months). Based on ASAMI scoring system, bony and functional results were assessed. The bony results were excellent in 24(60%), good in 12(30%), fair in 4(10%) and the Functional results were excellent in 18(45%), good in 16(40%), fair in 4(10%) and poor in 2(5%). In 16(40%) patients 20 wires had pin tract infection in this series. Most pin-tract infections healed well with regular dressing and oral antibiotics but in 8(20%) patients 8 affected loose wires were exchanged. Limb length discrepancy was 1.5cm in 18(45%) patients and 2.0cm in 22(55%) patients. The small sample sizes and short duration of follow-up were the study limitations. We need a life boat or life jacket during journey. As Orthopeadic Surgeon we are always in danger and Ilizarov method is the life boat technology in orthopedic surgery. It restores bone biology without disturbing the medullary cavity. To avoid repeated surgical intervention and to reduce the cost of treatment, we suggest that gap non-uniting infected tibia-fibula fracture which was primarily open should be fixed by Ilizarov external fixator than continuing treatment with indigenous uniaxial external fixator.
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Affiliation(s)
- M Kamruzzaman
- Dr Mohammad Kamruzzaman, Assistant Professor, Department of Orthopedics, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Takahashi M, Iwase J, Abe M, Kosaka H, Egawa H, Sedo H. Gustilo Type III Open and Comminuted Tibial Fractures Managed by Simultaneous Combination of a Free Latissimus Dorsi Muscle Flap and Ilizarov External Fixation: A Case Report. JBJS Case Connect 2020; 10:e1900346. [PMID: 32649153 DOI: 10.2106/jbjs.cc.19.00346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 70-year-old woman who sustained Gustilo type III open and comminuted tibial fractures presented with extensive soft-tissue defect. Definitive surgery was performed using a free latissimus dorsi muscle flap for the extensive soft-tissue defect and Ilizarov external fixation (IEF) to stabilize the fractures and arthrodese the ankle. Ankle arthrodesis was accomplished by the wires penetrating the implanted muscle flap. CONCLUSION The combined free flap and IEF management protocol described in this report was effective in achieving early weight-bearing and prompt bone healing in an elderly patient with poor bone quality and extensive open and comminuted fractures.
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Affiliation(s)
- Mitsuhiko Takahashi
- 1Department of Orthopaedic Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan 2Plastic and Reconstructive Surgery, Tokushima Prefectural Central Hospital, Tokushima, Japan
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Hosny GA, Ahmed ASAA. Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up. Int Orthop 2020; 44:503-509. [PMID: 31950212 DOI: 10.1007/s00264-019-04464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Nonunion of femur fractures is a devastating disabling complication which is rare in children. The purpose of this study was to report the outcomes of treating infected femur nonunions in children by the Ilizarov fixator in one stage. PATIENTS AND METHODS The study included 13 patients with unilateral infected nonunion of the femur with an average age of 9.1 years. The nonunion duration averaged 10.69 months. Ten cases were draining nonunions, and three patients had quiescent sinuses. Associated problems include shortening in all cases (mean 3.5 cm), joint stiffness (9 cases), and angular deformity (7 cases). The quiescent cases were treated by bloodless monofocal compression-distraction. Four draining cases were treated by debridement and compression with relengthening through nonunion site. The remaining six cases were treated by bifocal technique. RESULTS The mean follow-up duration was 60.15 months. External fixation period averaged 5.3 months. Successful union was achieved in all patients. Recurrences of infection occurred in two cases including one with refracture and another one with late pathological fracture. Other complications included pin tract infections, one delayed union, two residual angular deformities, and 6 cm residual shortening in one patient. ASAMI bone results were excellent (8 patients), good (3 patients), fair (one patient), and poor (one patient). The functional results were excellent (9 cases), good (3cases), and fair (one case). CONCLUSIONS The Ilizarov method provided a viable treatment option for treating paediatric infected femur nonunions in single stage of management with infection control in most cases and satisfactory outcomes.
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Affiliation(s)
- Gamal Ahmed Hosny
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt
| | - Abdel-Salam Abdel-Aleem Ahmed
- Department of Orthopaedic Surgery, Faculty of Medicine, Benha University, Farid Nada Street, Kalyubia, Benha, 13518, Egypt.
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Abstract
BACKGROUND The goal of this study was to perform a functional (subjective) and radiological evaluation of patients who had undergone forearm lengthening by distraction osteogenesis years before. MATERIAL AND METHODS Eleven patients with forearm shortening of various etiology were enrolled. They had undergone a total of 21 lengthening procedures. A retrospective analysis of radiological data was conducted and a subjective evaluation was accomplished by using a modified QuickDASH-9 questionnaire. RESULTS Average bone lengthening was 3.54cm, and mean lengthening index was 40.53day/cm. Eight pa-tients answered the questionnaire at a mean of 7.8yrs after the treatment. The mean questionnaire score was 9.75pts (of 36). Four patients rated the overall function of the affected limb as improved following distraction, while 3 patients were not able to see any improvement. One patient reported that the lengthening had impaired limb function. With regard to cosmetic aspects, 4 patients reported a worsening after the lengthening procedure while 3 patients reported improvement and 1 patient did not note any changes. CONCLUSIONS 1. Despite deformities and functional limitations, patients after forearm lengthening only occasionally suffered from moderate intensity pain. 2. The radiological outcomes were positive and the rate of complications was low. 3. The radiological outcomes did not match patient-declared functional and cosmetic results.
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Affiliation(s)
- Barbara Jasiewicz
- Uniwersytet Jagielloński, Colegium Medicum, Klinika Ortopedii i Rehabilitacji, Kraków, Polska / Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Cracow, Poland
| | - Sławomir Duda
- Uniwersytet Jagielloński, Colegium Medicum, Klinika Ortopedii i Rehabilitacji, Kraków, Polska / Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Cracow, Poland
| | - Tomasz Potaczek
- Uniwersytet Jagielloński, Colegium Medicum, Klinika Ortopedii i Rehabilitacji, Kraków, Polska / Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Cracow, Poland
| | - Maciej Tęsiorowski
- Uniwersytet Jagielloński, Colegium Medicum, Klinika Ortopedii i Rehabilitacji, Kraków, Polska / Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Cracow, Poland
| | - Wojciech Kącki
- Uniwersytet Jagielloński, Colegium Medicum, Klinika Ortopedii i Rehabilitacji, Kraków, Polska / Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Cracow, Poland
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Pajchert-KozŁowska A, Pawik Ł, Szelerski Ł, Żarek SŁ, GÓrski R, Pawik M, Fink-Lwow F, Morasiewicz P. Assessment of body balance of patients treated with the Ilizarov method for tibial nonunion. Acta Bioeng Biomech 2020; 22:131-137. [PMID: 33518732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The biomechanics of the musculoskeletal system in patients after tibial nonunion treatment using the Ilizarov method have not yet been fully explored. From the orthopaedic and patient point of view, after the treatment, an assessment should be carried out of the biomechanics of the musculoskeletal system. The aim of this study was to assess the body balance of patients treated with the Ilizarov method for tibial nonunion. METHODS The research group included 24 individuals with a mean age of 55 years, who were treated for aseptic tibial nonunion with the Ilizarov method. The control group was matched to the study group in terms of gender and age, and consisted of 32 subjects with a mean age of 50.5 years and no significant medical history. This study evaluated the balance of patients with the use of pedobarography. RESULTS In the control group, a statistically significantly shorter path of centre of gravity was observed. There were no statistical differences between the study and control groups for the field area of the centre of gravity. There were no statistical differences between the study and control groups for the minor axis length or major axis length of the centre of gravity. There was a relationship between the centre of pressure path length and the age of the participants in both the control group and the study group. CONCLUSIONS Treatment of patients with tibial nonunion with the Ilizarov fixator achieves similar balance to healthy volunteers. In the pedobarographic evaluation, patients treated for tibial nonunion using the Ilizarov method had similar statics of the musculoskeletal system to healthy volunteers.
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Affiliation(s)
| | - Łukasz Pawik
- Department of Physiotherapy in Motor Disorders and Dysfunctions, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Łukasz Szelerski
- Medical University of Warsaw, Department of Orthopedics and Musculoskeletal Traumatology, Warsaw, Poland
| | - SŁawomir Żarek
- Medical University of Warsaw, Department of Orthopedics and Musculoskeletal Traumatology, Warsaw, Poland
| | - RadosŁaw GÓrski
- Medical University of Warsaw, Department of Orthopedics and Musculoskeletal Traumatology, Warsaw, Poland
| | - Malwina Pawik
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Felicja Fink-Lwow
- Health Promotion, Faculty of Physiotherapy, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Piotr Morasiewicz
- Wroclaw Medical University, Department and Clinic of Orthopaedic and Traumatologic Surgery, Wrocław, Poland
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Wu H, Liang X, Zhao W, Guo B, Ren L, Qin S, Chen J, Peng A, Yang H. [Modified Ilizarov hip reconstruction in treatment of adolescent hip instability]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:1379-1383. [PMID: 31650752 PMCID: PMC8337446 DOI: 10.7507/1002-1892.201904107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/08/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of modified Ilizarov hip reconstruction in the treatment of hip instability. METHODS The clinical data of 13 young patients with hip diseases treated with modified Ilizarov hip reconstruction between January 2010 and March 2018 were retrospectively analyzed. There were 2 males and 11 females, aged from 14 to 34 years, with an average age of 24.2 years. There were 1 case of hip dysplasia and dislocation due to spinal bifida, 3 cases of hip dysplasia after pyogenic arthritis of the hip, 2 cases of developmental dysplasiaof the hip (DDH) accompanying femoral head necrosis who rejected hip replacement, 6 cases of young DDH refused to undergo hip replacement, and 1 case of bilateral hip dysplasia with dislocation due to sputum cerebral palsy. The disease duration was 2-20 years, with an average of 8.5 years. Preoperative Trendelenburg sign was positive in 12 cases and negative in 1 case. The preoperative Harris score of hip joint was 53.5±8.9 and the unequal length of lower limbs was (46.08±15.73) mm. Postoperative Harris hip score and patients' satisfaction with effectiveness evaluated according to their self scoring were used to assess the effectiveness. RESULTS All 13 patients were followed up 1-5 years, with an average of 2.6 years. Five patients developed postoperative needle infection, which improved after dressing change; 7 patients had limited knee joint activity and improved after knee joint function training. The Trendelenburg sign was negative at 1 year after operation, and the patient's hip pain symptoms were relieved or disappeared. The Harris hip score of patients at 1 year after operation was 84.5±6.1, which was significantly improved when compared with preoperative one ( t=-10.538, P=0.000). According to Harris hip score, the effectiveness results were excellent in 4 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 69.2%. The unequal length of lower limbs was (15.38±7.27) mm, which was significantly better than that before operation ( t=11.826, P=0.000). At last follow-up, the patients' satisfaction score was 80%-95%, with an average of 88%. CONCLUSION Modified Ilizarov hip reconstruction can be used to treat young patients with hip disease who are unsuitable or refuse to undergo artificial hip replacement. Its effectiveness is reliable, and it has unique advantages in limb limp improvement and limb shortening correction.
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Affiliation(s)
- Hongfei Wu
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - Xibin Liang
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022,
| | - Wei Zhao
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - Baofeng Guo
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - Longxi Ren
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, 100022, P.R.China
| | - Sihe Qin
- Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China
| | - Jianwen Chen
- Department of Orthopaedics, Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P.R.China
| | - Aimin Peng
- Department of Orthopaedics, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 100144, P.R.China
| | - Huaqing Yang
- Department of Orthopaedics, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 100144, P.R.China
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