Short-Term and Medium-Term Radiological and Clinical Assessment of Patients with Symptomatic Flexible Flatfoot Following Subtalar Arthroereisis with Spherus Screw

BACKGROUND

There have been no reports on arthroereisis screw insertion into the talus in patients with flexible flatfoot. We aimed to conduct a clinical and radiological assessment in patients with symptomatic pes planovalgus deformity treated with a talar screw.

METHODS

This study involved a prospective assessment of 27 patients treated surgically for symptomatic flexible flatfoot deformity in the period 2021-2022. The following parameters were assessed in this study: Meary's angle, the Costa-Bartani angle, the calcaneal pitch angle, surgery duration, the length of hospital stay, patient satisfaction, patients' retrospective willingness to consent to the treatment they received, postoperative complications, and the use of analgesics.

RESULTS

The mean follow-up period was 14.76 months. Meary's angle decreased from 18.63° before surgery to 9.39° at follow-up (p = 0.004). The Costa-Bartani angle decreased significantly from 154.66° before surgery to 144.58° after surgery (p = 0.012). The calcaneal pitch angle changed from 16.21° before to 19.74°. Complications were reported in three patients (11.11%). The mean surgery duration was 32 min. The mean hospital stay was 2.2 days. Fourteen patients (51.85%) were highly satisfied with the treatment, and 12 patients (44.44%) were quite satisfied with treatment. Twenty-five (92.59%) of the evaluated patients would choose the same type of treatment again. Six patients (22.22%) needed to use analgesics prior to surgical treatment, whereas none of the patients needed to use them by the final follow-up.

CONCLUSION

Spherus screw arthroereisis helps improve radiological parameters in patients with flexible flatfoot. We observed good clinical outcomes after treatment with a talar screw, with a majority of patients reporting moderate-to-high levels of satisfaction with treatment. Both short- and medium-term treatment outcomes of pes planovalgus treatment with the use of Spherus screw are good.

Direct Vertebral Rotation (DVR) Does Not Improve Clinical and Radiological Results Compared to Differential Rod Contouring (DRC) in Patients Treated Surgically for Idiopathic Scoliosis

Direct vertebral rotation (DVR) is the most widespread method to correct axial vertebral rotation. Differential rod contouring (DRC) also includes derotation, but not to the same extent as DVR. DVR requires additional surgical effort with potential consequences, which are absent in DRC; moreover, the data concerning the clinical benefits of apical derotation are not convincing. In the present study, clinical and radiological outcomes were compared in patients who underwent surgery for adolescent idiopathic scoliosis (AIS), having DVR and DRC vs. DRC only. In total, 73 AIS patients with curves of 40-85°, consecutively operated on by one surgeon, participated in this study and were followed up over 2 years. Scores from the SRS-22 questionnaire were analysed, the angles of trunk rotation (ATR) were measured with an inclinometer and a radiographic assessment of coronal and sagittal spinal profiles was conducted. In 38 cases, only DRC was performed, and in 35 DRC was performed and followed by DVR; the groups did not differ from an epidemiological point of view. Total SRS-22 scores after 2 years were similar in both groups (4.23 (±0.33) in DRC vs. 4.06 (±0.33) in DRC/DVR, p = 0.1). In all components of SRS-22, the differences were minor, with p being way above 0.05. The mean ATR in the DRC/DVR group was slightly smaller (8 ± 4°) than that of the DRC group (10 ± 5°), p = 0.16. Radiographic analysis did not show significant differences. The coronal curve was corrected by 66 ± 12% for DRC and 63 ± 15% for DVR, p = 0.28. Thoracic kyphosis in the DRC/DVR group increased by 1°, whereas in the DRC group the average kyphosis increased by 5° with a p value of 0.07. The complication rates were similar in both groups. This investigation did not show any advantages of the combination of DRC and DVR in scoliosis correction over DRC only, both radiologically and clinically, yet it affected intraoperative parameters, extending the operation time with only a minor increase in blood loss.

Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study

Background

Chevron osteotomy is one of the most common approaches to hallux valgus corrective surgery. This procedure is often combined with Akin osteotomy of the proximal phalanx of the hallux. There are no definitive guidelines specifying the indications for a given osteotomy technique nor data on postoperative loss of correction or the effect of the type of first-ray surgery on the development of adjacent-joint arthritis. The aim of this study was to assess radiographic treatment outcomes via chevron osteotomy with and without Akin osteotomy.

Methods

The study evaluated 117 patients treated in the period 2016-2019. Ninety-nine of those patients underwent distal chevron osteotomy alone, and 18 patients underwent a combined chevron-Akin double osteotomy. The analyzed radiograms had been obtained preoperatively, at 6 weeks after surgery, and after a long-term follow-up. The following parameters were assessed: the intermetatarsal angle (IMA), hallux valgus angle (HVA), interphalangeal angle (IPA), postoperative recurrence of valgus deformity, adjacent-joint arthritis, and complications.

Results

Chevron-Akin osteotomy helped maintain lower HVA and IPA values in long-term follow-up in comparison with those in the patients who underwent chevron osteotomy alone. The chevron osteotomy group showed a significant increase in the mean HVA from 18.37° at the first follow-up visit to 20.81° at the last follow-up visit. There were no differences between the groups in terms of the remaining assessed radiographic parameters. Hallux valgus surgery does not increase adjacent-joint arthritis.

Conclusion

The use of combined chevron-Akin osteotomy does not affect HVA or IMA correction. The combination of chevron and Akin osteotomies reduces the risk of increased HVA and IPA in long-term follow-up. The additional Akin osteotomy does not increase the risk of adjacent-joint arthritis. Combining chevron osteotomy with Akin osteotomy is recommended in hallux valgus deformity correction.

Prognostic Factors in Staged Bilateral Total Knee Arthroplasty-A Retrospective Case Series Analysis

BACKGROUND

Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure.

METHODS

We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications.

RESULTS

All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371).

CONCLUSIONS

We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size.

Radiographic Outcomes of Hallux Valgus Deformity Correction With Chevron and Scarf Osteotomies

There is no gold standard in the treatment of hallux valgus deformity. The purpose of our study was to compare various aspects of radiographic assessment following scarf and chevron osteotomies and try to determine which technique helps achieve a more pronounced intermetatarsal angle (IMA) and hallux valgus angle (HVA) correction and produces lower rates of complications, including adjacent-joint arthritis. This study included patients who underwent hallux valgus correction with the scarf (n = 32) or chevron (n = 181) method with a follow-up period of over 3 years. We evaluated the following parameters: HVA, IMA, duration of hospital stay, complications, development of adjacent-joint arthritis. The scarf technique helped achieve a mean HVA and IMA correction of 18.3° and 3.6°, respectively, and the chevron technique helped achieve a mean correction of 13.1° and 3.7°, respectively. The achieved deformity correction in terms of both the HVA and IMA was statistically significant in both patient groups. The loss of correction assessed with the HVA was statistically significant only in the chevron group. Neither group showed a statistically significant loss of IMA correction. The duration of hospital stay, reoperation rates, and fixation instability rates were comparable in the 2 groups. Neither of the evaluated methods caused a significant increase in total arthritis scores in the evaluated joints. Our study showed good outcomes of hallux valgus deformity correction in both evaluated groups; however, scarf osteotomy yielded somewhat better radiographic outcomes in HVA correction and no loss of HVA correction at 3.5 years of follow-up.

The Effect of the Covid-19 Pandemic on the Epidemiology of Ankle Joint Injuries in Adults and Children

BACKGROUND

Ankle joint injuries are an important orthopedic issue due to their high incidence and the variety of treatment methods available. This study assessed the effect of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. There is lack of papers which address this problem.

MATERIAL AND METHODS

This study compared epidemiological data on ankle joint injuries in adults and children collected during the period of the COVID-19 pandemic (2020) and a corresponding prepandemic period (2019). Epidemiological data, demographic data, treatment methods, hospital stay duration, and injury-to-surgery time were analyzed.

RESULTS

The total number of patients hospitalized for ankle fractures in the evaluated pandemic period was lower by 34% than that in the corresponding prepandemic period in 2019. The pediatric patient subpopulation showed a 70% decline during the analyzed period of COVID-19 pandemic. The number of hospitalized females declined by 12%, and the number of hospitalized males dropped by 53%.

CONCLUSIONS

1. Our study showed the impact of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. 2. The COVID-19 pandemic effected a decrease in the number of patients with ankle joint injuries, particularly pediatric and male patients with these injuries. 3. National lockdown measures had a considerable effect on lowering the numbers of pediatric patients with ankle joint injuries treated conservatively. 4. Importantly, the tendency can be noted among orthopedic surgeons and emergency room doctors to more readily qualify orthopedic patients for a trial of conservative treatment. This only prolongs the duration of treatment and time to the ultimate therapeutic surgery.

Subjective and Objective Outcomes of Ankle Joint Arthrodesis with Either Ilizarov or Internal Fixation

After arthroplasty, arthrodesis of the ankle joint is the most common method to treat advanced ankle osteoarthritis. The goal of the study was to assess the subjective and objective outcomes in 2 different types of fixation for ankle joint arthrodesis. We retrospectively assessed 47 patients who had undergone ankle joint arthrodesis with fixation either via an Ilizarov apparatus (group 1) (n = 21) or cannulated screws (group 2) (n = 26). The outcomes were measured by: (1) the quantity of analgesics administered, (2) the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, (3) general patient satisfaction, (4) the patients' decision to undergo the same procedure given another chance, and (5) the necessity of blood transfusion during hospitalization. Data was collected at the last postoperative follow-up visit. The AOFAS scores in group 1 and group 2 patients were 73.9   ± 13 and 72.7  ±  14.3, respectively. In group 1, 17 patients (81%) were very satisfied with the results, while in group 2, 19 patients (73%) were very satisfied with the results (p = .043). Two group 1 patients (10%) and four group 2 patients (15.3%) reported that they were satisfied with the outcomes (p = .035). Two patients (10%) from group 1 and three patients (11%) from group 2 were fairly satisfied. Seventeen patients (81%) after arthrodesis with Ilizarov fixation and 21 patients (81%) after arthrodesis with internal fixation would choose the same procedure given the opportunity to choose again. In group 1 there were no patients who required blood transfusion; in group 2 one patient (4%) required blood transfusion; the difference was statistically significant (p = .039). Nineteen group 1 patients (90%) were administered an analgesic preoperatively, while postoperatively only 6 (29%) required analgesics. In group 2, 24 patients (92%) were administered analgesics preoperatively, with 8 (31%) of them still requiring analgesics postoperatively. Ankle arthrodesis patients from both group 1 and group 2 achieved good subjective and objective results of treatment. We noted slightly better results in the Ilizarov apparatus group.

Radiographic Assessment of Tibiofibular Syndesmosis Injury with Different Durations and Types of Fixation

Introduction: There is no consensus among orthopedic surgeons on the number of cortical layers (tricortical or quadricortical fixation) involved or the duration of syndesmotic fixation after a tibiofibular syndesmosis (TFSD)-injury treatment. The purpose of this study was to assess radiographic parameters following the treatment of TFSD injuries, with various time-windows of syndesmotic screw removal and numbers of cortical layers involved. Materials and Methods: Fifty-five patients, aged from 25 to 75 years, were included in the study. The follow-up period ranged from 2 years to 4 years and 2 months. The patients were subdivided into groups based on the duration of the syndesmotic fixation (8–15 weeks—19 patients or 16–22 weeks—36 patients) and the number of cortices involved (tricortical—17 patients or quadricortical fixation—38 patients). Results: The quadricortical fixation group showed a significant development of ankle joint arthritis and subtalar joint arthritis at the final follow-up. The mean medial clear space was 2.84 mm in the tricortical fixation group and 3.5 mm in the quadricortical fixation group (p = 0.005). Both groups, with different screw removal times showed significant development of posttraumatic arthritis. A comparison of the two groups (with different time-windows of the screw removal) revealed a significant difference only in terms of the postoperative tibiofibular (TF) overlap and the observed rates of talonavicular arthritis at the final follow-up. Discussion: We found that the duration of the screw fixation had no effect on most of the evaluated radiographic parameters. Only the postoperative TF overlap was lower in the 8–15-week fixation group, and the proportion of patients with talonavicular joint arthritis at the final follow-up was higher in the 16–22-week fixation group. In addition, the number of cortices involved in the screw fixation had no effect on the radiographic outcomes in our patients, apart from the differences in one parameter—the medial clear space—at the final follow-up. Conclusion: We achieved similar radiographic results irrespective of the duration of the screw fixation and the number of cortices involved. All study subgroups showed the development of adjacent-joint arthritis following treatment. Considering the results of our study, the economic and medical aspects of treatment, and the possibility of a faster recovery, the most optimal solution seems to be the use of a tricortical fixation, with the screws being removed after 8–15 weeks.

Kinematic parameters after tibial nonunion treatment using the Ilizarov method

Background

Analysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an important measure for assessing musculoskeletal disorder treatments that aim to restore normal gait. The purpose of our study was to compare the kinematic parameters in patients with tibial nonunion treated using the Ilizarov method and those in a control group of healthy volunteers.

Methods

The study population consisted of 23 patients (age 54.9 ± 16.4 years) who were treated for tibial nonunion using the Ilizarov method, as well as 22 healthy adult controls (age 52.7 ± 10.6 years). Kinematic parameters were measured using a Noraxon MyoMOTION System. We measured hip flexion and abduction, knee flexion, ankle dorsiflexion, inversion, and abduction during walking.

Results

Our analysis showed significant differences between the patients’ operated limbs (OLs) and the controls’ nondominant limbs (NDLs) in the ranges of hip flexion, hip abduction, and knee flexion. We observed no significant differences in knee flexion between the OL and the NOL in patients or between the dominant limb (DL) and NDL in controls. Our evaluation of the kinematic parameters of the ankle joint demonstrated significant differences between the patients’ OLs and the controls’ NDLs in the ranges of ankle dorsiflexion, ankle inversion, and ankle abduction. There were also significant differences in the range of ankle dorsiflexion and ankle abduction between the patients’ NOLs and the controls’ DLs.

Conclusion

Tibial nonunion treatment using the Ilizarov method does not ensure complete normalization of kinematic parameters assessed 24–48 months following the completion of treatment and rehabilitation.

Content of blood cell components, inflammatory cytokines and growth factors in autologous platelet-rich plasma obtained by various methods

BACKGROUND

The evaluation of the efficacy of platelet-rich plasma (PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically active components in PRP obtained with the use of different methods of gravity separation.

AIM

To compare the content, repeatability and correlations between biologically active components in PRP obtained with four different commercial systems.

METHODS

From a whole blood sample of each of 12 healthy male volunteers, 4 PRP samples were prepared using 4 different commercial kits [Arthrex Autologous Conditioned Plasma (ACP), Mini GPS III, Xerthra, Dr. PRP] in accordance with the instructions provided by the manufacturers. A comparative analysis of blood cell components - 13 selected inflammatory cytokines and 7 growth factors - in the obtained PRP samples was performed using the Kruskal-Wallis test by ranks. The repeatability of results in each method was evaluated by the estimation of the coefficient of variation. The Spearman correlation was used to estimate the relationship between blood cell content and cytokines.

RESULTS

Significantly higher concentrations of platelets (PLT), white blood cells (WBC) and red blood cells (RBC) were found in PRP obtained with the use of Mini GPS III than in PRP obtained using other systems. Significant differences in the content of growth factors and cytokines in PRP were found. A positive correlation of the amount of PLT, RBC and WBC with the concentration of most of the growth factors was found but in only three inflammatory cytokines. The obtained correlations between blood cell components and cytokines differed between the systems in terms of statistical significance, which may be due to insufficient sample size. The repeatability of the obtained PLT concentration also varied between protocols with the lowest in Xerthra and the highest in Arthrex ACP.

CONCLUSION

Significant differences in the content of biologically active components and their repeatability were found in PRP obtained by various methods, providing new data for further research.

The functional and radiographic outcomes following distal radius fracture treatment in a cast for 4 and 6 weeks in the elderly: A randomized trial

BACKGROUND

The optimal duration of cast immobilization following distal radius fractures (DRFs) in elderly patients has not been established.

OBJECTIVES

To assess the functional and radiological parameters following DRF treatment in elderly patients using 2 different periods of cast immobilization.

MATERIAL AND METHODS

We assessed 50 patients (33 women and 17 men). The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. One subgroup (n = 26) included patients treated with a cast for 4 weeks, whereas the other subgroup (n = 24) included patients treated with a cast for 6 weeks. The following measures were assessed: union rate, radial inclination, volar tilt, radial height, Visual Analogue Scale (VAS) pain score, Mayo Wrist Score, and VAS activity score.

RESULTS

The mean volar tilt was 9.13° in the group treated with a cast for 4 weeks and 3.29° in the group treated with a cast for 6 weeks (p = 0.043). There were no differences between the groups in terms of any other functional or radiological parameters.

CONCLUSION

The VAS pain score, Mayo Wrist Score and VAS activity score were similar between the 2 study groups. The greatest volar tilt angle was observed after 6 weeks of cast immobilization. The study groups showed no significant differences in terms of radial inclination, union rate, radial height, or bone union. A period of 4 weeks of cast treatment was sufficient for elderly patients with DRFs.

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

INTRODUCTION

Retrospective study to assess correlation between the sagittal alignment of the cervical spine and the long-term outcomes of long cervical fusion due to cervical spondylotic myelopathy (CSM), with the emphasis on T1 slope minus cervical lordosis (T1S-CL).

SUMMARY OF BACKGROUND DATA

Growing evidence shows that the sagittal profile can play a major role in the outcomes of treatment, but the role of its correction is yet to be established.

MATERIAL AND METHODS

We conducted a retrospective analysis of 54 patients treated for CSM from 2006 to 2012. The neck pain-related disability was measured using NDI, the myelopathy was measured with the mJOA and Nurick scales. Six years after the surgery, standardised X-ray measurements were obtained, including C2-C7 lordosis (CL), C2-C7 sagittal vertical alignment (SVAC2-C7), T1 slope (T1S), and T1S minus CL (T1S-CL). The patients were divided based on the T1S-CL into two groups, using the threshold value of 16.5 degrees.

RESULTS

A statistically significant improvement was noted in the mean NDI, mJOA, and median Nurick scale during the initial two years in both groups. The better aligned group had a better outcome measured with NDI at all follow-ups. The mJOA was significantly better in the better aligned group, but only preoperatively; at all follow-ups, the difference was not significant. T1S-CL had the strongest correlation with the NDI at the final follow-up.

CONCLUSIONS

T1S-CL is an effective prognostic factor of the long term outcome after long cervical fusion in CSM treatment.

Acute Stroke Care during COVID-19: National Data

(1) Background: The pandemic of COVID-19 and subsequent lockdown strategies had a profound impact on many aspects of everyday life. During this time the world faced the unprecedented crisis of healthcare disrupting timely care delivery. This study was designed to evaluate the impact of the pandemic on the acute treatment of stroke in Poland. (2) Methods: The national data on hospitalizations with stroke as a primary diagnosis were obtained from the National Health Fund of Poland. Poisson regression was used to determine the significance of the change in hospital admissions. The differences between proportions were analyzed using the “N-1” Chi-squared test. (3) Results: During the COVID-19 period, the number of hospitalizations dropped by 8.28% with a monthly nadir of 22.02 in April. On a monthly scale during 2020, the greatest decrease was 22.02%. The thrombolysis ratio was also affected, with the highest monthly drop of 15.51% in November. The overall number of in-hospital deaths did not change. (4) Conclusions: The pandemic caused a serious disruption of the acute care of stroke. There is no evidence that the quality of care was seriously compromised.

A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients following Distal Radius Fractures Treated with 4- and 6-Week Cast Immobilization

BACKGROUND

There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization.

METHODS

This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: (1) muscle strength, (2) range of motion.

RESULTS

The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs.

CONCLUSION

Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

Effect of the COVID-19 pandemic on foot surgeries

BACKGROUND

Musculoskeletal dysfunction due to deformities and injuries of the foot is a common orthopedic problem.

OBJECTIVES

To analyze the effect of the COVID-19 pandemic on both elective and emergency foot surgeries.

MATERIAL AND METHODS

This study analyzed the effect of the COVID-19 pandemic on elective and emergency foot surgeries. The comparison included data collected in 2019 (March 15-October 15, when the epidemic did not influence the Polish healthcare system or patient demographics) and in a corresponding period in 2020. This study was conducted in the trauma and orthopedic surgery wards and the emergency departments of 2 regional Polish hospitals.

RESULTS

The analysis of the data from the orthopedic wards showed a reduction in the total number of admissions in 2020 by 55%. The number of elective and emergency interventions was differently related to the pandemic, with elective interventions declining by 72% and emergency interventions increasing by 27% in 2020 compared to 2019. The total number of elective foot surgeries in children decreased by 59% in 2020. The mean duration of hospital stay was approx. 2.5 days shorter in adults and 1.7 days shorter in children during the 2nd evaluation period. The emergency department data showed a decline of 32% in the number of patients presenting with injuries during the pandemic. Nonetheless, the pandemic did not affect the mean age of patients and the female-to-male ratio.

CONCLUSIONS

The global COVID-19 pandemic affected the epidemiology of foot injuries as well as the prevalence of foot surgeries in children and adults.

Effects of the COVID-19 Pandemic on the Epidemiology of Knee and Shoulder Arthroscopy

The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopy performed in an orthopedic department of a university hospital in Poland. This study compared the data on all shoulder and knee arthroscopy procedures performed in two different periods: The period of the COVID-19 pandemic in Poland (from March 4, 2020, to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019, to October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration. The total number of arthroscopy procedures conducted in the evaluated period in 2020 was approximately 8.6% higher than that in the corresponding 2019 period. The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019. The male-to-female ratio was shown to be lower at .85 during the pandemic, having decreased from 1.5 in 2019. The COVID-19 pandemic did not reduce the number of arthroscopy performed at our center, and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.

Dynamic Gait Parameters in Patients With Nonunion of the Tibia Following Treatment With the Ilizarov Method

The purpose of this study was a comprehensive assessment of the dynamic parameters of gait in patients who underwent Ilizarov treatment for nonunion of the tibia. The experimental group consisted of 24 individuals treated with the Ilizarov method for nonunion of the tibia. The control group comprised 31 healthy individuals, matched for BMI, sex, and age. The dynamic gait parameters in patients and in the control group were measured with a Zebris pedobarographic platform. The treatment group and the control group showed statistically significant differences in terms of the following gait parameters: maximum force during braking nonoperated-limb (NOL), time maximum force during braking operated-limb (OL), time maximum force during braking NOL, maximum force during push-off NOL, time maximum force during push-off OL, and maximum force forefoot OL. Most of the evaluated gait parameters were bilaterally similar in patients group. The only significant differences between the operated and nonoperated limb were seen in terms of Time maximum force during push-off and Maximum force forefoot. The most pronounced abnormalities in dynamic gait parameters were observed in the forefoot (maximum force forefoot OL was 13.3% lower than in the control group, maximum force forefoot OL was 12.4% lower than in NOL). The patients treated with the Ilizarov method did not achieve a complete normalization of dynamic gait parameters, as their gait parameters did not equal those measured in the control group. The Ilizarov method for the treatment of tibial nonunion helps restore a symmetrical distribution of gait parameter values between the affected limb and the healthy limb. Patients continue to show the following abnormalities in their dynamic gait parameters after treatment: higher values maximum force during braking NOL, Time maximum force during braking OL, time maximum force during braking NOL, maximum force during push-off NOL, contact time forefoot NOL, contact time midfoot NOL, contact time heel NOL and smaller values of time maximum force during push-off OL.

Analysis and comparison of autologous platelet-rich plasma preparation systems used in the treatment of enthesopathies: A preliminary study

BACKGROUND

Autologous platelet-rich plasma (PRP) injection is an alternative but widely accepted method for the treatment of degenerative changes in tendon attachments known as enthesopathies. The PRP is considered a safe source for high concentrations of the growth factors involved in the healing process. Despite initial promising outcomes, many recent studies report conflicting results for this treatment. This may be due to differences in the concentrations of platelets and growth factors in PRPs obtained using different methods.

OBJECTIVES

The aim of this study was to compare PRP preparation systems in terms of morphotic components and selected growth factors to find the most appropriate procedure for the treatment of enthesopathies.

MATERIAL AND METHODS

Whole blood samples from 6 healthy male volunteers were collected. Using different commercial kits (Mini GPS III System, Arthrex ACP, and Xerthra, Dr. PRP), 4 PRPs were prepared from the blood of each participant. All samples were analyzed for the content of morphotic components and the following growth factors: transforming growth factor-β1 (TGF-β1), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and platelet-derived growth factor AA (PDGF-AA).

RESULTS

The Mini GPS III produced PRP with the highest concentration of platelets and white blood cells (WBC) compared to the other systems included in the study. Significant differences in the levels of EGF and PDGF-AA were found only between the Mini GPS III and Arthrex ACP. There was positive correlation between the content of platelets and the levels of PDGF-AA and EGF. The red blood cells (RBC) concentration positively correlated with PDGF-AA, EGF and VEGF.

CONCLUSIONS

This study showed differences between the morphotic components and levels of selected growth factors in PRP obtained with the different preparation methods. Due to insufficient data, we cannot argue for or against any of the studied protocols for the treatment of enthesopathy. Further studies on a larger population are required to validate our results.

Assessment of Lower Limb Load Distribution in Patients Treated with the Ilizarov Method for Tibial Nonunion

Background

Successful treatment of tibial nonunion should lead to a complete bone union, lack of pain, and pathological mobility of the lower extremity, as well as to the achievement of satisfactory joint mobility and muscle strength, which in turn improves its biomechanics. The objective of this study was to assess the load placed on the lower limbs in patients subjected to treatment with the Ilizarov method due to aseptic tibial nonunion.

Material/Methods

This research involved 24 participants (average age, 55 years). All were diagnosed with aseptic tibia nonunion and treated with the Ilizarov external fixator between 2000 and 2017. The control group was matched to the treated group in terms of sex and age. This study used pedobarography evaluation to assess lower limb load distribution.

Results

No differences were found in the distribution of the load over the entire foot or of the forefoot and hindfoot of the treated limb in comparison to the non-dominant limb of the controls, or in the healthy limb of the treated group compared to the dominant limb of the control group. Similarly, differences in load distribution between the operated and healthy limbs of the treated group were insignificant.

Conclusions

Patients subjected to treatment with the Ilizarov external fixator for aseptic tibial nonunion show symmetrical load distribution on both lower limbs following treatment, which does not differentiate them in this respect from healthy individuals. Treated patients presented with a symmetrical distribution of the load on the lower extremities over the entire foot surface, including the forefoot and hindfoot. Finally, the Ilizarov external fixator enables restoration of correct static biomechanics of the treated limbs over the period of aseptic tibial nonunion therapy.

Clinical assessment and comparison of ACL reconstruction using synthetic graft (Neoligaments versus FiberTape)

BACKGROUND

Due to the low potential for primary biological healing of the anterior cruciate ligament (ACL), the most popular approach is currently reconstruction using a graft. Recent research indicates that the technique of strengthening a damaged ligament with synthetic tapes (internal bracing) may be an alternative to reconstructive treatment, especially in cases of partial ACL damage.

OBJECTIVES

To compare and evaluate the possibility of using a synthetic graft (Neoligaments or FiberTape) to treat partial lesions of the ACL.

MATERIAL AND METHODS

This was a retrospective cohort study. Selected from a pool of 128 patients undergoing primary unilateral intra-articular ACL reconstruction due to partial lesion of the ACL, group I (Neoligaments) and group II (FiberTape) each included 30 patients. Range of motion (ROM), the Lachman test, the anterior drawer test and the pivot-shift test, the Lysholm Knee Scoring Scale, and International Knee Documentation Committee (IKDC) 2000 scale were used for assessment. Follow-up was carried out after 2 years.

RESULTS

The knee joint regained anterior stability in both the subjective and objective assessments in all patients in both groups. The subjective results were respectively: in group I, 97.2 ±3.2 points on the Lysholm scale and 93.9 ±6.1 points on the IKDC 2000 scale; in group II, 96.1 ±4.9 points on the Lysholm scale and 93.2 ±6.8 points on the IKDC 2000 scale. Group comparison of the results of the IKDC 2000 scale, Lysholm Scale and ROM obtained postoperatively showed no statistically significant differences between groups.

CONCLUSIONS

Reconstruction of partial ACL lesions using a synthetic graft allows regained stability of the knee joint. The results of subjective assessment are comparable with the functional assessment results. The comparison between Neoligaments and FiberTape shows the same functional and objective results, although FiberTape is preferable from an economical perspective.

Diagnostic Challenges and Surgical Strategies in Ossification of the Posterior Longitudinal Ligament. Case Study

This article presents the case of a female patient suffering from cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) which was undiagnosed for a number of years. Besides presenting the clinical case, we describe the pathophysiology, symptoms, diagnostic methods and treatment options related to this condition, which is unusual in the European population.

The Epidemiology of Hip and Knee Primary and Revision Arthroplasties during the COVID-19 Pandemic

BACKGROUND

The purpose of this study was to provide a comprehensive assessment of the impact of the COVID-19 pandemic on the epidemiology of primary and revision arthroplasties of the hip and knee joint.

METHODS

This study compared the data on knee and hip arthroplasty procedures from 2 hospitals (primary and revision) conducted in two periods: the period of the COVID-19 pandemic in Poland (from 4 March 2020 to 15 October 2020) and the corresponding period prior to the pandemic (from 4 March 2019 to 15 October 2019). We compared the epidemiological data, demographic data, and hospital stay duration data from these two periods.

RESULTS

Our analysis demonstrated that the total number of hip arthroplasties conducted in 2020 decreased by 26% in comparison with 2019. In the case of knee arthroplasties, the total number of procedures in the evaluated period in 2020 decreased by 44%. Our study also showed that the mean time of hospital stay for orthopedic patients following hip or knee arthroplasty was 22.87% shorter. The female-to-male patient ratio decreased between the analyzed periods, and this was 22.96% lower during the pandemic.

CONCLUSION

The COVID-19 pandemic in these two hospitals in Poland led to reduced numbers of hip and knee replacement procedures, shorter hospital stays, and a decreased female-to-male patient ratio. The mean age of patients undergoing hip or knee arthroplasty remained unchanged during the national lockdown with respect to the pre-pandemic figure.

Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic - a two-center study

Background

Distal radius fractures (DRFs) constitute 15–21% of all fractures. There are no detailed data on the possible changes in the epidemiology and treatment of DRFs in children and adults during the Covid pandemic. The purpose of our study was a comprehensive assessment of the impact of the COVID-19 pandemic on distal radius fractures (DRF) epidemiology, including both children and adults and various fracture fixation methods in two large trauma centers in Poland.

Methods

This study compared the medical data on the treatment of distal radius fractures in Poland in two periods: the period of the COVID-19 pandemic (from March 15 to October 15, 2020) and the corresponding period prior to the pandemic (from March 15 to October 15, 2019). We assessed detailed data from two trauma centers for pediatric and adult patients. Outpatients seeking medical attention at emergency departments and inpatients undergoing surgery at trauma-orthopedic wards were evaluated. We compared epidemiological data, demographic data, treatment type, and hospital stay duration.

Results

The total number of patients hospitalized due to DRF during the pandemic was 180, it was 15.1% lower than that from the pre-COVID-19 pandemic period (212). In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly (by 22%) from 132 to 103 patients. Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably (by 30.3%) significantly lower in the period of the COVID-19 pandemic, from 119 to 83 patients. Compared to 13 patients from the pre-pandemic period, the number of surgically treated adults statistically increased to 20 patients (by 53.8%). Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7% during the pandemic, with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%.

Conclusions

Our study showed a significant impact of the COVID-19 pandemic on the epidemiology and treatment of DRFs in children and adults. We found decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic. The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age, shorter significantly length of hospital stay, and an increased number of men with DRFs.

Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method

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.

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

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.

Assessment of the lower limb biomechanics in patients after tibiofibular syndesmosis injury treatment

Purpose: There is no consensus as to the number of bone cortices engaged in tibiofibular syndesmosis treatment. The purpose of our study was to assess the weight distribution on the lower limbs after tricortical or quadricortical syndesmosis fixation and different timing of screw removal. Methods: A total of 55 patients who underwent treatment for acute tibiofibular syndesmosis injury were analyzed in this study. The Zebris pedobarographic platform was used to measure the distribution of body weight on the lower limbs. The study population was stratified by the time to syndesmotic screw removal (8–15 weeks versus 16–22 weeks) and the number of bone cortices involved in fixation (three [tricortical fixation] versus four [quadricortical fixation]). Results: The weight distribution on the operated and healthy limbs in patients with tricortical syndesmosis fixation was asymmetrical, with the mean load on the operated and healthy limbs of 48.38% and 51.62%, respectively. The patients who underwent quadricortical syndesmosis fixation exhibited a symmetrical distribution of weight on the operated and healthy limb. There was a symmetrical distribution of the load of body weight on the operated and healthy limbs both in the group with different times to syndesmotic screw removal. Conclusion: Tricortical syndesmosis fixation is associated with an asymmetrical weight distribution on the operated and healthy limbs. In treating tibiofibular syndesmosis injuries, based on our pedobarographic research, quadricortical syndesmosis fixation and leaving the syndesmotic screw in place for up to 15 weeks, seems more beneficial to the patient.

Assessment of the lower limb biomechanics in patients after tibiofibular syndesmosis injury treatment

PURPOSE

There is no consensus as to the number of bone cortices engaged in tibiofibular syndesmosis treatment. The purpose of our study was to assess the weight distribution on the lower limbs after tricortical or quadricortical syndesmosis fixation and different timing of screw removal.

METHODS

A total of 55 patients who underwent treatment for acute tibiofibular syndesmosis injury were analyzed in this study. The Zebris pedobarographic platform was used to measure the distribution of body weight on the lower limbs. The study population was stratified by the time to syndesmotic screw removal (8-15 weeks versus 16-22 weeks) and the number of bone cortices involved in fixation (three [tricortical fixation] versus four [quadricortical fixation]).

RESULTS

The weight distribution on the operated and healthy limbs in patients with tricortical syndesmosis fixation was asymmetrical, with the mean load on the operated and healthy limbs of 48.38% and 51.62%, respectively. The patients who underwent quadricortical syndesmosis fixation exhibited a symmetrical distribution of weight on the operated and healthy limb. There was a symmetrical distribution of the load of body weight on the operated and healthy limbs both in the group with different times to syndesmotic screw removal.

CONCLUSION

Tricortical syndesmosis fixation is associated with an asymmetrical weight distribution on the operated and healthy limbs. In treating tibiofibular syndesmosis injuries, based on our pedobarographic research, quadricortical syndesmosis fixation and leaving the syndesmotic screw in place for up to 15 weeks, seems more beneficial to the patient.

The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

Nonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques. A total of 75 patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients's mean age at the beginning of treatment was 46 years. The mean follow-up period was 10 years and 11 months. The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression. The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay. Bone union was achieved in all of the 75 evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me = 6.00 vs. Me = 4.00). We observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group. The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union, length of hospital stay, duration of Ilizarov treatment, or ASAMI bone scores. For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression. The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia-a retrospective comparative analysis

Introduction

This study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia.

Material and methods

In a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity.

Results

Union rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827).

Discussion

Our study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Assessment of body balance of patients treated with the Ilizarov method for tibial nonunion

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.

Assessment of body balance of patients treated with the Ilizarov method for tibial nonunion

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.

Graft of allogeneic knee extensor mechanism in treatment of giant cell tumor of the patella

Introduction: Cancer of the patella is a rare condition. Giant cell tumor of the patella is an extremely rare and a difficult to solve therapeutic problem. Depending on the degree of bone destruction, it may cause significant knee joint dysfunction. It is assumed that surgery is the treatment of choice. Material/Methods: This study presents an innovative treatment of a giant cell tumor of the patella in a 40-year-old male with significant dysfunction of the knee extensor mechanism. Complex therapy included neoadjuvant treatment using a human monoclonal antibody IgG2 that binds to RANKL (Denosumab) and follow-up allogeneic grafting of knee extension mechanism. Results: Follow-up CTs showed correct positioning and healing of grafted knee extensor mechanism. Early functional outcome was perfect. Seven weeks after the surgery, reduction of pain, improvement of the contour of the joint, full active extension and flexion of 110° were noticed. Fifteen months after the surgery, the patient presented complete active extension and flexion of the knee joint, actively participated in professional life and CT tests did not reveal features of tumor recurrence. Conclusions: Treatment of isolated giant cell tumor of the patella with destruction of patella and joint dysfunction does not have a clear solution in the available literature. Such a condition may also exclude traditional procedures. In such cases, grafting of the whole extensor mechanism appears to be the appropriate treatment.

Sport and physical activity after ankle arthrodesis with Ilizarov fixation and internal fixation

BACKGROUND

Severe osteoarthritis (OA) of the ankle joint constitutes an important social problem.

OBJECTIVES

We used (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA (University of California Los Angeles) activity scale, (4) the VAS (visual analogue scale) ACTIVITY scale, and (5) the FAAM (foot and ankle ability measure) SPORT scale to verify whether the type of ankle joint arthrodesis stabilization affected sports and physical activity levels.

MATERIAL AND METHODS

We carried out a prospective clinical study of 47 patients who had undergone ankle arthrodesis with Ilizarov external fixator stabilization (Group 1, n = 21) or internal stabilization with screws (Group 2, n = 26) at Orthopaedic Clinic at the Wroclaw Medical University, Poland, from 2007 to 2015. Sports and physical activity levels were measured by (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA activity scale, (4) the VAS ACTIVITY scale, and (5) the FAAM SPORT scale.

RESULTS

A comparison between the average results of Group 1 and Group 2 on the LOWER LIMB Activity scale and the GRIMBY scale before and after surgery revealed no significant differences. In Group 1, the mean scores on the VAS ACTIVITY scale and the UCLA activity scale after treatment were higher than in Group 2. In Group 1, the mean outcome in the SPORT FAAM scale after treatment was 40; in Group 2 it was 30.06.

CONCLUSIONS

Ilizarov fixation of ankle arthrodesis is associated with better scores on the FAAM SPORT, UCLA activity and VAS ACTIVITY scales after treatment than internal fixation. The scores on the GRIMBY scale and the UCLA activity scale were significantly higher after treatment than before treatment in both groups. In this study, ankle fusion with Ilizarov fixation and internal fixation was found to be effective in the treatment of ankle arthritis. The levels of sport and physical activity were satisfactory in both groups, but the outcomes after fixation with the Ilizarov apparatus were better than after internal stabilization.

Clinical evaluation of ankle arthrodesis with Ilizarov fixation and internal fixation

Background

Ankle arthrodesis may have internal or external stabilization.

We assessed whether the type of stabilization after ankle arthrodesis will affect: (1) functional outcome in Foot and Ankle Ability Measure (FAAM) scale, (2) pain level, (3) period of hospitalization, (4) rate of complications.

Methods

We retrospectively studied 47 individuals after ankle arthrodesis with Ilizarov fixation (group 1, n = 21) and internal stabilization (group 2, n = 26) at our institution in years 2007–2015. Clinical outcomes were measure by: (1) functional outcome in FAAM scale, (2) pain level, (3) period of hospitalization, (4) rate of complications.

Results

Total number of complications in Ilizarov group was 13, which corresponded to 0.62 complications per patient on average. In group 2 there were 15 complications, which corresponded to 0.58 complications per patient on average. The intergroup difference in rate of complications was not statistically significant (p = 0.066). In group 1 the mean VAS pain level before treatment was 4.69 and after treatment was 1.5 (p = 0.037). In group with internal stabilization the mean VAS pain level before treatment was 4.71 and after treatment was 2.9 (p = 0.044). In group 1 the mean period of hospitalization was 5.29 days, in group 2 was 5.71 days (p = 0.517). In group 1 the mean functional outcome in FAAM scale was 79.38, in group 2 was 70.11 (p = 0.458).

Conclusions

Ankle arthrodesis with Ilizarov stabilization is associated with lower prevalence of VAS pain level after surgery than after internal screws stabilization. Rate of complications, FAAM functional score and period of hospitalization were not statistically significant between group 1 and 2. Clinical outcome was satisfactory in group 1 and 2, but outcomes in Ilizarov group were slightly better than after internal stabilization.

The impact of configuration of the Ilizarov fixator on its stiffness and the degree of loading of distraction rods

BACKGROUND

The mechanical parameters of the Ilizarov fixator are influenced by many factors related to its spatial configuration. The aim of this study was to experimentally evaluate the impact of the type of implant and the number of distraction rods on the uniformity of loading of distraction rods and stiffness coefficients of the Ilizarov fixator.

METHODS

The tests were carried out on a physical model. The model was mounted in a universal loading station MTS 858 Mini Bionix. Forces in distraction rods are measured with the use of strain gauge force transducers. Displacements of bone fragments were measured by means of digital image correction.

FINDINGS

In the case of a fixator with 3 distraction rods, configuration of implants has no statistically significant effect on the forces occurring in distraction rods. In the case of a fixator with 4 distraction rods, there are statistically significant differences in the forces in distraction rods. The highest transverse stiffness coefficients occurs in the system with 4 distraction rods and the configuration of 1K1S implants, while the smallest transverse stiffness coefficients occurs in the fixator with 4 distraction rods and the configuration of 0K1S implants.

INTERPRETATION

Based on the results of experiments on the physical model, we observed an asymmetry in the distribution of forces transmitted through distraction rods. The configuration with 3 distraction rods provides more uniform distribution of forces in distraction rods and reduces the impact of the implant configuration on transverse stiffness coefficients. The use of a configurations with 4 rods may be advantageous when we want to obtain greater transverse stiffness coefficients of a system consisting of the fixator and fragments of the lengthened bone.

Minimal invasive posterior correction of Lenke 5C idiopathic scoliosis: comparative analysis of minimal invasive vs. open surgery

INTRODUCTION

Surgical management of adolescent idiopathic scoliosis in spite of usually favourable outcomes is still a major operation. Therefore, efforts are being undertaken to minimalize the procedure, reduce the surgical trauma and postoperative convalescence. The study was designed to compare posterior minimal invasive surgery using navigation based on intraoperative 3D imaging and standard open instrumented fusion in Lenke 5C idiopathic scoliosis treatment.

MATERIALS AND METHODS

From eight patients with Lenke 5C curves planned for posterior correction and instrumented fusion, four were treated with minimally invasive and four had open procedure. Operation length, estimated blood loss, number of fusion levels, days of opioid intake, length of hospital stay and radiation doses required were noted. Radiographic assessment of spinal curvatures was performed (magnitude, flexibility, sagittal alignment). The comparison of the data was done between open and minimally invasive treated patients.

RESULTS

In minimally invasive surgery group, the operations were longer on average 285 min ± 47.5 than in the open surgery group, 242.5 min ± 44.5 (p = 0.371) and resulted in slightly inferior coronal curve correction by 68.25% ± 6.2 vs. 78.25% ± 8.8, respectively (p = 0.072). We observed a clear reduction of intraoperative blood loss in minimally invasive patients (mean 138.75 ± 50 vs. 450 ± 106 ml, p = 0.016), shorter hospital stay, average 3.75 vs. 7 days (p = 0.043) and lower opioid requirements postoperatively - 2 vs. 3.25 days (p = 0.015).

CONCLUSIONS

The minimally invasive approach to idiopathic scoliosis treatment is a very promising technique to limit the extent of surgery maintaining the same goals as in the open method. It allows for lower blood loss, less requirement for opioids and a shorter hospital stay.

Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation

BACKGROUND

A number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads.

METHODS

Retrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform.

RESULTS

In group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant.

CONCLUSIONS

Balance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients' balance.

Increased Radiation but No Benefits in Pedicle Screw Accuracy With Navigation versus a Freehand Technique in Scoliosis Surgery

BACKGROUND

The clinical value of pedicle screws in spinal deformity surgery is well known; however, screw insertion is demanding and sometimes associated with complications. Navigation systems based on intraoperatively obtained three-dimensional (3-D) images were developed to minimize pedicle screw misplacements. However, there is a lack of data confirming superiority of navigation above other techniques. There are also concerns regarding increased radiation used during the procedure.

QUESTIONS/PURPOSES

The purposes of this study were (1) to compare accuracy of the two methods of pedicle screws placement: intraoperative 3-D image navigation versus a freehand technique in patients with idiopathic scoliosis; and (2) to assess the radiation dose received by patients with both methods.

METHODS

Between 2014 and 2016, 49 patients underwent posterior spinal fusion with all pedicle screw constructs for idiopathic scoliosis performed by two surgeons. The study design involved alternating the use of the freehand technique and navigation to position pedicle screws in consecutive patients, forming groups of 27 patients with 451 navigated screws and 22 patients with 384 screws positioned freehand. The two groups did not differ in age, sex, or magnitude of deformity. Two observers not involved in the treatment evaluated the position of the screws. The pedicle breach was assessed on intraoperatively obtained 3-D O-arm® scans according to a grading system: Grade 0 = no pedicle wall violation; Grade 1 = perforation ≤ 2 mm; Grade 2 = 2 to 4 mm; and Grade 3 = perforation > 4 mm. Grades 0 and 1 were considered properly positioned and Grades 2 and 3 represented malposition.

RESULTS

In terms of accuracy, we found no differences, with the numbers available, between the freehand and navigated groups in terms of the proportion of screws that were properly positioned (96% freehand and 96% in the navigation group, respectively; p = 0.518). Grade 3 pedicle screws were observed only in the freehand group and were all located in the upper thoracic spine. Patients undergoing navigated pedicle screw placement received a greater mean radiation dose than those whose screws were placed freehand (1071 ± 447 mGy-cm versus 391 ± 53 mGy-cm; mean difference, 680 mGy-cm; 95% confidence interval, 217-2053 mGy-cm; p < 0.001).

CONCLUSIONS

In patients with moderate idiopathic scoliosis undergoing primary surgery, we did not observe benefits of pedicle screw placement with CT-based navigation, but the patients experienced greater exposure to radiation.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Three-dimensional printing as a technology supporting the treatment of lower limb deformity and shortening with the Ilizarov method

BACKGROUND

Treatment of multiplanar deformities, especially in younger children, requires construction of a complex Ilizarov fixator, frequently with small dimensions. The aim of this study is to verify clinical application of a3D-printed bone model in treatment with the Ilizarov method.

METHODS

The study involved a 6-year-old child in whom clinical and radiological examination revealed multiplanar deformity of the right leg. Then, 3D models of individual bones were printed by means of additive manufacturing and were used as a scaffold to install the Ilizarov apparatus. To compare the expected and factual axial correction and lengthening, we measured spatial orientation of bone fragments three times. The factual axial correction and lengthening were determined with a photometric technique.

RESULTS

Ilizarov fixator with a configuration developed using a 3D model of the treated bone was mounted on the patient's leg. Corticotomy was carried out at the proximal metaphysis of the right tibia, along with osteotomy of the right talus. The treatment resulted in a 3.5-cm lengthening of the limb and a 7° correction of valgus angle. The values of actual lengthening and axial correction were 4.1% lower than the expected values of these parameters.

INTERPRETATION

Orthopedists should consider differences between the expected and actual lengthening and axial correction in planning treatment with the Ilizarov method. Three-dimensional printing is a useful technology that can be used to support treatment with the Ilizarov method.

Balance and lower limb loads distribution after Ilizarov corticotomy

INTRODUCTION

Normal balance and symmetric distribution of lower limb loads are associated with adequate muscle strength, joint mobility and proprioception. The aim of this study was to analyze the distribution of lower limb loads and balance prior to and after axis correction and lengthening with Ilizarov method.

MATERIALS AND METHODS

The prospective analysis included 20 patients from our clinic, who have been subjected to distraction-corrective lower limb corticotomies with the Ilizarov method in 2014-2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform.

RESULTS

Prior to the surgery, mean loads on affected and non-affected limbs corresponded to42%and58%of body weight, respectively. Mean loads on affected and non-affected limbs during the postoperative examination did not differ significantly. Mean path length of the center of gravity prior to and after the surgery amounted to143.27 cm and 125.11 cm, respectively. Mean area of the center of gravity was 7.81 cm²prior to the surgery and 5.81 cm²after the procedure.

DISCUSSION

Our present study showed that distraction-corrective Ilizarov corticotomy may provide more symmetric distribution of lower limb loads and improvement of balance. This outcome should be considered satisfactory from the perspective of the locomotor system statics. Corticotomies with Ilizarov method provide symmetric distribution of loads between non-affected and operated limb.

The impact of direct vertebral rotation (DVR) on radiographic outcome in surgical correction of idiopathic scoliosis

INTRODUCTION

Recent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment.

MATERIALS AND METHODS

Thirty-six consecutive patients who underwent posterior spinal fusion with pedicle screws only constructs for idiopathic scoliosis. Fifteen patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and postoperatively-coronal curves, kyphosis (T2-T12, T5-T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn.

RESULTS

We observed reduction of RAsag in all patients; however, in DVR group, decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p = 0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p = 0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2-T12 kyphosis has increased in 28 (65%) patients whereas in non-DVR group in 31 (69%) cases. Mean value of T2-T12 kyphosis growth was 16.7% in DVR and 22.1% in non-DVR group. These differences however did not occur statistically significant.

CONCLUSIONS

Direct vertebral rotation (DVR) maneuver reduces significantly apical rotation of the spine, enhances ability of coronal correction, and it does not reduce thoracic kyphosis.

The effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method

PURPOSE

Exerting axial pressure on the affected lower limb remains one of the most crucial elements of Ilizarov method. The objective was to determine the effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method.

METHODS

The study included 15 patients who underwent lower limb lengthening. The patients were tested on the third day after surgery using the pedobarographic platform. The tests were performed four times in the standing position: twice with the support of forearm crutches and twice without crutches. Patients were asked to either remain in the relaxed standing position (two tests) or use the lower limb equipped with Ilizarov apparatus to support the body weight (two tests).

RESULTS

In relaxed stance average pressure with forearm crutches was 24.1% for affected limb, as compared to 75.9% for the healthy limb. In test without forearm crutches average pressure for affected limb was 26.1%, as compared to 73.9% for the healthy limb. Patients shifted body weight to the affected limb with forearm crutches on average, at the rate of 53.6%. In test without forearm crutches the affected limb was supporting the body weight at the rate of 48.26%. None of the patients was able to fully support the body weight on the affected leg.

CONCLUSIONS

In spite of strict physiotherapy regimen, patients are neither able to equally distribute their body weight between the two lower limbs nor to shift their body weight to the limb equipped with Ilizarov apparatus.

The Use of 3D Printing Technology in the Ilizarov Method Treatment: Pilot Study

BACKGROUND

Significant developments in additive manufacturing technology have occurred in recent years. 3D printing techniques can also be helpful in the Ilizarov method treatment.

OBJECTIVES

The aim of this study was to evaluate the usefulness of 3D printing technology in the Ilizarov method treatment.

MATERIAL AND METHODS

Physical models of bones used to plan the spatial design of Ilizarov external fixator were manufactured by FDM (Fused Deposition Modeling) spatial printing technology. Bone models were made of poly(L-lactide) (PLA).

RESULTS

Printed 3D models of both lower leg bones allow doctors to prepare in advance for the Ilizarov method treatment: detailed consideration of the spatial configuration of the external fixation, experimental assembly of the Ilizarov external fixator onto the physical models of bones prior to surgery, planning individual osteotomy level and Kirschner wires introduction sites.

CONCLUSIONS

Printed 3D bone models allow for accurate preparation of the Ilizarov apparatus spatially matched to the size of the bones and prospective bone distortion. Employment of the printed 3D models of bone will enable a more precise design of the apparatus, which is especially useful in multiplanar distortion and in the treatment of axis distortion and limb length discrepancy in young children. In the course of planning the use of physical models manufactured with additive technology, attention should be paid to certain technical aspects of model printing that have an impact on the accuracy of mapping of the geometry and physical properties of the model. 3D printing technique is very useful in 3D planning of the Ilizarov method treatment.

Pedobarographic analysis of body weight distribution on the lower limbs and balance after Ilizarov corticotomies

BACKGROUND

Symmetrical distribution of the load of the lower limbs and balance are among the determinants of proper biomechanics of the musculoskeletal system. So far, it has not been elucidated whether the correction of the axis and the equalization of the length of the lower limbs allow for achieving proper balance and load distribution. The aim of the present study was to compare load distribution and balance of patients who underwent Ilizarov method corticotomies with healthy controls.

METHODS

The clinical studies evaluated 57 patients, who underwent corticotomy with the Ilizarov method. The control group consisted of 59 healthy volunteers. The evaluation assessed the distribution of the load of the lower limbs and balance using pedobarographic platform.

FINDINGS

In the study group operated limb bore 48.02% of the load on average, while the healthy limb 51.98%. These differences were not statistically significant. The average percentage of load in limbs in treated and control groups did not differ significantly. In the study group, the average length of path of the center of gravity was 145.47cm. In the control group, the average length of path of the center of gravity was 112.69cm. In the study group, the average area of the center of gravity was 7.54cm(2), while in the control group it was 5.19cm(2).

INTERPRETATION

Ilizarov method corticotomy allows for the obtainment value of the load distribution of the lower limbs in the study group not significantly different from those in a control group, but does not ensure the achievement of completely normal balance.

Sport and physical activity in patients after derotational corticotomies with the Ilizarov method

BACKGROUND

Torsional distortion causes numerous musculoskeletal pathologies. Effective treatment allows restoring limb function and return to sport activity. Objectives was to assess the sport activity in patients with derotational corticotomies using the Ilizarov method.

METHODS

It was case series retrospective study. The study examined 56 patients. The control group consisted of 54 patients. A mean follow-up time was 5 years and 6 months. A mean age at the start of treatment was 19 years and 10 months. Patients underwent derotational corticotomies of distal epiphysis of the femur or proximal epiphysis of the tibia using the Ilizarov method. The effect of etiology, type of treatment strategy, and rate, size, and level of derotation on the scores of four activity scales was evaluated; additionally, the activity was compared with the control group.

RESULTS

There were no differences in the scales of activity before and after treatment in the study and control groups. In the study group, higher activity after treatment was reported in the level of GRIMBY activity. Patients with internal torsion had a higher VAS activity level after treatment as compared to patients with external torsion.

CONCLUSIONS

Derotational corticotomies allow returning to or increasing physical and sport activity: they do not have a negative influence on physical activity after treatment as compared to the control group.

Clinical factors affecting lower limb torsional deformities treatment with the Ilizarov method

INTRODUCTION

One of the many uses of the Ilizarov fixator is for torsional deformities correction. Rotational and translational bone displacement related to torsional deformities correction includes the additional tension stresses, which affect the biology of the regenerated bone. Understanding the clinical factors will assist in designing the optimal treatment strategy, thus possibly improving the outcomes.

PATIENTS AND METHODS

It was case series retrospective study. The study examined 56 patients. The mean follow-up time was 5 years and 6 months. The mean age at the start of treatment was 19 years and 10 months. Patients underwent derotational corticotomies of distal metaphysis of the femur or proximal metaphysis of the tibia using the Ilizarov method. In these patients, following derotational corticotomies with the Ilizarov method, numerous variables were defined and their effect evaluated: the selected treatment strategy, the rate, size, type, and level of derotation on complications, the alignment index, the correction coefficient, the elongation index, and deformation correction factor.

RESULTS

The differences in the values of alignment index and deformation correction factor in this study subgroups were not statistically significant. We found differences in the elongation index and correction coefficient in a number of subgroups.

DISCUSSION

In the case of correcting torsional deformation without significant elongation, acute correction and with a value of >30° does not significantly affect the results. Treatment strategy, type and level of derotation had no major influence on torsional deformities treatment.

LEVEL OF EVIDENCE

Case-control study III.

Coexisting psoriasis,psoriatic arthritis, gout and Dupuytren's contracture

The authors describe the case of a 60-year-old Caucasian man with psoriasis who subsequently developed psoriatic arthritis, gout and Dupuytren's contracture. This is the first report documenting the simultaneous occurrence of psoriasis, psoriatic arthritis, gout and Dupuytren's contracture in a single patient. The etiopathology underlying the concurrent presence of these diseases is discussed.

Results and biomechanical consideration of treatment of congenital lower limb shortening and deformity using the Ilizarov method

One of the applications of the Ilizarov apparatus is the correction of congenital shortening and deformities. Ilizarov external fixator produces biomechanical structure with surrounding tissue, which is the reason why very important is correct stability of fixator. Large distraction in the case of high value of lengthening, and large deformity corection result in shear stresses that occur additionally in the regenerate, which can potentially lead to damage of the regenerating nutritive microcirculation of bone tissue and bone fragment displacements. Our objective was to assess the results of the Ilizarov method in the treatment of congenital shortening taking into account treatment strategy and the size of the axis of lengthening and correction. Our research problems include presenting the effects of biomechanics of musculoskeletal deformations on treatment results, presenting complications and their treatment. Between 1989 and 2009, 62 patients underwent surgery to correct congenital lower limb deficiencies at our Clinic; 33 patients were followed-up. In total, there were 70 surgeries (2.12/patient). Axial correction was performed in 26 patients (78.79%). Average age at the start of the treatment was 15.58 years. Mean follow-up was 8.58 years. Mean lengthening per surgery was 3.17 cm with the lengthening index of 50.7 day/cm. Results were very good for 23 patients, good for 7 patients, satisfactory for 3 patients. Complications appeared in 24 patients, problems occurred in 74.42% of the cases, obstacles in 4.65% of cases, and true complications in 20.93% of the cases. The best results were achieved in the treatment of patients with two-stage and two-segment lengthening with a total elongation of less than 7 cm, and without correction of the axis. Congenital shortening of the lower limb should be treated comprehensively because the shortening applies to all segments, and disturbs biomechanics of all lower limb. In the case of axial correction and large amount of elongation high soft tissue forces counteract the distraction forces. Hybrid construction may help to shorten treatment time, increase fixator stability and decrease rate of complications. We suggest use of hybrid Ilizarov fixator, especially when large elongation and axis corection are planned.

Biomechanical aspects of lower limb torsional deformation correction with the Ilizarov external fixator

The correction of torsional deformities with the Ilizarov apparatus is accompanied by rotational and translational displacement, which affects the biomechanics of the bone fragments. Understanding the biomechanical factors will assist in designing the optimal treatment strategy and mechanical properties of the fixator, thus shortening the duration of treatment and improving the outcomes. In order to determine the impact of different types of derotators on the kinematics of bone fragments in Ilizarov apparatus, physical models were studied. Translational and derotational displacement was measured using non-contact method (Optotrak Certus Motion Capture System). The results of the studies conducted on physical models have shown that regardless of the type of the derotator, the divergence between the applied angle of derotation and the obtained angle of rotation relative to fragments needs to be taken into account. Transverse displacement of fragments occur by 3.5 mm to approximately 9 mm, depending on the angle of derotation. For correction of rotational deformities up to 30°, it is advisable to use the type Z derotators because of its higher accuracy of derotation. Different types of derotators can affect the biomechanical conditions in the regenerating bone tissue through different kinematics characteristics.

Pedobarographic evaluation of body weight distribution on the lower limbs and balance after derotation corticotomies using the Ilizarov method

Distortion of the axis and shortening of the limbs result in multiple musculoskeletal pathologies. Rotation disorders should also be included among the disorders of the axis of the lower limb. In the case of rotational distortion, only derotation osteotomy can effectively correct torsion-associated deformations. Rotational distortion correction is accompanied by translational displacement and torsion, which results in more complex biomechanics. Using the pedobarographic platform, it is possible to evaluate static and dynamic posture and gait, percentage of body weight distribution on the lower limbs, and balance. Physiological gait and distribution of weight on the lower extremities are symmetrical. Balance is one of the determinants of proper biomechanics of the musculoskeletal system. An important aspect of treatment evaluation is pedobarographic assessment of balance and body weight distribution on the lower extremities ratio. The aim of this work was to evaluate the pedobarographic assessment of body weight distribution on the lower limbs and balance in patients with derotation corticotomies using the Ilizarov method. The study examined a group of 56 patients, who underwent derotation corticotomy using the Illizarov method between 1996 and 2012 at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System in Wrocław. The control group consisted of 54 patients, who were treated with correctional derotation-free corticotomy using the Ilizarov. Distribution of body weight on the lower limbs and balance were assessed with the pedobarographic platform. Following derotation corticotomy, the amount of body weight placed on the operated limb by subjects from the study group averaged 47.81%, 52.19% in the case of the healthy limb. These differences were not statistically significant. The difference between the average percentage of body weight placed on the diseased and healthy limb in the study group and the controls were not found to be statistically significant. There were no statistical differences in the average length of the gravity line or in the average surface area of the center of gravity position between the study and control groups. Balanced distribution of body weight on the lower limbs was achieved following derotation corticotomies using the Ilizarov method. Derotation corticotomies performed with the Ilizarov method allow for achieving normalization of body weight distribution on the lower limbs and balance, with values similar to those resulting from Ilizarov method derotation-free osteotomy.