[Clinical characteristics analysis of 22 062 patients of foot and ankle deformity from QIN Sihe Orthopaedic Surgery Database between May 25, 1978 and December 31, 2020].

Objective: Based on the clinical data of patients with foot and ankle deformities in the QIN Sihe Orthopaedic Surgery Database, to analyze the characteristics and treatment strategies of foot and ankle deformities, and provide a basis for clinical decision-making. Methods: A total of 22 062 patients with foot and ankle deformities who received orthopedic surgery between May 25, 1978 and December 31, 2020 were searched in the QIN Sihe Orthopedic Surgery Database. The gender, age at operation, regional distribution, etiology, type of deformity, operation method, postoperative fixation method, and other information were collected. Results: Among the 22 062 patients, there were 13 046 males (59.13%) and 9 016 females (40.87%); the age at operation ranged from 1 to 77 years, with a median of 17 years, and 20 026 cases (90.77%) were aged 5 to 40 years. The patients came from 32 provinces, municipalities, and autonomous regions across the China and 5 countries including India and the United States, et al. The etiology and diseases type covered 154 kinds (of which sequelae of poliomyelitis, cerebral palsy, spina bifida and tethered spinal cord, congenital equinovarus foot, post-traumatic foot and ankle deformity, and Charcot-Marie-Tooth disease accounted for the highest proportion). The types of deformities included varus foot, equinus foot, valgus foot, talipes calcaneus, equinocavus, high arched foot, claw toe, and flail foot. Surgical methods included tendon lengthening, soft tissue release, tendon transposition, osteotomy orthopedics, and ankle arthrodesis. The 36 620 operations were performed, including 11 561 cases of hip, knee, and lower leg operations to correct the foot and ankle deformities. Postoperative fixation methods included Ilizarov external fixator in 2 709 cases (12.28%), combined external fixator in 3 966 cases (17.98%), and plaster or brace fixation in 15 387 cases (69.74%). Conclusion: Male patients with foot and ankle deformities account for a large proportion, and the population distribution is mainly adolescents, with a wide distribution of regions, causes and diseases, and talipes equinovarus and varus foot are the main types of deformities. Foot and ankle deformities are often combined with deformities of other parts of the lower limb, which requires a holistic treatment concept. The application of foot soft tissue and bone surgery combined with Ilizarov external fixator and combined external fixators provides a guarantee for the correction of complex foot and ankle deformities.

Twenty Years Development of Tibial Cortex Transverse Transport Surgery in PR China.

Tibial cortex transverse transport (TTT) surgery is an extension of the Ilizarov technique. Based on the law of tension-stress, its primary function is to rebuild microcirculation which can relieve ischemic symptoms and promote wound healing. It has received more and more scholars' attention and has experienced a series of changes for 20 years since it entered PR China. The mechanisms involved have gradually become clear, such as the reconstruction of the polarization balance of macrophages, the promotion of vascular tissue regeneration, and the mobilization and regulation of bone marrow-derived stem cells. TTT technique is mainly used in the treatment of chronic ischemic diseases of the lower extremities. It has recently been successfully used in the treatment of primary lymphedema of the lower extremities. A series of improvements have been made in the external fixator's style, the size of skin incision and osteotomy, and distraction method. For example, the annular external fixator has been redesigned as a unilateral external fixator, and accordion technology has been introduced. For distraction methods after surgery, there was no uniform standard in the past. The technique can also be used in combination with other treatments to achieve better effects, such as interventional therapy, negative pressure sealed drainage, 3D printing technology, traditional Chinese medicine. Nevertheless, the surgery may bring some complications, such as secondary fracture, nail infection, skin necrosis at the surgical site, etc. Reports of complications and doubts about the technique have made the TTT technique controversial. In 2020, the relevant expert consensus was published with treatment and management principles, which might guide the better application and development of this technique.

Antibiotic calcium sulfate-loaded hybrid transport versus traditional Ilizarov bone transport in the treatment of large tibial defects after trauma.

BACKGROUND: The purpose of this study was to compare the clinical effects of antibiotic calcium sulfate-loaded hybrid transport (ACSLHT) and traditional Ilizarov bone transport (TIBT) in the treatment of large tibial defects after trauma. METHODS: Eighty-five patients with large tibial defects after trauma were selected for retrospective study. The range of tibial defects was 6-22 cm. After thorough debridement and infection controlled, bone transport technique was used to reconstruct tibial defects. Forty-four patients were treated with ACSLHT technique (the ACSLHT group), while the other 41 were treated with TIBT technique (the TIBT group). Time in external fixator was evaluated by EFI score. Enneking score was used to evaluate limb functions. SAS score was used to evaluate postoperative anxiety status. In addition, complication incidence was compared, including axis deviation, docking site nonunion, infection recurrence and so on. RESULTS: There was no significant difference in preoperative general data between ACSLHT and TIBT group. EFI score in ACSLHT and TIBT group was 0.6 ± 0.1 cm/month and 1.7 ± 0.3 cm/month, respectively (P < 0.05). Enneking score of ACSLHT and TIBT group was 86.5% and 75.1% (P < 0.05). SAS score of ACSLHT group was significantly lower than that of TIBT group (P < 0.05). Complication incidence in ACSLHT group was significantly lower than that in TIBT group (P < 0.05). CONCLUSIONS: Compared with TIBT group, ACSLHT group had shorter time in external fixator, better limb functions, lower postoperative anxiety score and lower complication incidence which is worth of clinical promotion.

Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review.

BACKGROUND: We present a case of an immense unprecedented tibial bone lengthening of 33.5 cm. The management of chronic osteomyelitis of the right tibia with subtotal tibial bone defect, talus defect and equinus ankle deformity. We demonstrate limb reconstruction by distraction osteogenesis and correction of ankle deformity with the Ilizarov technique. Limb salvage was preferred as an alternative to amputation to restore basic limb function. CASE PRESENTATION: A 16-year-old male patient fell and injured his right lower leg. He attempted to treat the symptoms with traditional home remedies. During 15 months of self-treating, he developed osteomyelitis of the right tibia and had lost function in his foot. Radiology revealed immense bone defect of the right tibia, including talus bone defect and equinus deformity of the calcaneus. The patient's right tibia was non weight-bearing, had drainage sinus just below his knee and a large scar anteriorly along the entire length of the tibia. CONCLUSION: Upon completion of treatment, the patient was able to avoid amputation of his leg with partially restored function for weight-bearing. He carried himself without assistance after 3 years of lost function in his right leg. Tibial bone distraction osteogenesis of 33.5 cm was done after 90% of the tibial length was defected. To the best of our best knowledge, this case is one of a kind to achieve distraction of tibial bone to such length.

[Acupoint puncture combined with Ilizarov technique for the treatment of elderly paitents with knee osteoarthritis].

OBJECTIVE: To explore the clinical effect of acupoint puncture combined with Ilizarov technique in the treatment of knee osteoarthritis in the elderly. METHODS: From March 2015 to February 2016, 76 patients with primary knee osteoarthritis were treated with tibial osteotomy acupoint puncture grouop and Ilizarov technique anatomical puncture group, including 24 males and 52 females, aged 56 to 75 years old with an average of 61.4 years old, and a course of 3 to 17 years with an average of 5.2 years. Among them, 38 cases were treated with external fixation of acupoint puncture needle and 38 cases were treated with external fixation of anatomical puncture needle. Preoperative full-length X-ray of both lower limbs showed tibial varus deformity, narrowing of medial knee joint space and enlargement of lateral knee joint space. The force line of the affected knee and lower limb was moved inward by body surface measurement, and the KSS knee function score was decreased. Symptoms included medial knee pain, flexion and extension, and conservative treatment for more than 2 years. RESULTS: The lower limb force lines of both groups were corrected and the osteotomy ends healed well. No nonunion of osteotomy, inadequate correction of lower limbs or recurrence of deformity were found. Seventy-five patients were followed up for 3, 6, 12 and 24 months after operation. There was no significant difference in knee joint mobility between the two groups before operation and on 6, 12, 24 months after operation(F=1.346, P>0.05). There were significant difference in KSS pain and total score between the two groups at 3 months after operation, acupoint puncture group was better than anatomical puncture group(P<0.05); there was no significant difference in KSS score at 12 months after operation(P>0.05). CONCLUSIONS: The acupoint puncture group formed a potential acupuncture effect in the acupoint area by continuously tightening the steel needle on Ilizarov ring external fixator during the post-operative adjustment. Within three months after wearing external fixator, the knee pain symptoms of knee osteoarthritis were relieved rapidly, continuously and effectively, which was significantly better than that of the anatomical puncture group.

Acupoint puncture combined with Ilizarov technique for the treatment of elderly paitents with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To explore the clinical effect of acupoint puncture combined with Ilizarov technique in the treatment of knee osteoarthritis in the elderly.@*METHODS@#From March 2015 to February 2016, 76 patients with primary knee osteoarthritis were treated with tibial osteotomy acupoint puncture grouop and Ilizarov technique anatomical puncture group, including 24 males and 52 females, aged 56 to 75 years old with an average of 61.4 years old, and a course of 3 to 17 years with an average of 5.2 years. Among them, 38 cases were treated with external fixation of acupoint puncture needle and 38 cases were treated with external fixation of anatomical puncture needle. Preoperative full-length X-ray of both lower limbs showed tibial varus deformity, narrowing of medial knee joint space and enlargement of lateral knee joint space. The force line of the affected knee and lower limb was moved inward by body surface measurement, and the KSS knee function score was decreased. Symptoms included medial knee pain, flexion and extension, and conservative treatment for more than 2 years.@*RESULTS@#The lower limb force lines of both groups were corrected and the osteotomy ends healed well. No nonunion of osteotomy, inadequate correction of lower limbs or recurrence of deformity were found. Seventy-five patients were followed up for 3, 6, 12 and 24 months after operation. There was no significant difference in knee joint mobility between the two groups before operation and on 6, 12, 24 months after operation(=1.346, >0.05). There were significant difference in KSS pain and total score between the two groups at 3 months after operation, acupoint puncture group was better than anatomical puncture group(0.05).@*CONCLUSIONS@#The acupoint puncture group formed a potential acupuncture effect in the acupoint area by continuously tightening the steel needle on Ilizarov ring external fixator during the post-operative adjustment. Within three months after wearing external fixator, the knee pain symptoms of knee osteoarthritis were relieved rapidly, continuously and effectively, which was significantly better than that of the anatomical puncture group.

Use of Ilizarov External Fixation Without Soft Tissue Release to Correct Severe, Rigid Equinus Deformity.

The purpose of the present retrospective study was to report the correction of severe, rigid equinus deformities using an Ilizarov external fixator alone, without adjunctive open procedures. Ten feet in 10 patients with rigid equinus deformities were enrolled and underwent gradual correction using an Ilizarov external fixator alone, without additional open procedures. The range of ankle joint motion was measured preoperatively and at the last follow-up visit. The radiographic outcome was assessed using the lateral tibiotalar angle on ankle radiographs taken preoperatively, immediately after removal of the Ilizarov fixator, and at the last follow-up visit. The mean duration of external fixator treatment was 40.1 ± 13.5 days. The preoperative mean ankle range of motion was -55.5° ± 22.2° of dorsiflexion and 63.0° ± 20.8° of plantarflexion. At the last follow-up visit, the mean dorsiflexion had increased to -2.5° ± 6.8° and the mean plantarflexion had decreased to 30.5° ± 12.6°. The mean lateral tibiotalar angle was 152.9° ± 19.7° preoperatively, 103.9° ± 9.4° immediately after removal of the Ilizarov external fixator, and 113.9° ± 11.6° at the last follow-up visit. Immediately after fixator removal, all the patients had clinical correction of their deformity to a plantigrade foot using the Ilizarov external fixator alone, with a mean correction of 49.0° ± 17.4°. Some recurrence was noted at the last follow-up examination, with a final mean correction of 39.0° ± 18.0°. The present study has demonstrated successful correction of severe, rigid equinus deformity with the use of an Ilizarov external fixator without the need for adjunctive soft tissue procedures. This method can be effective for patients with a high risk of complications after open procedures owing to their poor soft tissue envelope.

A holistic perspective of patients' lives post-Ilizarov external fixation.

BACKGROUND: The Ilizarov external fixator (IEF) is used in the treatment of complicated fractures with severe soft tissue damage. Despite advantages of being minimally invasive and allowing early weight-bearing, the IEF has limitations, including size, treatment duration and crucial pin-site care. Many patients showed enormous resilience despite the devastating effects of their injuries. Our aim was to assess the value of IEF treatment for trauma patients with a focus on their quality of life. METHODS: A postal survey was administered to 89 patients treated with an IEF at a level 1 trauma centre between January 2000 and June 2009. An SF-12 health survey was incorporated to measure quality of life. SPSS 18.0 was used for statistical analysis of the data. RESULTS: The response rate was 73%. The majority of patients (77%) were treated with IEF for primary fractures. The median duration in IEF was 174 days (56-614 days). The SF-12 mean mental component score was 51 (16-66) and the mean physical component score was 38 (16-57) at the time of survey. The mental component score was similar to that of a normal population but the physical component score was markedly below. A total of 96.8% respondents were satisfied with the IEF treatment and 91.7% reported that under the same circumstances they would have the same treatment again. CONCLUSIONS: Patient's quality of life scores correlated directly with their injury severity and pre-existing conditions. They were not negatively affected by IEF treatment itself. High quality of life scores (non-physical) were achieved with IEF treatment.

The Ilizarov paradigm: thirty years with the Ilizarov method, current concerns and future research.

The Ilizarov method of bone lengthening, reconstruction and osteosynthesis has developed immensely since its introduction by G.A. Ilizarov in the Soviet Union in the 1960s and in the Western countries in the early 1980s. It has become an integral part of the arsenal used by the orthopaedic community worldwide. The evolutionary development of the method and its current role has considerably improved the quality of life for millions of people around the whole world. Despite the great versatility of its possible applications for bone injuries and diseases, the Ilizarov method could not and cannot be the alternative to a range of other methods that are applied for some specific bone conditions, but rather is a method of choice. Its combination with the current methods of internal fixation or the means of internal fixation that use the biological principles that were laid down by G.A. Ilizarov have demonstrated the importance of tension stress, blood supply, functional loading, and fragment control during bone treatment. The objective of this study was to present an overview of the current state and concerns in the application of the Ilizarov method and define the prospective research trends aimed at regeneration stimulation, better control of treatment, infection barriers and patient comfort.

Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study.

BACKGROUNDS: Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods. METHODS: Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups. RESULTS: Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey. CONCLUSIONS: Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.

Adjunctive hyperbaric oxygen therapy in the treatment of atrophic tibial nonunion with Ilizarov external fixator: a radiographic and scintigraphic study in rabbits.

OBJECTIVE: The aim of this experimental study was to determine the effects of adjunctive hyperbaric oxygen therapy (HBO) on atrophic tibial nonunion treatment using Ilizarov external fixator. METHODS: Twenty New Zealand white rabbits were randomly divided into two equal groups. A circular external fixator was applied to the right tibia of all the rabbits. A 5-mm bone block was resected and a tibial pseudarthrosis was obtained after a 6-month waiting period. The experimental group rabbits (n=10) underwent daily 2.5 ATA HBO therapy for 2 hours for 20 days and the control group rabbits (n=10) did not receive any corresponding treatment. Osteoblastic activity was evaluated with bone scintigraphy on days 30 and 90. Fracture healing was evaluated by plain radiographs on days 30 and 90. RESULTS: On Day 30, radiological scores were statistically similar in both groups (p=0.167). However, on Day 90, the experimental group displayed significantly higher radiological scores (p<0.001). Osteoblastic activity was also higher in the experimental group on both scintigraphic assessments (p=0.005 and p=0.001). CONCLUSION: The results of this study suggest that HBO can be used as a supplementary therapy in the management of atrophic tibial nonunion.

Clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the ilizarov method--preliminary report.

INTRODUCTION: Postoperative edema of predominantly lymphatic origin is a significant hindrance to physiotherapy in patients subjected to limb lengthening by the Ilizarov method. New treatment methods are being sought, and Kinesiology Taping is one of them. MATERIAL AND METHODS: The study involved 24 patients of both sexes subjected to lower limb lengthening using the Ilizarov method who had developed edema of the thigh or crus of the lengthened extremity. The mean age of the patients was 21 years. The patients were randomized into two groups of twelve, which were then subjected to 10 days of standard physiotherapy. The study group was additionally treated with Kinesiology Taping (lymphatic application), while the control group received standard lymphatic drainage. Treatment results were assessed by comparing the linear circumferences of the lower limbs before and after the treatment. RESULTS: The application of Kinesiology Taping in the study group produced a decrease in the circumference of the thigh and crus statistically more significant than that following lymphatic drainage. CONCLUSIONS: 1. Both standard edema-reducing treatment in the form of lymphatic massage and Kinesiology Taping significantly reduced lower limb edema in patients treated by the Ilizarov method. 2. The application of Kinesiology Taping in the study group produced a significantly faster reduction of the edema compared to standard lymphatic massage.

Distribution of radiological density in bone regenerate in relation to cyclic displacements of bone fragments.

We asked how bone fragment displacement could influence the distribution of radiological density in bone regenerate formed during the process of bone lengthening. The metatarsi of 21 sheep were lengthened by 20 mm by the Ilizarov method. The bone fragments were externally fixed with a specially designed ring external fixator equipped with linear actuator driver system. The test sheep were divided into three experimental groups: the G1 and G2 groups (N = 8) and the GR group (N = 5)--the reference group. In the case of sheep from the G1 and G2 groups, the lengthening was supplemented with mechanical stimulation of the regenerate in the form of cyclic bone fragment displacements (CBFDs) with the amplitudes of 1 mm (G1) and 2 mm (G1). Mechanical stimulation was applied over 30 days for 1 h per day with a frequency of 1 Hz. Eight weeks after the procedure the sheep were sacrificed in accordance with the required procedures. The analysis of the degree of bone regenerate mineralization involved the studies based on the CT scanning. The analysis of the results obtained is based on the paramenter called the degree of regenerate mineralization (RMD). The analysis of radiological density was carried out in the selected measurement areas. Such an area was located in three horizontal zones, taking into account the regenerate height, i.e. in its middle part (half regenerate length); the top part, 2 mm from the edge of the proximal fragment; and the bottom part, 2 mm from the edge of the distal fragment. The value of the RMD parameter varies significantly, depending on the bone regenerate area. The results obtained show that the CBFD = 2 mm accelerates the rate of mineralization of an eight-week-old regenerate. In the case of CBFD = 1 mm, the mineralization rate is lower by more than a dozen per cent.

Nonunion: general principles and experimental data.

Nonunions of long bone fractures can be treated successfully with one operative procedure in more than 90% of patients. In fact, 80% of patients can have good to excellent final restoration of mechanical axis alignment and proper length. Patients with infected nonunions may require more than one procedure to eliminate infection and heal the nonunion. Treatment must be tailored to the individual patient to address all components of the problem. We reviewed the main experimental data regarding the knowledge of nonunions and the basic methods that may be applied to the treatment of nonunions.

Component changes of calcium and phosphorus in osteogenesis by lengthening procedures in adult canines.

OBJECTIVE: To explore chemical component changes of dog bone at different lengthening time and in different bone regions of interest, and to evaluate the mineralization during Ilizarov lengthening process. METHODS: The ash weight, the concentrations of calcium, phosphorus and the calcium/phosphorus ratio were measured at different intervals (2, 4, 6, 8, 12 weeks) since lengthening and the lengthened part was compared with a control area at each interval. RESULTS: The ash weight, the concentrations of calcium and phosphorus in the lengthened area differed at all development time. The calcium/phosphorus (Ca/P) ratio in the lengthened region remained significantly lower than that in the control region up to 12 weeks after the lengthening. CONCLUSIONS: These results suggest that also other inorganic ions play an important role in the mineralization process and that they become relatively more important since 8 weeks after the lengthening.

[Hyperbaric oxygenation in the treatment regimen using Ilizarov technique in patients with open fractures]. / Giperbaricheskaia oksigenatsiia v sisteme lecheniia po metodu Ilizarova bol'nykh s otkrytymi perelomami.

The dynamics of clinico-physiological parameters in complex treatment of patients with open fractures of the extremities using hyperbaric oxygenation was analyzed in 22 patients with severe injuries with different degree of ischemia of the extremity, and 9 patients with scanty injuries of the soft tissues. It was shown that vasospasm was observed in patients with the initially normal microcirculation after a course of HBO treatment. In patients with no or initially low capillary blood flow the microcirculation was enlarged due to vasodilatation of the arterioles. No considerable effects of the course of HBO on the main blood flow was revealed. Recommendations are given on using the HBO therapy in management of patients with severe open fractures and osteosynthesis of the injured segment by the Ilizarov methods.

Component changes of calcium and phosphorus in osteogenesis by lengthening procedures in adult canines / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore chemical component changes of dog bone at different lengthening time and in different bone regions of interest, and to evaluate the mineralization during Ilizarov lengthening process.</p><p><b>METHODS</b>The ash weight, the concentrations of calcium, phosphorus and the calcium/phosphorus ratio were measured at different intervals (2, 4, 6, 8, 12 weeks) since lengthening and the lengthened part was compared with a control area at each interval.</p><p><b>RESULTS</b>The ash weight, the concentrations of calcium and phosphorus in the lengthened area differed at all development time. The calcium/phosphorus (Ca/P) ratio in the lengthened region remained significantly lower than that in the control region up to 12 weeks after the lengthening.</p><p><b>CONCLUSIONS</b>These results suggest that also other inorganic ions play an important role in the mineralization process and that they become relatively more important since 8 weeks after the lengthening.</p>

[Reduction of the period of treatment for leg lengthening. Technique and advantages]. / Réduction de la durée du traitement dans les allongements osseux progressifs. Technique et advantage.

PURPOSE OF THE STUDY: We assessed an adaptation of the Ilizarov method aimed at a considerable reduction in the period of treatment for leg lengthening in order to limit complications related to the duration of the external fixation. This technique associates multiple segment lengthening, automatic high-frequency lengthening, and stimulation of bone regeneration by extemporaneous compression at the end of traction. MATERIAL AND METHODS: We analyzed 78 cases of automatic fémur lengthening in 40 patients and simultaneous fémur and tibia lengthening in 38 patients. There were 51 men and 27 women, mean age 13.2 years (6 - 43 years). Mean length deficiency was 4.3 cm for the fémur and 3.5 cm for the tibia. Femoral and/or tibial deformations were observed in 32 patients. Minimal follow-up was 1.5 years. The automatic traction device was composed of the conventional Ilizarov fixator and complementary elements. Different assemblies were used depending on the associated deformations allowing their progressive correction. For 17 patients, radioimmunoassay of thyrocalcitonin and parathormone was performed to compare the time courses. RESULTS: Mean femoral lengthening achieved was 49 mm (8.5 to 20%). Mean tibial lengthening was 42 mm (7.2 to 18.8%). The consolidation index was 18.1 to 21.3 days/cm for single-segment lengthenings and 11.5 days/cm (mean) for two-segment lengthenings (taking into account both the femoral and tibial gain in length). The ideal moment of compression was 5.6 N/cm(2). Acceleration of the bone repairing process was evidenced by activation of the osteotrop hormone system. According to the SOFCOT classification of complications (1990), 60 patients (76.9%) were in category I, 15 (19.3%) in category II, and 3 (3.8%) in category III. DISCUSSION: Improvement of lengthening procedures with external fixators remains an important issue. Treatment periods are often long with consolidation indices for the femur ranging from 39.6 d/cm to 45 d/cm, which can lead to many types of complications. Use of a high-frequency progressive lengthening procedure based on the Ilizarov method considerably reduces the rate of complications compared with progressive lengthening methods and has allowed achieving more satisfactory results in a shorter treatment period. CONCLUSION: Multiple-segment lengthening using an automatic lengthening procedure set at 1 mm per day in four times provides an important reduction in the treatment delays since distraction is performed more rapidly and fewer steps are needed. Automatic high-frequency lengthening with the Ilizarov method provides optimal conditions for tissue regeneration: Treatment periods are shorter and anatomic and functional outcome is very satisfactory. Stimulation by extemporaneous compression of the regeneration zone allows a significant reduction in the duration of consolidation. Shorter delays to consolidation help avoid device-related complications.

Effect of methotrexate on distraction osteogenesis.

To assess the potential of using distraction osteogenesis to reconstruct bone deficient limbs after limb salvage for musculoskeletal sarcomas, the authors examined the effect of methotrexate on distraction osteogenesis in a rabbit tibial lengthening model. Eighteen rabbits underwent tibial corticotomy and application of a ring external fixator. Rabbits were assigned randomly to one of two groups in which either methotrexate (n = 12) or placebo (n = 6) was administered during a 21-day distraction period. Serum methotrexate levels and complete blood cell counts were monitored during distraction, and radiographs of the tibia were obtained weekly. Half of the animals from each group were sacrificed at the end of distraction, and the remaining animals were sacrificed after 6 weeks of neutral fixation when bone normally bridges the gap. Using methotrexate at serum concentrations similar to those used clinically for the treatment of human osteosarcomas, the authors were unable to show significant radiographic, histologic, or chemical differences in the effect of this antineoplastic drug on distraction osteogenesis in the rabbit model.