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1.
Int Orthop ; 48(6): 1427-1438, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38558191

ABSTRACT

PURPOSE: To present the technique of correction of multiplanar deformities around the knee in children and adolescents using the monolateral external fixator. Also, to evaluate the results of the technique regarding radiological correction, time to union, and possible complications. METHODS: A total of 29 patients (47 limbs) were prospectively included in the study (14 males and 15 females). Their median age was 13 years (range, 7-17). All patients had at least a 2-plane deformity around the knee which was corrected using a monolateral external fixator. The primary outcome measure was deformity correction (correction of mechanical axis deviation (MAD) in both the coronal and sagittal planes with correction of rotational deformities). The secondary outcome measures included bony union, radiographic, and functional results (assessed by using the Association for the Study and Application of the Method of Ilizarov (ASAMI) score). RESULTS: The median pre-operative MAD improved from 6.3 to 0.4 cm post-operatively. According to the ASAMI scoring system, the radiographic scoring was excellent in all cases (100%), and the functional scoring was excellent in 22 cases (89.7%) and good in three cases (10.3%). CONCLUSION: The simple monolateral fixator can be an effective tool for multiplanar correction of complex deformities around the knee without limb length discrepancy.


Subject(s)
External Fixators , Knee Joint , Humans , Adolescent , Female , Child , Male , Knee Joint/surgery , Knee Joint/diagnostic imaging , Knee Joint/abnormalities , Prospective Studies , Radiography/methods , Treatment Outcome , Ilizarov Technique/instrumentation
2.
Lasers Med Sci ; 39(1): 110, 2024 Apr 22.
Article in English | MEDLINE | ID: mdl-38649644

ABSTRACT

The sample comprised 44 volunteers who had undergone some surgical procedure and were equally divided into four groups. G1 started the therapy 24 h after the surgical procedure with the device off. G2 followed the same time pattern, 24 h, but with the device turned on. G3 and G4 started therapy three days after the surgical procedure; in G3, the device was turned off, and in G4, the device remained on during therapy; each session lasted 30 min, using 660 nm (red), energy 180 J. For all groups, the therapy started with daily use for seven days and followed the interval use of three times a week until completed 21 days. The revaluation was performed after 7 and 21 days. The results found show changes in HR at rest, systolic and diastolic BP, and in peripheral oxygen saturation, which showed a significant difference in the groups that used on-therapy (p < 0.05). In the MCGILL Scale evaluation, the mean total score showed a more accentuated drop in the groups that used ILIB, (p < 0.05). ILIB may have prevented a more significant evolution of firosis levels; however, no changes were observed in the evaluation of sleep and anxiety. The application of the ILIB in patients undergoing plastic surgery was supported in terms of hemodynamics and pain; in addition, starting the ILIB application 24 h after the procedure proved to be more advantageous.


Subject(s)
Plastic Surgery Procedures , Humans , Female , Male , Adult , Middle Aged , Plastic Surgery Procedures/methods , Ilizarov Technique/instrumentation , Hemodynamics , Young Adult , Oxygen Saturation , Surgery, Plastic/methods
3.
JBJS Case Connect ; 14(2)2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38669349

ABSTRACT

CASE: The patient was an 18-year-old man who had sustained diaphyseal fractures of the left femur and tibia in a traffic accident and underwent surgery at another hospital. A severe left foot equinovarus deformity developed in the early after surgery. The patient's left foot deformity was addressed using unconstrained gradual external fixator correction (the Matsushita method) in combination with soft-tissue contracture through Achilles tendon lengthening and was maintained after removing the external fixation. CONCLUSION: The Matsushita method can be effective in the correction of post-traumatic equinovarus foot deformities.


Subject(s)
Achilles Tendon , Equinus Deformity , Ilizarov Technique , Humans , Male , Adolescent , Achilles Tendon/surgery , Ilizarov Technique/instrumentation , Equinus Deformity/surgery , Equinus Deformity/etiology , Tibial Fractures/surgery , Tibial Fractures/diagnostic imaging , Femoral Fractures/surgery , Clubfoot/surgery
4.
Med Sci Monit ; 27: e930849, 2021 May 28.
Article in English | MEDLINE | ID: mdl-34045428

ABSTRACT

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 AND 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.


Subject(s)
Fractures, Ununited , Ilizarov Technique/instrumentation , Lower Extremity , Postoperative Complications , Tibial Fractures , Weight-Bearing/physiology , Biomechanical Phenomena , External Fixators , Female , Fractures, Ununited/physiopathology , Fractures, Ununited/surgery , Humans , Lower Extremity/injuries , Lower Extremity/physiopathology , Lower Extremity/surgery , Male , Middle Aged , Muscle Strength , Outcome Assessment, Health Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Radiography/methods , Reproducibility of Results , Tibial Fractures/diagnostic imaging , Tibial Fractures/rehabilitation , Tibial Fractures/surgery
5.
Foot Ankle Surg ; 27(4): 432-438, 2021 Jun.
Article in English | MEDLINE | ID: mdl-32561159

ABSTRACT

BACKGROUND: Distraction osteogenesis is frequently used for brachymetatarsia. METHODS: Brachymetatarsia of the fourth ray was treated with the Ilizarov method in 10 females. Distraction rate was 1.00-0.75mm a day. Radiography and ultrasonography were used to study the regeneration course throughout the distraction and fixation phases. RESULTS: Mean lengthening achieved was 2.28cm in the average distraction period of 30.2 days and average fixation phase of 50.2 days. Ultrasonography detected the regeneration signs and zonal structure of the regenerate earlier than radiography. It confirmed slow regeneration in two patients and their distraction rate was corrected. One patient had premature consolidation on distraction day 10 and needed re-osteotomy. CONCLUSIONS: Combination of radiography and ultrasonography to study bone regeneration in brachymetatarsisa provides a better monitoring of distraction callus progression. Ultrasonography is of great value to detect regeneration problems during early stages of lengthening.


Subject(s)
Bone Regeneration , Foot Deformities, Congenital/diagnostic imaging , Foot Deformities, Congenital/surgery , Ilizarov Technique/instrumentation , Metatarsal Bones/surgery , Osteogenesis, Distraction/methods , Adolescent , Adult , Female , Humans , Metatarsophalangeal Joint , Osteotomy , Prospective Studies , Radiography/methods , Treatment Outcome , Ultrasonography/methods , Young Adult
6.
Knee ; 27(5): 1618-1626, 2020 Oct.
Article in English | MEDLINE | ID: mdl-33010781

ABSTRACT

BACKGROUND: The aim of this study was to assess the clinical and radiological results of the dome-shaped high tibial osteotomy (HTO) which was fixed with a novel construct comprised of semi-circular Ilizarov frames and pins. METHODS: The patients with at least five years of follow-up were evaluated. One-hundred and thirty-two knees of 114 patients were included in the final analysis. The clinical evaluation included range of motion and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Anatomical femorotibial angle (aFTA), anatomical medial proximal tibial angle (aMPTA), tibial slope and Insall-Salvati ratio were calculated on standard weight-bearing radiographs. RESULTS: The average aFTA was improved from 1.6° varus to 8.7° valgus (P < 0.001). The average WOMAC score (P < 0.001) and flexion value (P = 0.014) were improved at the latest follow-up (WOMAC: 17.2, flexion: 142.5) compared with the preoperative period (WOMAC: 59.6, flexion: 129.2). The sagittal radiological parameters were not significantly affected. The five-year survival was 96.2%, and 10-year survival was 83.3%. CONCLUSIONS: The semi-circular Ilizarov pin construct provided satisfactory outcomes both clinically and radiologically at mid- to long-term follow-up.


Subject(s)
Bone Nails , Ilizarov Technique/instrumentation , Osteoarthritis, Knee/surgery , Osteotomy/methods , Radiography/methods , Range of Motion, Articular/physiology , Tibia/surgery , Adult , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/physiopathology , Tibia/diagnostic imaging , Time Factors , Treatment Outcome , Weight-Bearing
7.
J Orthop Surg Res ; 15(1): 179, 2020 May 19.
Article in English | MEDLINE | ID: mdl-32430044

ABSTRACT

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.


Subject(s)
Fracture Fixation, Internal/methods , Ilizarov Technique , Internal Fixators , Pseudarthrosis/surgery , Tibia/injuries , Tibia/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Fracture Fixation, Internal/instrumentation , Humans , Ilizarov Technique/instrumentation , Male , Middle Aged , Pseudarthrosis/diagnostic imaging , Retrospective Studies , Tibia/diagnostic imaging , Treatment Outcome , Young Adult
8.
Appl Opt ; 59(7): 2077-2084, 2020 Mar 01.
Article in English | MEDLINE | ID: mdl-32225730

ABSTRACT

A single-mode-multimode-single-mode (SMS) optical fiber-based displacement sensing system mounted on an Ilizarov transverse tibial bone transport device for microcirculation reconstruction is reported. Wide-range displacement is approximated as a uniform extension of a spring that is connected to an SMS optical fiber structure acting as the displacement sensor and allowing full displacement characterization. Transmission spectrum changes are measured, providing a displacement range of 24 mm with a sensitivity of $ - {55.42}\;{\rm pm/mm}$-55.42pm/mm and a resolution of 45.2 µm. The experimental results are characterized using a polynomial response curve for measuring the displacement due to transverse distraction of the Ilizarov device. The SMS fiber interrogation system is based on a macrobending fiber edge filter-based ratiometric measurement system. The use of SMS fibers together with the macrobending fiber-based interrogation system eliminates the influence of temperature on the displacement measurement. The implementation of the all-fiber sensing system of this investigation has uniquely facilitated a smart clinical device with a wide displacement range as well as operating in real-time monitoring when attached to the Ilizarov transverse tibial bone transport device. It also means that this fiber-optic sensing device can be made more cost-effective, simpler in construction, and more versatile while providing a high degree of measurement accuracy and resolution.


Subject(s)
Bone Transplantation/instrumentation , Ilizarov Technique/instrumentation , Optical Fibers , Tibia/diagnostic imaging , Equipment Design/instrumentation , Fiber Optic Technology/instrumentation , Humans , Light , Models, Theoretical , Temperature
9.
J Foot Ankle Surg ; 59(2): 337-342, 2020.
Article in English | MEDLINE | ID: mdl-32131000

ABSTRACT

Ankle fusion is a treatment option for end-stage ankle arthritis. Fusion site stability and optimal foot positioning are crucial parameters. We present the results of our double fixation technique, combining both cross-screw fixation and Ilizarov external fixator frame via transmalleolar approach. We reviewed the files from 52 patients operated for ankle fusion in our center. In our technique, we use a transmalleolar approach, initial stabilization with 2 cannulated, half-threaded cross screws, and final stabilization with an Ilizarov external fixator frame. Fusion stability, weightbearing time, complication rates, and final functional scores were recorded and evaluated. Mean frame removal time was 11.2 ± 2.1 weeks, and 71.6% of patients were fully weightbearing at that time. Absolute fusion stability was reported in 88.46% of patients at that time, while no pseudarthrosis was noted in final follow-up at 12 months. According to the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot-ankle score evaluation at 12 months, 90.4% of patients reported excellent and 9.6% good results. None of the patients was referred for symptomatic forefoot arthritis, and there were no cases of deep infection or deep vein thrombosis. Material-related complications were reported in 1 patient who was treated with implant removal after 1 year. Ankle fusion is a salvage procedure that offers optimal results in end-stage ankle arthritis. Our technique offers absolute fusion site stability with excellent functional results, minor complications, and the advantages of early protected weightbearing. Careful patient selection in addition to fine foot positioning should be regarded as crucial for the final outcome.


Subject(s)
Ankle Joint/surgery , Arthritis/surgery , Arthrodesis/methods , Bone Screws , External Fixators , Ilizarov Technique/instrumentation , Adult , Aged , Ankle Joint/diagnostic imaging , Arthritis/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Treatment Outcome
10.
J Foot Ankle Surg ; 59(2): 343-346, 2020.
Article in English | MEDLINE | ID: mdl-32131001

ABSTRACT

The purpose of this study was to compare the mid-term clinical outcomes between screw internal fixation and Ilizarov external fixation in patients who underwent ankle arthrodesis and to elucidate the differences between the 2 fixation methods. This study investigated 43 ankles in 41 patients who underwent ankle arthrodesis at 1 of the 2 study institutions. There were 15 men and 26 women, and their mean age was 66.2 (range 49 to 87) years. The primary disease included osteoarthritis (OA) (79%), rheumatoid arthritis (RA) (16.3%), and Charcot joint (4.7%). Patients were divided into 2 groups depending on the surgical approach: the screw group (S) and the Ilizarov group (I). The following items were evaluated and compared between the 2 groups: patient characteristics, Tanaka-Takakura classification based on preoperative plain X-ray images, duration of surgery, blood loss, surgical complications, time to start weightbearing, and the Japanese Society of Surgery of the Foot (JSSF) standard rating system for the ankle-hindfoot. Duration of surgery was significantly shorter in the S group (162.3 versus 194.9 min), and the amount of blood loss was also significantly lower in the S group (29.2 versus 97.5 ml). Preoperative JSSF scale was significantly lower in the I group (44.8 versus 33), but postoperative JSSF scale was not significantly different between the 2 groups (82.1 versus 77.9). The S group had satisfactory clinical outcomes with a shorter duration of surgery and smaller amount of blood loss than the I group. However, severe patients in the I group achieved similar treatment outcomes.


Subject(s)
Ankle Joint/surgery , Arthrodesis/methods , Bone Screws , Ilizarov Technique/instrumentation , Osteoarthritis/surgery , Aged , Aged, 80 and over , Ankle Joint/diagnostic imaging , External Fixators , Female , Humans , Male , Middle Aged , Radiography , Treatment Outcome
11.
Eur J Orthop Surg Traumatol ; 30(4): 671-680, 2020 May.
Article in English | MEDLINE | ID: mdl-31893294

ABSTRACT

BACKGROUND: Soft tissues (wound dehiscence, skin necrosis) and septic (wound infection, osteomyelitis) complications have been historically recognized as the most frequent complications in surgical treatment of high-energy proximal tibia fractures (PTFs). Staged management with a temporary external fixator is a commonly accepted strategy to prevent these complications. Nonetheless, there is a lack of evidence about when and how definitive external or internal definitive fixation should be chosen, and which variables are more relevant in determining soft tissues and septic complications risk. The aim of the present study is to retrospectively evaluate at midterm follow-up the results of a staged management protocol applied in a single trauma center for selective PTFs. METHODS: The study population included 24 cases of high-energy PTFs treated with spanning external fixation followed by delayed internal fixation. Severity of soft tissues damage and fracture type, timing of definitive treatment, clinical (ROM, knee stability, WOMAC and IOWA scores) and radiographic results as well as complications were recorded. RESULTS AND CONCLUSION: Complex fracture patterns were prevalent (AO C3 58.3%, Schatzker V-VI 79.1%), with severe soft tissues damage in 50% of cases. Mean time to definitive internal fixation was 6 days, with double-plate fixation mostly chosen. Clinical results were highly satisfying, with mean WOMAC and IOWA scores as 21.3 and 82.5, respectively. Soft tissue complication incidence was very low, with a single case of wound superficial infection (4.3%) and no cases (0%) of deep infection, skin necrosis or osteomyelitis. Staged management of high-energy PTFs leads to satisfying clinical and radiographic results with few complications in selected patients.


Subject(s)
Fracture Fixation, Internal , Ilizarov Technique , Soft Tissue Injuries , Surgical Wound Infection , Tibial Fractures , Clinical Protocols , Female , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/methods , Humans , Ilizarov Technique/adverse effects , Ilizarov Technique/instrumentation , Male , Middle Aged , Orthopedic Fixation Devices , Outcome and Process Assessment, Health Care , Patient Selection , Radiography/methods , Soft Tissue Injuries/diagnosis , Soft Tissue Injuries/etiology , Soft Tissue Injuries/prevention & control , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Tibial Fractures/diagnosis , Tibial Fractures/etiology , Tibial Fractures/surgery , Time-to-Treatment , Trauma Severity Indices
12.
Acta Orthop Belg ; 86(2): 335-341, 2020 Jun.
Article in English | MEDLINE | ID: mdl-33418626

ABSTRACT

A significant number of patients with pilon tibial fractures develop complications, the most devastating being a combination of infection and non-union with bone loss. The results of the Ilizarov bone transport technique were retrospectively evaluated in ten patients. All underwent an extensive resection and reconstruction aiming at an ankle arthrodesis. The outcome was registered by clinical and radiographic examination as proposed by Paley's functional and bone results classification. A good healing at the level of the docking site could be obtained in all patients but with a re- intervention in 8 of the 10. In 5 of these patients, re-intervention with a transcalcaneal nailing leaded to the final healing. Other options are debridement of the docking site (2 patients) and a new Ilizarov procedure (1 patient). If patients are prepared to participate in a long-term treatment with the risk of multiple interventions a reconstruction can be performed, resulting in a limb with an acceptable function, allowing all activities of daily life and even a professional occupation. To obtain this final result with a definite union at the docking site a secondary retrograde intramedullary nailing is considered a valuable and safe procedure.


Subject(s)
Ankle Injuries , Arthrodesis , Bone Transplantation/methods , Fracture Fixation, Intramedullary/methods , Ilizarov Technique , Postoperative Complications , Reoperation , Tibial Fractures , Wound Infection , Ankle Injuries/complications , Ankle Injuries/diagnosis , Ankle Injuries/surgery , Arthrodesis/adverse effects , Arthrodesis/methods , Belgium/epidemiology , Debridement/methods , Female , Fractures, Ununited/complications , Fractures, Ununited/diagnosis , Fractures, Ununited/surgery , Humans , Ilizarov Technique/adverse effects , Ilizarov Technique/instrumentation , Male , Middle Aged , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/surgery , Reoperation/methods , Reoperation/statistics & numerical data , Soft Tissue Injuries/complications , Soft Tissue Injuries/diagnosis , Soft Tissue Injuries/surgery , Staphylococcus/isolation & purification , Tibial Fractures/complications , Tibial Fractures/diagnosis , Tibial Fractures/epidemiology , Tibial Fractures/surgery , Wound Infection/complications , Wound Infection/microbiology , Wound Infection/surgery
13.
J Pediatr Orthop B ; 29(4): 337-347, 2020 Jul.
Article in English | MEDLINE | ID: mdl-31503102

ABSTRACT

Congenital pseudarthrosis of the tibia is defined as a non-union of a tibial fracture that develops in a dysplastic bone segment of the tibial diaphysis. Pathologically, a fibrous hamartoma surrounds the bone at the congenital pseudarthrosis of the tibia site. The cases of 25 children, who have congenital pseudarthrosis of the tibia, were included in this study. Their ages ranged from 15 months to 15 years at the time of treatment. Neurofibromatosis-1 was present in 24 children. They were managed according to our classification system and treatment protocol. The treatment for mobile pseudarthrosis (types 1 and 2) included complete excision of the pathological periosteum, insertion of autogenous iliac crest bone graft, and combined fixation using intramedullary rod and Ilizarov external fixator. For type 3 pseudarthrosis (stiff pseudarthrosis), a pre-constructed Ilizarov fixator was applied for simultaneous distraction of the pseudarthrosis and deformity correction without open surgery. Evaluation of results was mainly radiological and included achievement of union, leg length equalization, deformity correction and prevention of refracture. Consolidation of the pseudarthrosis and osteotomies was achieved in all cases (100%). Refracture occurred in one case (4%) at the site of previous pseudarthrosis. Residual limb length discrepancy more than 2.5 cm occurred in two cases (8%). Valgus deformity of the ankle was present in 12 cases (48%) and was treated by supramalleolar osteotomy. Follow-up ranged from 24 to 48 months (average 36.9 months) after fixator removal. The results of our treatment protocol, based on our classification system, have been consistently good and predictable in all cases of congenital pseudarthrosis of the tibia. Mobility of the pseudarthrosis is an important factor in choosing the type of interference.


Subject(s)
Bone Transplantation , Fracture Fixation, Intramedullary , Ilizarov Technique , Leg Length Inequality , Osteotomy , Postoperative Complications , Pseudarthrosis/congenital , Tibia , Adolescent , Bone Transplantation/adverse effects , Bone Transplantation/methods , Child , Child, Preschool , Egypt/epidemiology , Fracture Fixation, Intramedullary/adverse effects , Fracture Fixation, Intramedullary/instrumentation , Fracture Fixation, Intramedullary/methods , Fracture Fixation, Intramedullary/statistics & numerical data , Humans , Ilium/transplantation , Ilizarov Technique/adverse effects , Ilizarov Technique/instrumentation , Infant , Leg Length Inequality/diagnosis , Leg Length Inequality/epidemiology , Leg Length Inequality/etiology , Neurofibromatosis 1/diagnosis , Osteotomy/adverse effects , Osteotomy/methods , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Pseudarthrosis/classification , Pseudarthrosis/diagnosis , Pseudarthrosis/epidemiology , Pseudarthrosis/surgery , Recurrence , Reoperation/methods , Reoperation/statistics & numerical data , Tibia/diagnostic imaging , Tibia/pathology , Tibia/surgery , Tibial Fractures/diagnosis , Tibial Fractures/etiology , Tibial Fractures/surgery
14.
J Knee Surg ; 33(2): 213-222, 2020 Feb.
Article in English | MEDLINE | ID: mdl-30650438

ABSTRACT

Infected nonunion and malunion of tibial plateau are rare injuries with no standardized protocols for treatment. This study assessed the outcome of chronic infected intra-articular proximal tibial fractures with and without metaphyseal bone loss managed with the Ilizarov ring fixator. A series of six patients of intra-articular infected nonunion of the tibial plateau and two patients with malunited plateau with metaphyseal nonunion were treated in a tertiary care hospital. Three of these eight patients had a metaphyseal bone loss or bone gap after debridement and underwent internal transport with distal corticotomy to obtain the bone length. The remaining five patients underwent static ring fixation after correction of the articular deformity. Clinical evaluation was done by Knee Society Score, Rasmussen radiological and Association for the Study and Application of Methods of Ilizarov scores. All patients but one achieved union with the ring fixator. The average follow-up was 33 months (range, 12-120 months). Average time to achieve union was 11.5 months (range, 3-30). The scores were good in four patients and poor in the rest four, out of which three had undergone internal transport. Proximal tibia intra-articular infected nonunion and malunion with or without metaphyseal bone loss can be treated successfully with the Ilizarov fixator. Malunion of the tibial plateau has to be addressed in cases with varus alignment of the limb or articular step-off of ≥ 5mm between the two tibial surfaces. Patients with associated metaphyseal bone loss tend to have complications and take a longer duration to heal. Single-stage treatment avoids intra-articular malunion and loss of limb alignment.


Subject(s)
Fractures, Malunited/surgery , Fractures, Ununited/surgery , Ilizarov Technique/instrumentation , Infections/surgery , Intra-Articular Fractures/surgery , Tibial Fractures/surgery , Adult , Chronic Disease , Debridement , External Fixators , Female , Fracture Healing , Fractures, Malunited/etiology , Fractures, Ununited/etiology , Humans , Infections/complications , Intra-Articular Fractures/complications , Male , Middle Aged , Retrospective Studies , Tibia/injuries , Tibia/surgery , Treatment Outcome , Young Adult
15.
Bone Joint J ; 101-B(9): 1168-1176, 2019 09.
Article in English | MEDLINE | ID: mdl-31474141

ABSTRACT

AIMS: The Precice intramedullary limb-lengthening system has demonstrated significant benefits over external fixation lengthening methods, leading to a paradigm shift in limb lengthening. This study compares outcomes following antegrade and retrograde femoral lengthening in both adolescent and adult patients. PATIENTS AND METHODS: A retrospective review of prospectively collected data was undertaken of a consecutive series of 107 femoral lengthening operations in 92 patients. In total, 73 antegrade nails and 34 retrograde nails were inserted. Outcome was assessed by the regenerate healing index (HI), hip and knee range of movement (ROM), and the presence of any complications. RESULTS: The mean lengthening was 4.65 cm (1.5 to 8) in the antegrade group and 4.64 cm (1.6 to 8) in the retrograde group. Of the 107 lengthenings, 100 had sufficient datapoints to calculate the mean HI. This was 31.6 days/cm (15 to 108). There was a trend toward a lower (better) HI with an antegrade nail and better outcomes in adolescent patients, but these were not statistically significant. Hip and knee ROM was maintained and/or improved following commencement of femoral lengthening in 44 patients (60%) of antegrade nails and 13 patients (38%) of retrograde nails. In female patients, loss of movement occurred both earlier and following less total length achieved. Minor implant complications included locking bolt migration and in one patient deformity of the nail, but no implant failed to lengthen and there were no deep infections. Three patients had delayed union, five patients required surgical intervention for joint contracture. CONCLUSION: This study confirms excellent results in femoral lengthening with antegrade and retrograde Precice nails. There is a trend for better healing and less restriction in hip and knee movement following antegrade nails. There are clinical scenarios, that mandate the use of a retrograde nail. However, when these are not present, we recommend the use of antegrade nailing. Cite this article: Bone Joint J 2019;101-B:1168-1176.


Subject(s)
Bone Lengthening/instrumentation , Bone Nails , Femur/surgery , Leg Length Inequality/surgery , Adolescent , Adult , Aged , Bone Lengthening/methods , Female , Humans , Ilizarov Technique/instrumentation , Male , Middle Aged , Retrospective Studies , Young Adult
16.
BMJ Case Rep ; 12(8)2019 Aug 26.
Article in English | MEDLINE | ID: mdl-31451460

ABSTRACT

Untreated traumatic hip dislocation is a rare condition in children. Capsular arthroplasty is a previously abandoned surgical technique in dealing with developmental dysplasia of the hips but not described in traumatic dislocations. We present a 2-year follow-up of a 7-year-old boy who sustained chronic traumatic posterior hip dislocation treated as a first case in published literature combining a modified version of the Codivilla-Hey Groves-Colonna procedure, using tensor fascia lata graft and application of a hinged Ilizarov frame. The patient is currently independent on all activities of daily living.


Subject(s)
Arthroplasty , External Fixators , Fascia Lata/transplantation , Hip Dislocation , Hip Injuries/complications , Ilizarov Technique/instrumentation , Tendon Transfer/methods , Activities of Daily Living , Arthroplasty/instrumentation , Arthroplasty/methods , Child , Hip Dislocation/diagnosis , Hip Dislocation/etiology , Hip Dislocation/rehabilitation , Hip Dislocation/surgery , Humans , Male , Treatment Outcome
17.
Injury ; 50(3): 770-776, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30711321

ABSTRACT

INTRODUCTION: Pin site infection is the commonest complication of Ilizarov external fixation. The aim of the study was to examine if use of antiseptics was superior over control and further if daily dressing was superior to weekly dressing in regular pin site care in reducing the burden of pin site infection in Ilizarov fixators. PATIENTS AND METHODS: A total of 114 patients (2363 pin sites) were randomised to receive regular pin site care alone (30 patients, 638 pin sites) or with additional application of povidone iodine (27 patients, 561 pin sites), silver sulfadiazine (27 patients, 570 pin sites) and chlorhexidine (30 patients, 594 pin sites). The pin tracts were sub-randomised to receive daily (1212 pin sites) or weekly (1151 pin sites) dressings. The primary outcome was pin site infection days rate across all four groups. The secondary outcomes were - mean duration to first episode of infection, differences between daily and weekly dressing groups, mean duration of antibiotic therapy and incidence of re-interventions and sequelae. We also recorded frequency of bacterial pathogens in all microbiological samples submitted. Block randomization using computer-generated random numbers was used. The assessor of outcome was blinded. RESULTS: All patients completed the study. Pin site infection rate days per 1000 pin site days observed was marginally less in chlorhexidine group, but was not statistically significant compared to other antiseptics and control group (Absolute value in control, povidone iodine, silver sulphadiazine and chlorhexidine groups were respectively 2.04 ± 4.27, 2.04 ± 3.65, 1.85 ± 3.37, 1.37 ± 2.35, p value 0.92). Daily dressing category showed slightly less pin site infection days rate within each group and overall, but this was also not statistically significant (1.56 ± 3.99 versus 2.10 ± 5.1, p value 0.35). There was no statistically significant difference among the groups with regard to other secondary outcomes. Methicillin Sensitive Staphylococcus aureus was the most common bacterial pathogen isolated. CONCLUSION: Use of antiseptics does not offer any advantage in regular pin site care in Ilizarov external fixation and daily pin site care is not superior to weekly pin site care. Empirical therapy in early and low grade pin site infections must be targeted against Staphylococcus.


Subject(s)
Anti-Infective Agents, Local/therapeutic use , External Fixators/microbiology , Ilizarov Technique/instrumentation , Povidone-Iodine/therapeutic use , Prosthesis-Related Infections/prevention & control , Staphylococcal Infections/prevention & control , Surgical Wound Infection/prevention & control , Adult , Aged , Bandages , Female , Humans , Ilizarov Technique/adverse effects , Male , Middle Aged , Prospective Studies , Prosthesis-Related Infections/microbiology , Single-Blind Method , Treatment Outcome , Young Adult
18.
BMC Musculoskelet Disord ; 20(1): 66, 2019 Feb 08.
Article in English | MEDLINE | ID: mdl-30736769

ABSTRACT

BACKGROUND: We evaluated our results of lengthening of free vascularized fibular grafts using a unilateral external fixator in patients with residual leg length discrepancy after free vascularized fibular graft for lower limb reconstruction. CASES PRESENTATION: Two patients were administrated to our hospital with residual tibial length discrepancy after vascularized free fibular graft surgery. Lengthening of the free vascularized fibular graft with a unilateral external fixator was performed to correct the leg length discrepancy. Both patients recovered well with no difficult in activities of daily living at the last follow-up. CONCLUSIONS: This study shows that lengthening of free vascularized fibular grafts with an external fixator is an effective treatment for massive residual leg shortening after vascularized free fibular graft surgery.


Subject(s)
Bone Transplantation/methods , Composite Tissue Allografts/transplantation , Fibula/transplantation , Ilizarov Technique , Leg Length Inequality/surgery , Tibia/surgery , Activities of Daily Living , Adolescent , Composite Tissue Allografts/growth & development , External Fixators , Female , Fibula/diagnostic imaging , Fibula/growth & development , Humans , Ilizarov Technique/instrumentation , Leg Length Inequality/diagnostic imaging , Leg Length Inequality/physiopathology , Recovery of Function , Tibia/diagnostic imaging , Tibia/growth & development , Treatment Outcome
19.
Medicine (Baltimore) ; 98(1): e13978, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30608438

ABSTRACT

Treatment of chronic Monteggia fracture-dislocations remains controversial in skeletally immature patients. The present study aimed to review the clinical outcomes of surgical treatment with an Ilizarov mini-fixator for chronic Monteggia fracture-dislocations in children. From April 2003 to March 2014, 5 pediatric patients (4 males, 1 female) with chronic Monteggia fracture-dislocation were treated with an Ilizarov mini-fixator at our institution. The median age at the time of surgery was 9 years (range 5-14 years), median duration from injury to surgery was 31 months (range 2-125 months), and median duration of follow-up was 12 months (range 11 months-10 years). All patients underwent opening wedge osteotomy of the proximal ulna followed by the application of an Ilizarov mini-fixator. Although closed reduction was attempted after ulnar osteotomy and application of the Ilizarov mini-fixator, open reduction of the radial head was required in all patients. In 4 patients, dense scar tissue in the radiocapitellar joint was excised to enable reduction of the radial head; the remaining patient had traumatic radioulnar synostosis, and underwent separation of the synostosis followed by anconeus interposition arthroplasty. No patient received bone grafting at the ulnar osteotomy site, repair or reconstruction of the annular ligament, or temporary fixation of the radial head with transarticular wire. The median period of external fixation was 10 weeks (range 8-13 weeks). Although there were no severe complications such as deep infection and neurovascular disturbance, asymptomatic radial head subluxation occurred in 2 patients. The patient with traumatic synostosis had residual posterior subluxation with limitation of forearm rotation, and another patient with radial head enlargement had residual anterior subluxation. The median postoperative ranges of motion in pronation, supination, extension, and flexion were 90°, 90°, 0°, and 140°, respectively. The median Kim's elbow performance score was 65 (range 50-75) preoperatively, which improved to 94 (range 80-100) at final follow-up. The outcome was rated as excellent in 4 cases, and good in 1. In pediatric chronic Monteggia fracture-dislocations, ulnar osteotomy followed by the application of an Ilizarov mini-fixator is a viable option that is less invasive than plate fixation.


Subject(s)
Elbow Joint/surgery , Ilizarov Technique/instrumentation , Monteggia's Fracture/surgery , Osteotomy/methods , Ulna/surgery , Adolescent , Bone Wires/adverse effects , Child , Child, Preschool , Chronic Disease , Female , Fracture Fixation/methods , Humans , Joint Dislocations/surgery , Male , Open Fracture Reduction/methods , Range of Motion, Articular/physiology , Synostosis/complications , Treatment Outcome , Ulna/injuries , Elbow Injuries
20.
Acta Orthop Traumatol Turc ; 52(5): 334-342, 2018 Sep.
Article in English | MEDLINE | ID: mdl-30497657

ABSTRACT

OBJECTIVE: The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other. METHODS: The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs. RESULTS: A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = -6.12, 95%CI = -12.07-0.17; CS: MD = -6.43, 95%CI = -12.53-0.3), ulnar variance (RCT: MD = -0.81, 95%CI = -1.25-0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10-0.65; CS: RR = 0.15, 95%CI = 0.06-0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs. CONCLUSIONS: VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs. LEVEL OF EVIDENCE: Level 1, Therapeutic study.


Subject(s)
Bone Plates , Ilizarov Technique/instrumentation , Radius Fractures/surgery , External Fixators , Humans , Treatment Outcome
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