Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods.

Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods / Tratamento de fraturas do planalto tibial com fixador externo circular: Uma análise comparativa de duas formas de montagem

Abstract Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences (p> 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Resumo Objetivo Comparar os resultados funcionais entre duas técnicas de fixação externa circular utilizadas no tratamento de fraturas complexas da extremidade proximal da tíbia. Materiais e Métodos Trata-se de um estudo de coorte retrospectivo, com 51 pacientes submetidos ao tratamento cirúrgico de fraturas complexas do planalto tibial com fixador externo circular. Os pacientes foram divididos em dois grupos: 12 pacientes tratados com a técnica clássica e 39 pacientes tratados com a técnica simplificada. As variáveis analisadas incluíram idade, sexo, mecanismo da lesão, energia do trauma, lesões associadas, tipo de fixador, tempo de uso do fixador e resultados clínico-radiográficos. A técnica clássica lança mão principalmente de fios de Kirschner transfixantes, e a simplificada substitui os fios de Kirschner por pinos de Schanz no bloco distal do fixador externo circular. Resultados A partir da comparação das montagens, não encontramos diferenças estatisticamente significativas (p> 00,5) entre os dois grupos em relação aos resultados clínico-radiográficos, incluindo a consolidação da fratura, a qualidade da redução da fratura articular, a amplitude de movimento, a discrepância residual na medida dos membros inferiores e a dor do paciente no pós-operatório. Conclusão Sugerimos que a técnica simplificada, utilizando pinos de Schanz no lugar dos fios de Kirschner, pode ser uma alternativa viável e eficaz no tratamento de fraturas complexas da extremidade proximal da tíbia com fixador externo circular. Essa abordagem simplificada pode oferecer benefícios, como menor taxa de infecção e maior conforto para o paciente, sem comprometer os resultados clínicos e radiográficos, o que justifica, o seu uso.

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing.

Objective This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing. Methods Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test. Results Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated. Conclusions The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing / Tratamento das pseudoartroses infectadas da tÍbia pelo mÉtodo de Ilizarov associado ao curativo de Orr

Abstract Objective This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing. Methods Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test. Results Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated. Conclusions The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Resumo Objetivo Analisar os resultados e os dados clínicos e epidemiológicos do tratamento das pseudoartroses infectadas da tíbia pelo método de Ilizarov associado ao curativo de Orr. Métodos Para analisar os dados de n = 43 pacientes com diagnóstico de pseudoartrose infectada da tíbia foram aplicados métodos estatísticos descritivos e inferenciais e os resultados ósseos e funcionais foram avaliados de acordo com os critérios de avaliação de Paley. As variáveis qualitativas foram apresentadas por distribuição de frequências absolutas e relativas. As variáveis quantitativas foram apresentadas pelo teste de DAgostino-Pearson. Resultados Foi encontrado que 37 (86,04%) eram do sexo masculino, 6 (13,95%) femininos. A faixa etária mais frequente entre os pacientes foi de 50 a 59 anos (25.6%), p-valor = 0.8610. O tempo de tratamento é maior no tratamento trifocal (23.8 meses) quando comparado com o Bifocal (15.6 meses), p-valor =0.0010* (altamente significante). Os resultados ósseos excelentes representaram 72,09%, 23,25% foram de resultados considerados bons. Os resultados funcionais considerados excelentes foram 55,81%, os resultados bons foram 6,97%, resultados regulares foram 27,90. O curativo com gaze vaselinada (curativo de Orr) mostrou-se eficaz, alcançando assim a cicatrização das feridas com cobertura de partes moles em todos os pacientes avaliados. Conclusões O método de Ilizarov proporcionou uma mudança substancial no tratamentos das infecções ósseas, especialmente das pseudoartroses infectadas. A versatilidade deste método se transformou em uma ferramenta eficaz, permitindo a cura do processo infeccioso, bem como correção das possíveis deformidades e do encurtamento.

Ilizarov Ring External Fixation for Complex Tibial Plateau Fractures / Fixação externa do anel de Ilizarov para fraturas complexas do platô tibial

Abstract Objective To analyze the results of clinical, radiological, and functional outcomes of tibial plateau fracture (Schatzker Type V, VI) treated with Illizarov ring external fixator with or without minimum opening. Methods A total of 52 tibial plateau fractures of type V, VI were treated with Ilizarov ring external fixator with or without mininum internal fixation were studied. Functional outcome assessment was done using the American Knee Society (AKS) score with clinical, radiological union, and complications were analyzed. Results There were 37 (71.15%) male and 15 (28.84%) female patients, with a mean age of 39.07 ± 12.58 years old. Road traffic accidents (RTAs) were the major cause of fracture, accounting for 32 cases (61.53%) followed by fall injury, with 16 cases (30.76%), and direct impact, with 4 cases (7.69%). Twenty-one (40.38%) cases were type V and 31 (59.61%) cases were type VI fractures, and there were 24 (46.15%) cases of open fracture. The mean AKS score of Type V and Type VI fractures were 82.8 and 80.70, respectively, but this was statistically not significant at p<0.05. The mean AKS score of closed and open fractures were also statistically not significant at p<0.05. Conclusions For Schatzker Types V and VI complex tibial plateau fractures, Ilizarov external fixation is a safe, cost-effective and efficient treatment method that presents a satisfactory outcome.

Resumo Objetivo Analisar os resultados clínicos, radiológicos e funcionais da fratura do planalto tibial (Schatzker Tipo V, VI) tratada com fixador externo do anel Illizarov com ou sem abertura mínima. Métodos Um total de 52 fraturas do planalto tibial dos tipos V e VI foram tratadas com fixador externo do anel Ilizarov com ou sem fixação interna mínima. A avaliação do desfecho funcional foi feita utilizando-se o escore da American Knee Society (AKS, na sigla em inglês) com consolidação clínica, radiológica e complicações encontradas. Resultados Foram 37 (71,15%) pacientes do sexo masculino e 15 (28,84%) do sexo feminino, com idade média de 39,07 ± 12,58 anos. Acidentes de trânsito (ATs) foram a principal causa das fraturas, contabilizando 32 casos (61,53%), seguidos por lesão por queda, com 16 casos (30,76%), e impacto direto, com 4 casos (7,69%). Foram 21 (40,38%) casos de fraturas tipo V, 31 (59,61%) casos do tipo VI e 24 (46,15%) casos de fratura exposta. Os escores médios da AKS para as fraturas tipo V e VI foram de 82,8 e 80,70, respectivamente, mas não foi estatisticamente significativo em p <0,05. O escore médio da AKS para fraturas fechadas e abertas também não foi estatisticamente significativo em p <0,05. Conclusões Para a fratura do planalto tibial complexa dos tipos V e VI de Schatzker, a fixação externa de Ilizarov é um método de tratamento seguro, econômico e eficiente que resulta em resultados satisfatórios.

Evaluation of the Quality of Life of Patients Using Circular External Fixator in a Trauma Hospital.

Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

Evaluation of the Quality of Life of Patients Using Circular External Fixator in a Trauma Hospital / Avaliação da qualidade de vida dos pacientes em uso de fixador externo circular em um hospital de trauma

Abstract Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

Resumo Objetivo Avaliar a qualidade de vida dos pacientes em uso do fixador externo do tipo Ilizarov para tratamento de fraturas complexas e de suas sequelas Método Trata-se de um estudo observacional e transversal, em que foi aplicado o questionário 36-item short form survey (SF-36) (traduzido para a língua portuguesa) durante as consultas ambulatoriais em 2 períodos, nos meses de julho de 2018 e janeiro de 2019. Os pacientes que participaram do estudo realizaram seus procedimentos cirúrgicos no período de janeiro a junho de 2018. Resultados Foram avaliados 36 pacientes em uso de fixador externo do tipo Ilizarov. Foi observado predomínio do sexo masculino e idade média de 37,9 anos. As fraturas de ossos da perna e suas complicações representaram metade da amostra. Foi observada melhora na capacidade funcional e nos aspectos emocionais dos pacientes ao longo do tratamento. Conclusão O uso do fixador externo circular constitui um método importante e eficaz para o tratamento cirúrgico de fraturas complexas e de suas sequelas. Este trabalho permitiu concluir que, após o tratamento, os pacientes alcançaram retorno funcional às atividades diárias com adequada qualidade de vida.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility.

Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility / Nível de satisfação e dor na retirada de fixador externo em um ambulatório

Abstract Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Resumo Objetivo Quantificar os níveis de satisfação e dor dos pacientes submetidos a retirada ambulatorial de fixadores externos sem anestesia. Métodos Estudo prospectivo envolvendo 28 pacientes usando fixadores externos submetidos a três questionários associados à Escala Visual Analógica e Numérica da dor durante diferentes etapas da retirada. Resultados A média de dor prévia à retirada foi de 3,61. Logo após o término do procedimento, encontramos média de 6,68 para a dor mais intensa, e de 2,25 para a dor menos intensa. A variação da dor média foi de 4,43, e a dor após uma semana teve média de 2,03. A lembrança dolorosa da retirada foi menor do que a dor referida imediatamente após a retirada (média de 5,29). A predominância no estudo foi de pacientes do sexo masculino de meia-idade, e 89,3% usavam fixador externo do tipo circular. O principal segmento dos membros envolvido foi a perna, e a maior parte dos pacientes não havia feito uso de fixador externo previamente (71,4%); eles optaram pela retirada ambulatorial por se tratar de opção mais rápida (75%), e para evitar internação hospitalar (25%). O momento de dor mais intensa ocorreu durante a retirada dos pinos de Schanz (60,7%), sendo pior nas extremidades dos membros para 75% dos entrevistados. Uma maioria absoluta de 85,7% mostrou-se satisfeita após a retirada, e 82,1% afirmaram que se submeteriam novamente ao procedimento. Conclusão A retirada ambulatorial de fixadores externos sem anestesia é uma opção bem tolerada pelos pacientes, tratando-se de um procedimento com bons níveis de aceitabilidade e satisfação.

Evaluation of the Treatment of Patients Subjected to Osteogenesis Induced by Tibia Bone Distraction / Avaliação do tratamento de pacientes submetidos a osteogênese por distração na tíbia

Abstract Objectives To evaluate the management of tibial fractures resulting in bone loss (traumatic or infection-related) and the complications occurring during treatment with external fixator and immediately after apparatus removal. Methods Forty patients were selected from 2010 to 2017. The mean age of the patients was 33.02 years; 34 subjects were male and 6 were female. All patients had tibial bone regeneration, suffered trauma (mainly related to motorcycle accident) and were followed-up at an outpatient facility. Results Proximal tibial bones of up to 17 cm in length and distal tibial bones of up to 14 cm in length were obtained. The largest trifocal transport had the same length as the regenerated bone tissues, which was 14.5 cm. Regarding complications, 29 (72.5%) patients had infections in the pin and wire paths. There were 9 (22.5%) cases of de novo fracture, 6 of which were managed with the implantation of a new circular fixator, and 2 cases of infection of the regenerated bone. On average, patients were subjected to 4.72 procedures (ranging from 2-12), had the fixator for 20.75 months (ranging from 7-55 months), and stayed at the hospital for 53.7 days (ranging from 5-183 days), mainly because of soft-tissue complications, intravenous antibacterial therapy, and even social issues. Two (5%) patients presented symptomatic gonarthrosis, and two other patients had symptomatic ankle arthritis. Three of the patients showed lower limb discrepancy of 3.0, 3.7, and 5.0 cm. Conclusion Despite not being widely available, the Ilizarov method is useful for solving the majority of tibial bone losses, regardless of their etiology.

Resumo Objetivo Avaliar o tratamento das fraturas de tíbia que evoluíram com perda óssea (traumática ou secundária a infecção) e as complicações ocorridas durante o tratamento com fixador externo e no período imediatamente após sua retirada. Métodos Foram selecionados 40 pacientes tratados entre 2010 e 2017, com a idade média de 33,02 anos, sendo 34 do sexo masculino e 6 do sexo feminino. Todos os pacientes portavam regenerado ósseo da tíbia, foram vítimas de trauma (sobretudo motociclístico), e estavam em seguimento ambulatorial. Resultados Foram obtidos regenerados ósseos da tíbia proximal de até 17 cm e da tíbia distal de 14 cm. O maior transporte trifocal teve a soma do tamanho dos tecidos dos ossos regenerados, medindo 14,5 cm. Como complicações, 29 (72,5%) pacientes tiveram infecção no trajeto dos pinos e fios. Houve 9 (22,5%) casos de refratura, sendo 6 deles tratadas com novo fixador circular, e 2 infecções no osso regenerado. Os pacientes foram submetidos a uma média de 4,72 procedimentos cirúrgicos (2-12), portaram fixador por 20,75 meses (7-55 m.) e permaneceram internados por 53,7 dias (5-183) devido principalmente a complicações de partes moles, a antibioticoterapia intravenosa ou até mesmo a questões sociais. Dois (5%) pacientes apresentaram gonartrose sintomática e outros 2 artrite sintomática do tornozelo. Três apresentaram discrepância de membros inferiores de 3,0; 3,7; e 5,0 cm. Conclusão Apesar de não ser um método de tratamento amplamente disponível, o método de Ilizarov é útil para solucionar a maioria das falhas ósseas da tíbia, independente da sua etiologia.

Experience in fixation of infected non-union tibia by Ilizarov technique - a retrospective study of 42 cases.

OBJECTIVE: The aim of the study is to evaluate the clinical and functional outcome in treatment of infected tibial nonunion by the Ilizarov method. METHODS: The authors retrospectively analyzed 42 patients with infected tibial nonunion with bone loss; shortening and deformity treated at this institution during the period of February 2012 to April 2015 were included in the study. The results were evaluated according to Association for the Study and Application of the Methods of Ilizarov (ASAMI) criteria. Pin tract infections were assessed by Moore and Dahl score. RESULTS: Bone results were excellent in 60% of patients (n = 25), good in 15% (n = 6), fair in 25% (n = 11), and poor in none. The functional results were excellent in 55% of patients, good in 30%, fair in 5%, and poor in 10%. The most common complication found in this study was pin tract infection. CONCLUSION: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion, as it addresses the problems associated with the condition, although the procedure is cumbersome.

OBJETIVO: O objetivo do estudo é avaliar o desfecho clínico e funcional no tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov. MÉTODOS: Os autores analisaram retrospectivamente 42 pacientes com pseudartrose infectada da tíbia com perda óssea. Os casos de encurtamento e deformidade tratados nesta instituição durante o período de fevereiro de 2012 a abril de 2015 foram incluídos no estudo. Os resultados foram avaliados de acordo com os critérios da Associação para o Estudo e Aplicação dos Métodos de Ilizarov (Association for the Study and Application of the Methods of Ilizarov [ASAMI]). As infecções no trajeto dos fios e pinos foram avaliadas pela classificação de Moore e Dahl. RESULTADOS: Os resultados ósseos foram excelentes em 60% dos pacientes (n = 25), bons em 15% (n = 6) e moderados em 25% (n = 11); nenhum paciente apresentou resultados ruins. Os resultados funcionais foram excelentes em 55% dos pacientes, bons em 30%, razoáveis em 5% e ruins em 10%. A complicação mais comum encontrada neste estudo foi infecção no trajeto dos fios e pinos. CONCLUSÃO: Embora seja um procedimento complicado, a fixação de Ilizarov continua a ser uma modalidade de tratamento excelente para pseudartrose da tíbia, uma vez que aborda os problemas associados à condição.

Experience in fixation of infected non-union tibia by Ilizarov technique - a retrospective study of 42 cases / Experiência na fixação de pseudartrose infectada da tíbia com a técnica de Ilizarov - Estudo retrospectivo de 42 casos

ABSTRACT OBJECTIVE: The aim of the study is to evaluate the clinical and functional outcome in treatment of infected tibial nonunion by the Ilizarov method. METHODS: The authors retrospectively analyzed 42 patients with infected tibial nonunion with bone loss; shortening and deformity treated at this institution during the period of February 2012 to April 2015 were included in the study. The results were evaluated according to Association for the Study and Application of the Methods of Ilizarov (ASAMI) criteria. Pin tract infections were assessed by Moore and Dahl score. RESULTS: Bone results were excellent in 60% of patients (n = 25), good in 15% (n = 6), fair in 25% (n = 11), and poor in none. The functional results were excellent in 55% of patients, good in 30%, fair in 5%, and poor in 10%. The most common complication found in this study was pin tract infection. CONCLUSION: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion, as it addresses the problems associated with the condition, although the procedure is cumbersome.

RESUMO OBJETIVO: Avaliar o desfecho clínico e funcional no tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov. MÉTODOS: Os autores analisaram retrospectivamente 42 pacientes com pseudartrose infectada da tíbia com perda óssea. Os casos de encurtamento e deformidade tratados nesta instituição de fevereiro de 2012 a abril de 2015 foram incluídos no estudo. Os resultados foram avaliados de acordo com os critérios da Associação para o Estudo e Aplicação dos Métodos de Ilizarov (Association for the Study and Application of the Methods of Ilizarov [ASAMI]). As infecções no trajeto dos fios e pinos foram avaliadas pela classificação de Moore e Dahl. RESULTADOS: Os resultados ósseos foram excelentes em 60% dos pacientes (n = 25), bons em 15% (n = 6) e moderados em 25% (n = 11); nenhum paciente apresentou resultados ruins. Os resultados funcionais foram excelentes em 55% dos pacientes, bons em 30%, razoáveis em 5% e ruins em 10%. A complicação mais comum encontrada neste estudo foi infecção no trajeto dos fios e pinos. CONCLUSÃO: Embora seja um procedimento complicado, a fixação de Ilizarov continua a ser uma modalidade de tratamento excelente para pseudartrose da tíbia, uma vez que aborda os problemas associados à condição.

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital.

OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann­Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital / Avaliação clínica de pacientes submetidos à distração osteogênica no membro inferior em hospital universitário

ABSTRACT OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

RESUMO OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann-Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Alargamiento de extremidades: actualización y revisión del tema / Limb lengthening: review and update

El alargamiento de extremidades trata las discrepancias de longitud de extremidades superiores e inferiores. Lograr un adecuado tratamiento temprano evita secuelas irreversibles como la artrosis. El estudio de las discrepancias se realiza con una telerradiografía estandarizada, la cual entrega la información de cuál es el segmento óseo comprometido y cuál es el largo total a corregir. Menos de 15mm de discrepancia se ha demostrado que no tiene influencia sobre la mecánica de la marcha ni de las articulaciones. Más de 15mm produce una alteración en las cargas articulares, rangos de movimiento articular, compensaciones musculares, compensaciones de columna (escoliosis compensatoria), entre otras, que producen secuelas a largo plazo. Los métodos de tratamiento existentes son conservadores y quirúrgicos. Dentro de estos últimos están los fijadores externos e internos. Los fijadores externos tienen una alta frecuencia de infecciones superficiales a través de las agujas, sin embargo, son versátiles y capaces de corregir prácticamente cualquier deformidad. Los fijadores internos (por ejemplo, clavos intramedulares) no pueden corregir grandes deformidades, así como tampoco realizar grandes alargamientos, sin embargo, su frecuencia de complicaciones es mucho menor y son mucho mejor tolerados por el paciente. Estos métodos de tratamiento logran resultados muy precisos. Tienen un margen de error de 3,5 mm de longitud, lo cual no tiene consecuencias mecánicas para una extremidad. La tasa de satisfacción es de alrededor del 90 por ciento y logran un alivio del dolor significativo...

Limb lengthening can be used to correct upper and lower limb length discrepancies. To obtain an appropriate treatment early in life prevents irreversible consequences, such as arthritis. The limb length discrepancies study is performed with a standardised leg length X-ray. This X-ray shows the compromised bone segment and what the total limb length discrepancy is. A limb length discrepancy of less than 15mm has no influence on factors such as, gait mechanics, joint range of motion, or long term joint degeneration. Over 1.5cm, several consequences appear such as: joint overload, decreased joint range of motion, muscle compensations and compensatory spine malalignment. Existing treatment includes non-surgical and surgical methods. Among the latter are internal and external fixations. External fixations have a high frequency of superficial infections, but are highly versatile, being able to correct virtually any deformity. The internal fixation (e.g. intramedullary nails) cannot correct large deformities, or make big lengthenings, but its complication rate is much lower and is much better tolerated by the patient. These treatment methods achieve very accurate results. They have an error of 3.5mm in length, which has no mechanical consequences to an extremity. The satisfaction rate is high, with around 90 percent achieving a significant pain relief...

Effect of autologous stem cells on regenerated bone during distraction osteogenesis by Ilizarov technique in the radius of dogs: histomorphometric analysis

PURPOSE:To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS:Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS: The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS:The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.

Effect of autologous stem cells on regenerated bone during distraction osteogenesis by Ilizarov technique in the radius of dogs: histomorphometric analysis

PURPOSE:To investigate by histomorphometry the distraction osteogenesis by Ilizarov technique in dog radius with the use of autologous stem cells in regenerated bone. METHODS:Ten dogs (20 radiuses) underwent the osteotomy of 20% of extension of their radiuses, and osteogenic distraction using the Ilizarov technique after this procedure at rate of 1mm per day divided into 0.5mm every 12 hours. The elongation was performed until the regeneration reached 20% of the total length of the radius. The stem cells were isolated, concentrated and injected in the regenerated bone, when it reached 10% of the length of the entire radius. The regenerated bone was evaluated using histomorphometric analysis when the elongation was 20% the size of radius. RESULTS: The bone formation was evidenced by histomorphometric indices were significantly greater in the study group. In the histology evaluation the type of healing was mixed in 80% (intra membrane and endocondral) in both groups; the osteoblastic activity from moderate to intense was greater in the study group; and the space occupied by the newly-formed bone tissue was more evident in the study group. CONCLUSIONS:The histomorphometric indices in this study expressing the microarchitecture, trabecular thickness, trabecular spacing, number of trabecula and quantity of bone that was significant in the group study. These data suggest that the use of undifferentiated stem cells autologous bone marrow in the regenerate bone induces osteogenesis and bone quality.(AU)

Tibiocalcaneal arthrodesis using an Ilizarov fixator / Artrodese tibiocalcaneana usando fixador de Ilizarov

OBJECTIVE: To evaluate the results of arthrodesis with Ilizarov fixator with tibiocalcaneana. METHODS: We studied 12 patients with a mean age of 35 years, and 9 (75%) men and 3 (25%) women, underwent arthrodesis tibiocalcaneana. The diagnosis in the preoperative talus infection. We used a modified surgical technique Reckling (6 patients) and the Ilizarov technique, modified by Catagni (6 patients). Patients were evaluated by the AOFAS scale research and patient satisfaction. RESULTS: Union was achieved in 100% of cases. The mean time to healing was 6 months (range 4-12 months) and mean duration of external fixator removal was 9 months (range 4-13 months). Stretching was performed in 6 patients with an average of 4 cm. The follow-up with Vancomycin lasted around 6 months. The average AOFAS score was 72.5 points (range 57 to 89 points). All patients were satisfied with the result. CONCLUSION: Despite the small number of cases, arthrodesis tibiocalcaneana seemed to be a good solution for cases of complex pathologies of the talus, such as infection, resulting in bone healing, pain relief and patient satisfaction.

OBJETIVO: Avaliar os resultados da artrodese tibiocalcaneana com fixador de Ilizarov. MATERIAL E MÉTODO: Estudaram-se 12 pacientes, com idade média de 35 anos, sendo nove (75%) homens e três (25%) mulheres; submetidos à artrodese tibiocalcaneana. O diagnóstico no pré-operatório foi infecção do tálus. Usou-se a técnica cirúrgica modificada de Reckling (seis pacientes) e a técnica de Ilizarov, modificada por Catagni (seis pacientes). Os pacientes foram submetidos à avaliação pela escala da American Orthopaedic Foot & Ankle Society (AOFAS) e pesquisa do grau de satisfação. RESULTADOS: A consolidação ocorreu em 100% dos casos. O tempo médio de consolidação foi de seis meses (variando de quatro a 12 meses) e o tempo médio de retirada do fixador externo foi de nove meses (variando de quatro a 13 meses). Foi feito alongamento em seis pacientes com média de 4 cm. O seguimento ambulatorial com Vancomicina durou em média seis meses. A média na escala AOFAS foi de 72,5 pontos (variando de 57 a 89 pontos). Todos os pacientes se mostraram satisfeitos com o resultado. CONCLUSÃO: A artrodese tibiocalcaneana se mostrou como uma boa solução para casos de lesões complexas do tálus, como infecção, resultando em consolidação óssea, alívio da dor e satisfação do paciente.

Tibiocalcaneal arthrodesis using an Ilizarov fixator.

OBJECTIVE: To evaluate the results of arthrodesis with Ilizarov fixator with tibiocalcaneana. METHODS: We studied 12 patients with a mean age of 35 years, and 9 (75%) men and 3 (25%) women, underwent arthrodesis tibiocalcaneana. The diagnosis in the preoperative talus infection. We used a modified surgical technique Reckling (6 patients) and the Ilizarov technique, modified by Catagni (6 patients). Patients were evaluated by the AOFAS scale research and patient satisfaction. RESULTS: Union was achieved in 100% of cases. The mean time to healing was 6 months (range 4-12 months) and mean duration of external fixator removal was 9 months (range 4-13 months). Stretching was performed in 6 patients with an average of 4 cm. The follow-up with Vancomycin lasted around 6 months. The average AOFAS score was 72.5 points (range 57 to 89 points). All patients were satisfied with the result. CONCLUSION: Despite the small number of cases, arthrodesis tibiocalcaneana seemed to be a good solution for cases of complex pathologies of the talus, such as infection, resulting in bone healing, pain relief and patient satisfaction.

TREATMENT OF PROXIMAL FEMORAL EPIPHYSIOLYSIS WITH SUBTROCHANTERIC OSTEOTOMY BY THE ILIZAROV METHOD.

OBJECTIVES: To evaluate the treatment of severe proximal femoral epiphysiolysis through subtrochanteric osteotomy using the Ilizarov method and to propose a new method for calculating the necessary correction. METHODS: A case study was carried out among patients affected by severe proximal femoral epiphysiolysis who underwent subtrochanteric osteotomy with external multiplanar fixation and were evaluated postoperatively using the modified Southwick classification. A method was developed for calculating the angular correction needed for the surgical procedure. RESULTS: Thirteen hips were analyzed: four left hips (30.8%) and nine right hips (69.2%). The majority of the patients (61.5%) were male, with a mean age of 14 years. In relation to pain and function, the results were excellent for 30.8%, good for 46.2% and regular for 23.0%, and none of the patients presented poor results. Regarding mobility, the results were excellent for 46.2%, good for 30.8% and regular for 23.0%. Radiographically, the results were excellent for 7.7%, good for 69.2%, regular for 15.4% and poor for 7.7%. CONCLUSIONS: Percutaneous treatment of severe proximal epiphysiolysis using the Ilizarov method is a good treatment option with good indices for improvement of pain and function. The proposed calculation method can help in planning surgical procedures, with variations between calculated and measured angles of the order of 3°.