Long term self esteem assessment after height increase by lengthening and then nailing.

The purpose of the study is to assess the long term psychosocial functioning after height increase, using the external fixation then nailing method. Rosenberg Self-esteem scale and a questionnaire to assess social functioning were completed by 28 patients both preoperatively and at a mean follow-up of 7 years. The mean total score of RSE self-esteem for the 28 patients before lengthening was 21.5 (SD 1.03) (20-24). The mean total score of RSE for the patients 1 year after lengthening was 22 (SD 1.17) (20-24) with highly significant difference (p = 0.002).The mean total RSE self-esteem score after 7 years was 21.7 (SD 1.12) (21-25) with no significant difference (p = 0.11) Improvement was an evident in the short term self esteem after 1 year of follow up of the patients with height increase. On the other hand, there was an evident deterioration in the long term psychosocial evaluation during follow up after 7 years of height increase, returning to near pre-operative levels of self esteem.

[Treatment of severe tibial fractures with extensive soft tissue damage and/or contamination. Quality of life after use of the Ilizarov external fixator]. / Behandlung schwerster Tibiafrakturen mit gefährdetem Weichteilmantel und/oder Kontamination. Lebensqualität nach Einsatz des Ilizarov-Fixateur externe.

BACKGROUND: The Ilizarov external fixator (IF) is an immediate and definitive treatment option for severe tibial fractures compromised by extensive soft tissue damage. The aim of this study was to assess the general performance of the IF and especially the impact on patient quality of life. METHOD: A postal questionnaire including an SF-12 health survey and questions about various other aspects of quality of life was sent to all patients who received an IF for primary fracture treatment at a level 1 trauma centre between January 2000 and June 2009. RESULTS: A total of 48 completed questionnaires were received from patients treated with IF for severe tibial fractures. The median time to removal of the IF was 154 days (range 70-614 days). The mean SF-12 mental component score (MCS) was 52 (SD±12) and the mean physical component score (PCS) was 38 (SD±11). Of the patients 100 % answered that they were either satisfied or very satisfied with the treatment and 91 % would choose the same method of treatment under similar circumstances. CONCLUSIONS: This study demonstrates a high performance of IF in the treatment of severe tibial fractures with compromised soft tissue where more standard forms of treatment are contraindicated.

[Meaning of living with external fixation for grade III open fracture of lower limbs: patient view]. / Significado de conviver com fixação externa por fratura exposta grau III em membros inferiores: o olhar do paciente.

The present study is aimed to understand the meaning of living with an external fixation device for grade III open fractures of the lower limbs from the perspective of the patient. The data were collected with six young adults who were undergoing outpatient orthopedic treatment in a public hospital in the city of São Paulo, through semi-structured interviews with open questions, between June and August 2010. Seeking to understand the meaning of this experience, we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon "try to live in spite of feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

Significado de conviver com fixação externa por fratura exposta grau III em membros inferiores: o olhar do paciente / Meaning of living with external fixation for grade III open fracture of lower limbs: patient view / Significado de la vida con fijación externa por fractura expuesta grado III en miembros inferiores: la mirada del paciente

O objetivo deste estudo foi compreender o significado de conviver com fixação externa por fratura exposta grau III em membros inferiores, sob o olhar do paciente. Os dados foram coletados com seis adultos jovens que faziam tratamento ambulatorial ortopédico, em um hospital público da cidade de São Paulo, por meio de entrevista semiestruturada com questões abertas, entre junho e agosto de 2010. Na busca do significado desta vivência, mantivemos uma atitude fenomenológica na análise, o que propiciou desvelar o fenômeno "buscar viver apesar de se sentir preso em uma gaiola". Os pacientes apontam que é o desejo pessoal e apoio de outras pessoas que propiciam a reorganização de suas vidas, apesar dos inúmeros desafios que precisam superar para adaptarem-se ao fixador acoplado ao seu corpo, do medo que sentem em relação ao futuro e das dúvidas quanto ao tratamento.

The present study is aimed to understand the meaning of living with an external fixation device forgrade III open fractures of the lower limbs from the perspective of the patient.The data were collected with six young adults who were under going out patient orthopedic treatment in a public hospital in the city of SãoPaulo, through semi-structured interviews with open questions, between Juneand August 2010. Seeking to understand the meaning of this experience,we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon"try to live in spiteof feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

El objetivo de este estudio fue comprender el significado de vivir con fijación externa para las fracturas abiertas de grado III de los miembros inferiores bajo la mirada del paciente. Los datos fueron recogidos con seis jóvenes adultos que no habían recibido tratamiento ortopédico de ambulatorio en un hospital público en la ciudad de SãoPaulo, a través de entrevistas semi estructuradas con preguntas abiertas,entre junio y agosto de 2010. En búsqueda del significado de esta experiencia que hemos mantenido una actitud de análisis fenomenológico, lo que llevó a revelar el fenómeno"tratan de vivir a pesarde sentirse atrapado en una jaula." Los pacientes indican que es el deseo y el apoyo de otros que están a favor de la reorganización de la vida personal, apesar de los numerosos desafíos que se deben superar para adaptarse a la sujeción acoplada a su cuerpo,el miedo que sienten sobre el futuro y las dudas en el tratamiento.

The analysis of self-esteem based on patients` self-perception after Ilizarov limb lengthening treatment.

In the article there is shown the analysis of patients self-perception after the Ilizarov limb lenghening treatment due to inequality. 150 patients both sexes (78 girls and 72 boys) were tested between 1992 and 2003 in our center. The average age for girls at the time of follow-up was 19.5 years and 18.5 years for boys. In the survey there was used four point-scale SES by Irena Dzwokowska, Kinga Lachowicz-Tabaczek and Mariola Lagun which was based on Rosenberg work. The results were divided into two groups: low or high score. It was evaluated according to the table of standards which included people age and sex. Then the score was transformed into standard ten. For statistical calculations was used MicroSoft Excel spreadsheet. In the case of statistical studies was used Spss v.17.0. It was found that among survey respondents regardless of gender and age after the satisfactory completion of Ilizarov treatment patients gain a high level of self-assessment at 7 standard ten. The high self-esteem can predict the level of patients` comfort in many aspects of their lives. People with such a hight self-perception will experience more positive emotions and will be healthier and more active.

Pitfalls of lengthening over an intramedullary nail in tibia: a consecutive case series.

BACKGROUND: Lengthening over a nail was introduced to reduce the overall complication rate in the classic Ilizarov method. Previous studies reported that an intramedullary nail could decrease the time of external fixation, prevent anatomic malalignment and collapse; Internal friction, damage to endosteal blood supply and infection rates, however, may be higher. Whether the approach achieves it goals with acceptable complication rates is unclear. The aim of this study was to describe the results and complications of tibial lengthening over a nail. METHODS: We retrospectively reviewed 40 patients with 80 lengthened tibial segments over an intramedullary nail between 2004 and 2009. The average age of the patients at the time of surgery was 22 years (range 18-38 years). Functional and psychological outcomes were evaluated using the questionnaires. RESULTS: The average lengthening achieved was 7.73 cm, 23.5% of initial length. The external fixation index was 1.1 months/cm, and bone-healing index was 1.7 month/cm. The most common complications were valgus angulations of tibia in 20 segments (25%) and equinus contracture in 58 segments (72%). Functional and psychological outcomes were satisfactory after surgery. CONCLUSIONS: Lengthening over a nail did not fully prevent axial deviation of regenerate. Equinus contracture was the most common complication but it could be rectified by early intervention such as intramuscular recession or an additional foot frame. Limb lengthening increased functional and psychological outcomes even though there were many complications after surgery.

Ilizarov technique of lengthening and then nailing for height increase.

PURPOSE: To investigate the risks and types of complications associated with the Ilizarov technique of lengthening and then nailing in persons of normal height. METHODS: Records of 26 men and 6 women aged 21 to 47 (mean, 27) years with body height of 160 to 176 (mean, 170) cm who underwent tibial and fibular lengthening and then intramedullary nailing were reviewed. They were skeletally mature healthy persons, with no systemic/local bone disease, deformity or limb length discrepancy. Pain was assessed using the visual analogue scale (VAS). Patient satisfaction in terms of the treatment outcomes and expectations was also assessed. Complications encountered during or after treatment were recorded. RESULTS: The mean lengthening achieved was 7.6 (range, 3.5-12) cm or 26% (range, 10-40%) of the original length. The mean duration of external fixation was 96 (range, 45-135) days. The mean follow-up duration after intramedullary nailing was 38.7 (range, 24-93) months. The mean VAS pain score was 9.3 at week 1, 6.6 at week 4, and 5.7 at week 8. After intramedullary nailing, the mean VAS pain score was 2.6 at week 4, 0.9 at month 6, and 0.3 at year 1. 91% of the patients were satisfied with the outcome at week 6; 81% after intramedullary nailing, and 94% at the one-year follow-up. Four patients had revision operations: one for pin exchange owing to pin bending after a fall, one for adjusting external rotation of the tibia after nailing, one for bone grafting for delayed union, and one for drainage of a haematoma just after nailing. CONCLUSION: Most complications related to patient discomfort and psychological stress, which were important issues in this type of patients.

Long-term psychosocial functioning after Ilizarov limb lengthening during childhood.

BACKGROUND AND PURPOSE: Few studies have been concerned with the patient's perception of the outcome of limb lengthening. We describe the psychological and social functioning after at least 2 years of follow-up in patients who had had a leg length discrepancy and who had undergone an Ilizarov limb lengthening procedure. PATIENTS AND METHODS: Self-esteem and perceived competence were measured in 37 patients (aged 17-30 years) both preoperatively and at a mean follow-up of 7 (2-14) years. At follow-up, health-related quality of life, functioning at school, daily activities, and treatment-related experiences were measured, and also retrospectively for the preoperative period. RESULTS: Preoperative and follow-up scores for self-esteem were similar. Overall perceived competence scores at follow-up were comparable to that of a healthy normal population. Patients' perceived athletic competence was lower and their perceived level of behavioral conduct was higher. At follow-up, patients had more positive appraisal of their physical appearance. Most health-related quality of life scores were not significantly different to those of the healthy normal population, apart from a reduced gross motor function, less vitality, and more pain. Patients with a remaining leg length inequality (LLI) of more than 2 cm had lower quality of life scores for gross motor function, sleep, pain, vitality, and depressive feelings. INTERPRETATION: At an average of 7 years after an Ilizarov limb lengthening procedure, patients still have physical restraints, but they appear to have normal psychosocial functioning, self-esteem, and perceived competence. These patients have quality of life scores comparable to those of norm groups, apart from a reduced gross motor function, less vitality and more pain. Residual LLI of more than 2 cm remains important even after long-term follow-up; these patients report lower quality of life.

Supporting limb reconstruction patients: a fine-wire circular fixator support group.

INTRODUCTION: External fixator frames are widely used in limb reconstruction surgery. They are used for relatively long periods and the multidimensional impact on patients is documented. We examined the role of a nurse-led specialist group when supporting patients both pre-operatively and postoperatively. PATIENTS AND METHODS: All patients with external fixators were contacted via postal questionnaire. Questions asked covered regularity of attendance at the specialist group, information received and problems with the frames. RESULTS: Thirty-seven patients replied. Twenty-one had attended the clinic and nearly all (32) had been offered the opportunity to attend. Most reported being well prepared for surgery and felt that the information given was satisfactory. Problems were generally addressed within the group and patients attended the group with frame-related problems before attending their general practitioner or the accident and emergency department. All patients found the group environment supportive. CONCLUSIONS: We describe a unique patient support group. To our knowledge, it is the first in the country. It is a valuable resource in equipping patients prior to surgery as well as dealing with problems that arise with the frame in situ. We recommend it to other limb reconstruction units.

Does leg lengthening pose a threat to a child's mental health?: An interim report one year after surgery.

UNLABELLED: Previous studies suggest that children react with functional and psychological disturbances after leg lengthening (LL). Long-term effects are not known, and there is a lack of prospective studies. The aim of this interim prospective study was to investigate the psychological impact of the Ilizarov technique on a sample of children 1 year after surgery. METHODS: : The subjects were 27 patients aged 6 to 16 years treated using the Ilizarov technique at the Pediatric Orthopaedic Department, Uppsala University Hospital, between 1997 and 2005. A control group of healthy children matched for age and sex were also included.Semistructured interviews and psychometric measures (anxiety, depression, self-esteem, behavior) were administered to patients and parents before surgery and 1 year after. Psychological measures were correlated with medical records (days of hospitalization, gained length, etc). The control group was examined at initial assessment only. RESULTS: : Before reconstructive surgery, the LL group had a significantly lower self-esteem compared with the control group. Aggressive behavior, attention and externalization problems, anxiety, and depression were significantly reduced after LL. Parents' state anxiety was also reduced. There were no differences in trait anxiety between the parents of patients and the parents of the control children. CONCLUSIONS: : Patients reported pain, psychological discomfort, complications, and restrained function during LL. However, there were no adverse psychological effects at 1-year follow-up; rather, there were signs of improved mental health. No single psychological parameter could predict the outcome after LL.

[Psychiatric symptoms in patients treated with an Ilizarov external fixator]. / Ilizarov eksternal fiksatörü uygulanan hastalarda psikiyatrik belirtiler.

OBJECTIVES: The Ilizarov technique limits daily activities of patients and may cause psychiatric symptoms. We investigated psychiatric symptoms associated with the use of an Ilizarov circular external fixator (CEF) and the relationship between symptoms and duration of CEF application in adult patients. METHODS: The study included 40 adult male outpatients (mean age 26.4 years; range 20 to 40 years) who were treated with a CEF. The participants were administered a questionnaire on sociodemographic and clinical characteristics. Psychiatric symptoms were assessed using the Symptom Check List (SCL-90-R). Data were compared with those of a control group consisting of 30 healthy males with similar sociodemographic features. RESULTS: Significant differences were found between the patient and control groups with regard to somatization (p=0.03), interpersonal sensitivity (p=0.027), depression (p=0.003), anxiety (p=0.025), hostility (p=0.004), paranoid ideation (p=0.021), additional scale (p=0.000), and overall symptom (p=0.024) scores. There was at least one psychiatric symptom in 52.5% of the subjects treated with a CEF. Hostility, interpersonal sensitivity, sleep disturbances, obsessive-compulsive signs, and anxiety were detected in 37.5%, 35%, 32.5%, 20%, and 20%, respectively. The duration of CEF application was positively correlated with depression and interpersonal sensitivity (p=0.000), and negatively correlated with anxiety (p=0.001). CONCLUSION: Our data demonstrate that, during treatment with a CEF, psychiatric problems emerge, which warrant careful evaluation of the psychiatric condition of the patients.

Living with the Ilizarov frame: adolescent perceptions.

INTRODUCTION: The Ilizarov technique has become an established method in the treatment of children with serious skeletal disorders. Whilst the technique is acknowledged for solving difficult conditions, the application of the external fixator marks the beginning of an arduous treatment programme. Research has suggested that undergoing such treatment can negatively impact upon the physical and psychological well-being of the young person. Yet limitations in research design reduce the usefulness of the findings, given in that most of the previous studies have used retrospective, quantitative data collection approaches, often with a heterogeneous sample population. We wished to gain a richer insight into the experiences of adolescents living with the frame by drawing on both qualitative and quantitative approaches. AIMS: To explore adolescents' perceptions of the anticipated and actual impact of the Ilizarov frame on aspects of daily activity. DESIGN: A mixed-method approach, using a prospective and longitudinal study design. METHOD: Fifteen adolescents undergoing the Ilizarov treatment were contacted at several predetermined time-points during the course of their treatment to share their perceptions of living with the frame. At several of these points semi-structured interviews were used to ascertain their perceptions, whilst quantitative data were gained at all time-points by adolescents completing a range of psychometric measures. FINDINGS: Adolescents found that life with the frame was not as bad as anticipated, and they adopted a pragmatic approach, appreciating that this was something they 'just had to get through'. Peers had a substantial role in supporting their friend to adjust and cope with the frame. Psychometric scores were largely within normal limits. CONCLUSION: This study suggests that, while the Ilizarov treatment is demanding for adolescents, it is one that they can tolerate without sustained adverse psychological impact.

[Short stature treatment by lower limb lengthening--multicenter study from five centers]. / Leczenie niskiego wzrostu metoda Ilizarowa--zbiorcza analiza wyników z pieciu osrodków w Polsce.

MATERIAL: 26 patients (17 female, 9 male) from 5 centers were evaluated. The age at the beginning of treatment ranged from 6 to 29 years (mean 13.8). The cause of short stature in 19 patients was achondroplasia or pseudoachondroplasia, in next 2--other bone dysplasias. The other 5 patients had not bone pathology and were treated because of cosmetic indications. Preoperative body height ranged from 90 to 149 cm (mean 120). Axial deviations of the lower extremities were noted in 11 patients. Mean follow-up was 3.7 years. METHOD OF TREATMENT: Most of patients were treated with Ilizarov device using cross lengthening strategy (2 stages--opposite femur and tibia lengthening). Mean duration of treatment including interval between two stages (mean 12 months) was 29 months. Planned increase of body height ranged from 10 to 26 cm (mean 16.4). RESULTS: Planned or greater lengthening (mean 14.8 cm) was achieved in 14 patients. Partial planned lengthening (mean 65% of planned lengthening) was achieved in 8 patients (mean 11.8 cm) including two patients who resigned the second stage of treatment. In two patients lengthening was stopped during first month of treatment because of great complications. In 2 patients treatment was not completed (interval between first and second stage). Mean increase of body height of patients with complete treatment was 13.1 cm (from 2 to 28). Problems, obstacles and complications were analyzed according to Paley classification. PROBLEMS: There were 24 problems in 15 patient (inflammation process around K wires--15 patients, bone healing disturbances--3, regenerate fracture--2, transient foot equinus--2 and axial deviation of the lower extremity--1). OBSTACLES: There were 31 obstacles in 19 patients (regenerate's defect--7 patients, premature bone consolidation--6, foot equinus--4 and other--14). COMPLICATIONS: There were 26 complications in 18 patients (axial deviation of the lengthened segment--8, foot equinus--6, paresis of the peroneal nerve--3, fractures--2 and other--5). The most serious complication was hemiparesis after cerebral embolism (1 patient) and damaging of the femoral artery (1 patient) both disrupting bone lengthening. CONCLUSION: The risk of complication in surgical treatment of short stature patients is high. Qualification for short stature treatment because of cosmetic indication should be made very careful and after precise psychological and/or psychiatric investigation.

The psychological and social functioning of 14 children and 12 adolescents after Ilizarov leg lengthening.

We studied the psychological and social impact of the Ilizarov leg lengthening procedure in 26 patients (aged 6-17 years), who had completed the treatment at least 2 months previously. Measurements of depression and anxiety were performed preoperatively and at follow-up. Questions about functioning at school, daily life activities and treatment-related experiences were answered by the patient and his/her parents. The school or work results showed no significant decline during the lengthening procedure. Serious sleeping problems occurred during the procedure. There was no subjective improvement in physical skill after the procedure and almost one-fourth of the children still had complaints about their leg. We conclude that the Ilizarov procedure caused no serious psychological disturbances.

Reflections of a novice researcher.

Nurses can benefit from active participation in research activities. Involvement in research is not just an academic pursuit but is essential for effective, quality care. Nurses should actively seek the support of colleagues and research support structures to enable involvement in research. Clinical nurses are capable of making an important research contribution.

The Ilizarov method for correction of complex deformities. Psychological and functional outcomes.

We reviewed the psychological profile and functional ability of forty-five children (fifty-two extremities) who had had correction of deformities of the lower extremities with the Ilizarov method. Psychological changes were evaluated with the Post-Hospitalization Behavior Questionnaire and the Children's Depression Inventory, and the functional status was measured with the Children Health Information Service Rand Scale. The over-all satisfaction of the patient with regard to the outcome of the operation was assessed as well. The operations were performed between 1988 and 1992. The average age at the time of the operation was twelve years (range, three to eighteen years), and the average duration of follow-up was thirty-six months (range, twenty-four to seventy-two months). The lengthening index, duration of lengthening, and average number of complications were similar to those reported in other studies. All of the children had a normal psychological score, forty-two had no limitations in daily activities, and thirty-seven were satisfied with the over-all result.