Distraction Period Research Articles

ВЛИЯНИЕ СУЛЬФАТИАЗОЛА СЕРЕБРА НА ЗАЖИВЛЕНИЕ КОЖНЫХ РАН, ОБРАЗУЮЩИХСЯ ПРИ ПРОРЕЗЫВАНИИ СПИЦАМИ АППАРАТОВ НАРУЖНОЙ ФИКСАЦИИ

The study of the healing mechanisms of skin wounds resulting from damage to the skin by transosseous needles of external fixation devices in the treatment of osteoarticular pathology with the aim of further targeted correction of these processes is one of the urgent tasks of modern traumatology and orthopedics. The effect of silver sulfathiazole, recommended for the prevention of infectious complications, on the healing of this type of wound has not been studied previously. The aim of the study was to investigate the effect of silver sulfathiazole on the healing of skin wounds formed during the cutting of external fixation devices by pins. The experimental study was performed on 35 sexually mature male Wistar rats. Modeling of a skin wound formed during the cutting of external fixation devices by pins was carried out in sterile operating room conditions, under drug anesthesia of animals that underwent transosseous osteosynthesis of the femur using an original design of the external fixation device. By tractional movement of the proximal pin with a dosed stretching of the supports at a rate of 1 mm in 4 steps, tension and cutting of the skin were carried out for 10 days (the distraction period), then the device was in a static position for 15 days (the period of fixation of the limb in the device), after which the device was dismantled and observation was carried out for another 30 days. The animals were divided into 2 groups. In the control group, the simulated wound healed under natural healing conditions; in the experimental group, silver sulfathiazole applications were performed twice daily during the distraction period. Skin wounds were examined using light microscopy and morphometry after 10 days of distraction, 15 days of fixation, and 30 days after the apparatus was removed. The thickness of the epidermis, dermis, and the numerical density of the sebaceous glands and hair follicles were measured on digital images of histological preparations stained with hematoxylin and eosin. The volume density of elastic fibers was determined on preparations stained with orcein according to Tenzer-Unn. The obtained quantitative data were subjected to statistical analysis. The study showed that the formation of a skin wound with transosseous pins is accompanied by tissue tension. Healing of this type of wound occurs with a delay in epithelialization and an increase in the duration of the inflammatory phase. This affects the mechanisms of extracellular matrix synthesis and leads to the formation of scar tissue in the area of damage. The use of silver sulfathiazole applications promotes accelerated wound closure by epithelium, a reduction in the period of inflammation, normalization of elastin synthesis, and a decrease in cicatricial changes in the skin regenerate.

Changes of masseter muscle after mandible distraction osteogenesis in patients with Hemifacial microsomia: a retrospective study.

Mandible distraction osteogenesis (MDO) is widely used to reconstruct the mandible in patients with mild Hemifacial microsomia (HFM). However, the masseter's response to mandible distraction remains unclear. In this study, we analyze the effect of the surgical intervention on masseter muscle by a retrospective analysis. The procedure consisted of a five-day latent period, a three-week distraction period, and a six-month consolidation period. CT data were manually segmented and measured with Mimics software before surgery, within 3 months, and more than 1 year postoperatively. Masseter volume, masseter length, masseter width, and mandible ramus height were measured and analyzed using paired t-test, Pearson, and Spearman correlation analysis. We included 21 patients with HFM who underwent mandible distraction osteogenesis from 2015 to 2020. The masseter volume on the affected side increased immediately after surgery from (6,505.33 ± 3,671.95) mm3 to (10,194.60 ± 5638.79) mm3, but decreased to (8,148.38 ± 3,472.57) mm3 at the second follow-up correlated to mandible ramus height (r = 0.395, P = 0.038). A similar trend was observed in changes in masseter length. Symmetry and width of masseter muscle had no longitudinal statistical significance. Masseter muscle involvement benefits from MDO in the short term. To achieve long-term efficacy, more attention should be paid to muscle reconstruction.

Outcomes after completing growth-friendly surgical treatment for early-onset scoliosis in patients with skeletal dysplasia.

The aim of this study was to compare outcomes after growth-friendly treatment for early-onset scoliosis (EOS) between patients with skeletal dysplasias versus those with other syndromes. We retrospectively identified 20 patients with skeletal dysplasias and 292 with other syndromes (control group) who had completed surgical growth-friendly EOS treatment between 1 January 2000 and 31 December 2018. We compared radiological parameters, complications, and health-related quality of life (HRQoL) at mean follow-up of 8.6 years (SD 3.3) in the dysplasia group and 6.6 years (SD 2.6) in the control group. Mean major curve correction per patient did not differ significantly between the dysplasia group (43%) and the control group (28%; p = 0.087). Mean annual spinal height increase was less in the dysplasia group (9.3 mm (SD 5.1) than in the control group (16 mm (SD 9.2); p < 0.001). Mean annual spinal growth adjusted to patient preoperative standing height during the distraction period was 11% in the dysplasia group and 14% in the control group (p = 0.070). The complication rate was 1.6 times higher (95% confidence interval (CI) 1.3 to 2.0) in the dysplasia group. The following complications were more frequent in the dysplasia group: neurological injury (rate ratio (RR) 5.1 (95% CI 2.3 to 11)), deep surgical site infection (RR 2.2 (95% CI 1.2 to 4.1)), implant-related complications (RR 2.0 (95% CI 1.5 to 2.7)), and unplanned revision (RR 1.8 (95% CI 1.3 to 2.5)). Final fusion did not provide additional spinal height compared with watchful waiting (p = 0.054). There were no significant differences in HRQoL scores between the groups. After growth-friendly EOS treatment, patients with skeletal dysplasias experienced a higher incidence of complications compared to those with other syndromes. Surgical growth-friendly treatment for skeletal dysplasia-associated EOS should be reserved for patients with severe, progressive deformities that are refractory to nonoperative treatment.

Histomorphologic, Biomechanical, and Functional Analysis in Mandibular Osteogenesis Induced by External Distraction

The induced bone generation procedure (osteogenic distraction [OD]) is frequently used in cases of jaw deformities in patients with, hemifacial microsomia, mandibular hypoplasia, and so on. This study was undertaken to provide criteria to perform this procedure. The authors evaluated the effects of various parameters using OD to determine the optimal variables. Sixty distractors were placed in 30 canine subjects who then underwent OD after appropriate osteotomy. The procedures were performed during varying latency periods, distraction periods, distraction rate distance, and the consolidation period. Bone biopsies and radiographic studies were performed at 0, 7, 14, 21, 45, and 55 days after the distraction process. The observed changes and the most efficient mandibular OD parameters are reported.

Compression-distraction devices in the treatment of congenital disorders in children. Case series

Relevance. In many cases, Pierre Robin sequence and congenital micrognathia lead to respiratory failure, obstructive sleep apnea, and aspiration of food due to swallowing problems. Compression-distraction osteogenesis method allowed for the effective achievement of a stable clinical result with the minimum losses for the child's body.Purpose. The study aimed to conduct a retrospective analysis of various types of compression-distraction devices based on the Department of Maxillofacial Surgery of the Republican Children's Clinical Hospital.Material and Methods. Since 2010, 36 children aged three months to 13 years have been operated, 20 boys and 16 girls. Four children were operated using an multi-vector external compression-distraction device. Two children with Pierre Robin sequence had surgery with a Conmet intraoral compression-distraction device, 27 children – with a KLS Martin bone-borne compression-distraction device, of which 15 had Pierre Robin sequence, and 12 had congenital lower micrognathia. Seven children had tracheostomy, which had been placed due to permanent sleep apnea.Results. Three (8.33%) children were operated using external compression-distraction devices. From three months to one year. A patient with Pierre Robin sequence, tracheostomy, and cannula. A tracheostomy was installed at the age of 15 days due to persistent apnea. At three months of age, bilateral osteotomy of the mandible with the installation of an external compression-distraction device was performed. Compression was for three days; then, they began distraction of one mm/day for 15 days. Five months later, the child began to breathe freely through the natural respiratory tract; under mask anesthesia, the compression-distraction device was removed. Four children (11.11%) aged 8 to 12 months were operated using multi-vector external compression-distraction device. A patient aged one year with Pierre Robin sequence, tracheostomy, and cannula. The external compression-distraction device was installed at the age of eight months. The distraction period was 12 days. The consolidation period was three months. The treatment result was independent breathing through the natural respiratory tract. The tracheostomy cannula was removed. Twenty-nine children 2 (5.56%) were operated using intraoral bone-borne compressiondistraction devices. A child aged 14 months, diagnosed with Pierre Robin sequence, complained of periodic sleep apnea with signs of acrocyanosis. Moderate to severe obstructive sleep apnea was detected. A bilateral osteotomy of the mandible was performed, and a bone-borne compression-distraction device was installed. Compression was for three days, then the distraction of 0.5 mm twice a day – for 14 days. Distraction was performed at 14 mm. After five months, the bone-borne CDD was removed, and polysomnography was repeated. The apnea-hypopnea index (AHI) was &lt;5. Respiratory function was fully restored.Conclusion. Thus, 24 children showed successful results with the use of compression-distraction device (an orthognathic occlusion was formed, glossoptosis was eliminated, natural breathing and feeding were restored); 11 children did not have a satisfactory result (due to distraction interruption, it was not possible to achieve a physiological bite, there was postoperative wound suppuration with wound dehiscence). There was one negative result due to trauma: the child fell on his chin at home during the consolidation period, and the compression-distraction device broke, which resulted in disocclusion.

Reverse Dynamization Accelerates Regenerate Bone Formation and Remodeling in a Goat Distraction Osteogenesis Model.

This article was updated on December 20, 2023, because of previous errors, which were discovered after the preliminary version of the article was posted online. Figure 4 has been replaced with a figure that presents different p values. Also, on page 1943, the text that had read: "Quantitative microCT confirmed that the total volume of the regenerate in the RD group was much smaller compared with the SF (p = 0.06) and DF (p = 0.007) groups, although it was significantly smaller only compared with the DF group (Fig. 4-A). The total volume of the intact bone (contralateral tibia) was significantly smaller in the RD group compared with the other groups, but the RD group had values closest to those for the intact tibia. Similarly, the RD group had less bone volume compared with the SF and DF groups, and this value was significantly different from the DF group (p = 0.034; Fig. 4-B). Of the 3 groups, the RD group had vBMD that was the closest to that of intact bone. It also had significantly higher vBMD compared with the SF and DF groups (p < 0.0001 for both; Fig. 4-C).The results of torsional testing (Fig. 4-D) confirmed that the regenerate bone formed under conditions of RD was significantly stronger than that formed under SF or DF (p < 0.001 versus SF group, and p = 0.0493 versus DF group)."now reads: "Quantitative microCT confirmed that the total volume of the regenerate in the RD group was significantly smaller compared with the SF and DF groups (p < 0.01 for both groups; Fig. 4-A). The total volume of the intact bone (contralateral tibia) was significantly smaller compared with the SF and DF groups (p < 0.0001 for both). The RD group had values closest to those for the intact tibia, and this difference was not significant (Fig. 4-A). Similarly, the RD group had less bone volume compared with the SF and DF groups, and this value was significantly different from the DF group (p < 0.01; Fig. 4-B). Of the 3 groups, the RD group had vBMD that was the closest to that of intact bone, but the intact bone was significantly different compared with all of the other groups (p < 0.0001 for all groups). The RD group had significantly higher vBMD compared with the SF and DF groups (p = 0.042 and p = 0.046, respectively; Fig. 4-C).The results of torsional testing (Fig. 4-D) confirmed that the regenerate bone formed under conditions of RD was significantly stronger than that formed under SF or DF (p < 0.0001 versus SF group, and p = 0.0493 versus DF group). The intact group was significantly different compared with the SF group (p < 0.0001)."

Treatment of Gustilo-Anderson type III open fractures with segmental long bone loss secondary to gunshot and war ınjurıes in paediatric patients with bone segment transport by the limb reconstructıon system (LRS)

ObjectiveThe information on firearm- or explosive-related extremity injuries in children is very limited. Reports of segmental bone loss due to these types of fractures are even rarer and the treatment remains a problem. There has been no report of distraction osteogenesis with limb reconstruction system (LRS) specifically in children. We evaluated the treatment results of Gustilo–Anderson type 3 open fractures with segmental bone loss due to firearm injuries by distraction osteogenesis performed with LRS in skeletally immature patients. MethodsNine patients with Gustilo–Anderson (GA) type 3 open fractures with segmental bone loss due to firearm injuries who had not completed their skeletal development were included. Two of the patients had GA type 3a, four had type 3b, and the remaining three had type 3c. Bony and functional assessment was conducted using Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. ResultsMean follow-up period was 20.1 months (range 5.5–35 months). The mean bone loss was 45.5 mm (range 15–80 mm) before the treatment started. The mean time of external fixation (day) was 180.6. The mean distraction index (distraction period per cm) was 11.3 day/cm. The mean time for bone union index (duration of bony union per cm) was 33.7 days/cm. Bony union was achieved in all patients at the end of the treatment. Bony results as per ASAMI score were excellent in seven fractures and good in three. Functional results were excellent in five patients, good in two, and fair in two. We had no fair or poor results with respect to bony results but had two fair functional results. ConclusionsLRS provides a good treatment choice for children with fractures with segmental bone loss due to firearm injuries. It also provides easy access to the wound with its monolateral construction.

Joint distraction for the treatment of knee osteoarthritis

Knee osteoarthritis (OA) is a common degenerative joint disease characterized by cartilage destruction and changes in subchondral bone. Treatment options for end-stage OA are limited, with joint replacement and high tibial osteotomy as the common procedures. High tibial osteotomy may be preferable to joint replacement in the young active patient, malaligned knee, and limited to medial compartment OA. However, both procedures may lead to complications and have durability concerns in young patients. Fortunately, joint distraction (JD) has emerged as a joint-preserving treatment for end-stage OA. The reversal of tissue degeneration observed with JD could be the result of one or more proposed mechanisms, such as partial unloading, synovial fluid pressure oscillation, mechanical and biochemical changes in subchondral bone, or adhesion and chondrogenic commitment of joint-derived mesenchymal stem cells. The procedure involves the use of an external fixator to unload the cartilage and underlying bone for a short time period. In addition, new implantable knee devices, which create unloading instead of distraction and do not require removal, have also been developed. There is a lack of standardization for the JD technique which results in significant variation of implant type, duration of treatment, and rehabilitation. Nevertheless, clinical studies demonstrate long-term pain relief and improved patient outcomes. Interestingly, the increase in joint space width following treatment indicates that cartilage repair occurred throughout and after the distraction period. Although JD appears to be an effective therapeutic choice, the rate of complications remains high, with pin-tract infection being the most common.

To Angulate or Not to Angulate the Ulna during the Progressive Distraction Period Performed with a Monolateral External Fixator in Paediatric Patients with a Chronic Monteggia Fracture?

The purpose of this study was to compare the clinical and radiographic evolution of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixators (MEFs) with or without angulation of the ulna during the distraction period. This retrospective study evaluated 20 children (14 boys and 6 girls) with CMFs. According to the strategy of ulnar lengthening, two groups of patients were identified: patients undergoing gradual lengthening with (Group A, n = 11) or without ulna angulation (Group B, n = 9). The mean age at the time of surgery was 7.7 years old (range, 5.4-12.9). The mean time from initial trauma to surgery was 26.3 months (range, 1-96), and the mean follow-up was 24.6 months (range, 5.5-45.4). Clinical outcomes were evaluated by Kim et al.'s Elbow Performance Score, while radiographic outcomes were assessed on plain radiographs. Age at surgery, sex, laterality, time between trauma and surgery, and time of follow up in the two groups of patients showed no significant differences. The radial head was successfully reduced in 9 of 9 and 10 of 11 patients in Groups B and A, respectively (p = 1.00). The mean time to achieve radial head reduction was shorter in Group B (18.1 ± 5.3 days) than in Group A (39.2 ± 18.7 days; p = 0.004). The mean angulation of the ulna at the end of treatment was significantly lower in Group B (0.6° ± 1.1°) than in Group A (25.9° ± 6.3°; p &lt; 0.0001). The average ulnar lengthening at the end of treatment in Group B (14.1 ± 5.8 mm) was, on average, 7.7 mm less than that in Group A (21.8 ± 9.7 mm; p = 0.05). The Kim et al. Elbow Performance Score at the last follow-up visit was comparable between the two groups of patients (p = 1.00). A shorter time to achieve radial head reduction and less deformity of the ulna can be expected in paediatric patients with CMFs undergoing intraoperative restoration of ulnar alignment and gradual lengthening without angulation postoperatively.

A Non-Syndromic, Non-Micrognathic Neonate Presenting With Persistent Glossoptosis Who was Successfully Treated With Mandibular Distraction Osteogenesis

Most causes of upper airway obstruction are rare in the nonsyndromicneonatal period. However, if present, such as in cases of glossoptosis, they may cause major respiratory problems during the first few weeks of life. Historically, the subset of patients with severe glossoptosis resulting in respiratory distress have been dependent on tracheostomies to obtain a secure airway. Mandibular distraction osteogenesis (MDO) is a procedure in which osteotomies are performed in the mandible and a distraction device is fixated. After an optional latency phase, distraction is performed in order to lengthen the mandible and increase the airway diameter. MDO has been shown to improve airway diameter, eliminate desaturations, and reduce tracheostomy dependency in neonates who are prone to airway distress. Additionally, MDO has been shown to be more effective than other surgical alternatives. In this article, a case is presented of a non-syndromic, non-micrognathic neonate who presented with persistent glossoptosis of unknown origin resulting in sustained desaturations. The patient was treated with mandibular distraction osteogenesis using bilateral distractors. After a 10 days distraction period, the mandible was successfully advanced by 8.5 mm bilaterally. The airway diameter increased by 6 mm and airway resistance decreased from 82% to 0.3%. As a result of the surgical intervention, desaturations were eliminated and a tracheostomy was avoided. This case is unique in that the patient had repeated desaturations without evidence of an underlying syndrome or micrognathia. Other clinicians may use this case report as a guide to treat patients who have similar presentations.

The catabolic-to-anabolic shift seen in the canine osteoarthritic cartilage treated with knee joint distraction occurs after the distraction period.

BackgroundCartilage regenerative mechanisms initiated by knee joint distraction (KJD) remain elusive. Animal experiments that are representative for the human osteoarthritic situation and investigate the effects of KJD at consecutive time points could be helpful in this respect but are lacking. This study investigated the effects of KJD on the osteoarthritic joint of dogs on two consecutive timepoints.MethodsOsteoarthritis was bilaterally induced for 10 weeks in 12 dogs using the groove model. Subsequently, KJD was applied to the right hindlimb for 8 weeks. The cartilage, subchondral bone and synovial membrane were investigated directly after KJD treatment, and after 10 weeks of follow-up after KJD treatment. Macroscopic and microscopic joint tissue alterations were investigated using the OARSI grading system. Additionally, proteoglycan content and synthesis of the cartilage were assessed biochemically. RT-qPCR analysis was used to explore involved signaling pathways.ResultsDirectly after KJD proteoglycan and collagen type II content were reduced accompanied by decreased proteoglycan synthesis. After 10 weeks of follow-up, proteoglycan and collagen type II content were partly restored and proteoglycan synthesis increased. RT-qPCR analysis of the cartilage suggests involvement of the TGF-β and Notch signalling pathways. Additionally, increased subchondral bone remodelling was found at 10 weeks of follow-up.ConclusionWhile the catabolic environment in the cartilage is still present directly after KJD, at 10 weeks of follow-up a switch towards a more anabolic joint environment was observed. Further investigation of this timepoint and the pathways involved might elucidate the regenerative mechanisms behind KJD.The Translational Potential of this ArticleFurther elucidation of the regenerative mechanisms behind KJD could improve the existing KJD treatment. Furthermore, these findings could provide input for the discovery or improvement of other joint regenerative treatment strategies.

Features of the reparative osteogenesis of the distraction of the tibial regenerate and osteotropic growth factors in patients with achondroplasia at the age of 9–12 years

BACKGROUND: Despite studies on various issues of distraction osteosynthesis, many morphological aspects of this problem are still insufficiently studied and remained debatable.&#x0D; AIM: To determine the features of the reparative activity of the regenerate and analyze the content of some osteotropic growth factors in children with achondroplasia.&#x0D; MATERIALS AND METHODS: Growth factors were determined in serum and blood plasma using equipment from Thermo Fisher (USA). Factor concentrations were determined using ELISA kits: PDGF-AA (RD Systems, USA), PDGF-BB (RD Systems, USA), IGF-1 (Immunodiagnostic systems, USA), IGF-2 (Mediagnost, Germany), TGF-1 (eBioscience, USA), and TGF-2 (eBioscience, USA). The structural state of the tibial regenerate was determined using by ultrasonography (HITACHI, Japan). Patients with achondroplasia aged 912 years (n = 32) were examined at the beginning of distraction (1020 days), in the middle of distraction (2140 days), and at the end of distraction (4163 days).&#x0D; RESULTS: The ultrasound method showed the dynamic formation of the structural state of the distraction regenerate at the studied stages of distraction. At the same stages of distraction, the concentration of osteotropic growth factors was assessed.&#x0D; CONCLUSIONS: The serum content of osteotropic growth factors in the blood of children with achondroplasia differs from age-normative values. Growth factors that play a key role in osteogenesis, IGF-1, BMP-4, TGF-1, and TGF-2 were reduced, whereas the expressions of IGF-2 and BMP-6 were compensatory increased. At the end of the distraction period, the values of all studied growth factors exceeded the initial values, regardless of their preoperative values and their dynamics at the stages of distraction. The assessment of the dynamics of the concentration of osteotropic growth factors in the blood of patients with achondroplasia during the distraction period and natural growth period indicate the presence of a commonality of processes during the distraction period and prenatal growth of the tibia. Our comprehensive ultrasound study of the structural state of the distraction regenerate of the tibia and biochemical studies of growth factors in the blood of patients with achondroplasia at the age of 912 years made it possible to identify the features of reparative osteogenesis of the distraction regenerate of the tibia and the physiological effect of osteotropic growth factors from the viewpoint of the process of reparative regeneration.

Changes in venous drainage after posterior cranial vault distraction and foramen magnum decompression in syndromic craniosynostosis.

The authors' objective was to measure the effect of posterior cranial vault distraction (PCVD) plus foramen magnum decompression (FMD) on dural sinus volume and venous flow in patients with syndromic craniosynostosis. The volumes of the sagittal, straight, transverse, and sigmoid sinuses of 5 consecutive patients with syndromic craniosynostosis who underwent PCVD+FMD were calculated in cubic centimeters with T2-weighted volumetric MRI sequences before surgery, immediately after surgery, and after the end of the distraction process. Tridimensional reconstructions of phase-contrast magnetic resonance angiography (PC-MRA) images were obtained with multiplanar reconstruction (MPR). The average total volume of all dural sinuses increased immediately after surgery (from 10.06 cm3 to 12.64 cm3) and continued to increase throughout the 30-day distraction period (from 12.64 cm3 to 14.71 cm3) (p = 0.04), except that the right sigmoid sinus remained stable after the initial increase. The most important increases were observed for the left transverse sinus (+113.2%), right transverse sinus (+104.3%), left sigmoid sinus (+91.3%), and sagittal sinus (+41.8%). Less important modifications were evident for the right sigmoid sinus (+33.7%) and straight sinus (+23.4%). Significant improvements in venous flow were noted on the tridimensional reconstructions of the PC-MRA images. Venous obstruction grading score improved in 4 patients (average [range] 2.4 [ 2-5]) (p = 0.023) and remained stable in 1 patient. All patients had chronic tonsillar herniation (CTH) (mean [range] 16.6 [8-26] mm), and 3 had syringomyelia. CTH showed improvement on the last follow-up MRI evaluation in 4 patients (mean [range] 10.5 [0-25] mm) and worsened from 15 mm to 19 mm in 1 patient. Syringomyelia improved in 2 patients and remained unchanged in 1. This study has provided the first radiological evidence of the impact of craniofacial surgery on dural sinus anatomy and venous drainage. The venous anomalies described in patients with syndromic craniosynostosis are not static, and PCVD+FMD triggers a dynamic process that can lead to significant modifications of intracranial venous drainage. The traction exerted by the distracted bone flap onto the occipitoparietal dura mater adherent to the inner calvaria may account for the enlargement of the dural sinus throughout the distraction period. The impact of these modifications on venous pressure, intracranial pressure, CTH, and hydrocephalus remains to be determined.

Experimental and clinical studies on the reduction of bone lengthening terms at the Ilizarov Center

Introduction The list of pathological conditions that need surgical correction of bone length is very long. In the literature on the topic under discussion, it is reported that the best results are obtained by lengthening according to the Ilizarov method. But many surgeons are not satisfied with the long duration of external fixation, which requires a large number of adjustments and patient compliance. The aim of this work is a analysis of the modern technologies for limb lengthening that actually shorten the time of osteosynthesis using the apparatus for external fixation. Materials and methods Literary sources have been analyzed since the first publication on limb lengthening according to Ilizarov in 1963. The search was carried out in the databases of the RSCI, NCBI Pubmed, Medline. The developments of the employees of the Ilizarov Center are presented. Results An analysis of the literature showed that the fixation units of the apparatus, units for providing movement for distraction, compression and correction of angles have been improved. The invasiveness of the surgical intervention is minimized. Best results can be obtained using automatic lengthening. The Ilizarov Center has developed and experimentally proven methods for reducing the period of distraction and the period of fixation with the apparatus. We combined three factors: an increased round-the-clock distraction rate (2 or 3 mm) with a motorized distractor adjusted to the Ilizarov frame and fixation reinforcement along with regeneration stimulation with HA-coated intramedullary wires in our experimental and clinical trials. This technology has easily conquered a number of clinical practices in Russia, France and Serbia. Conclusion Experimental and clinical substantiation of a two- or three-fold increase in the rate of automated distraction in the conditions of intramedullary reinforcement with a bioactive implant can drastically reduce not only the time of the distraction period, but also the duration of the fixation period with the Ilizarov apparatus.

Plating after lengthening in treating phalangeal and metacarpal deficiency: An alternative method.

Objectives This study aims to investigate whether plating after lengthening in patients with phalanges and metacarpals deficiency could significantly shorten the duration of external fixation and decrease bone healing index.Patients and methods Between February 2010 and December 2018, 11 phalanges in nine patients (6 males, 3 females; mean age: 28.4±4.4 years; range, 22 to 35 years) and nine metacarpals in six patients (2 males, 4 females; mean age: 21.0±2.9 years; range, 16 to 25 years) were lengthened at a rate of 0.25 mm in two increments. A unilateral external fixator was applied in all cases. A locking compression plate was applied at the end of the distraction period before the external fixator was removed. Removal of the plate was considered two years after the internal fixation.Results The desired length and bone consolidation were achieved in all cases. The additional lengths achieved in the phalanges and metacarpals group were 18.3 mm and 27.7 mm on average, respectively. The bone healing indexes in the phalanges and metacarpals were 1.33 and 1.44 mo/cm, respectively. No significant difference was observed in the pre- and postoperative range of motion of involved metacarpophalangeal joint of both phalangeal (95% CI: -0.469~1.014, t=0.820, p=0.432) and metacarpal (95% CI: -0.689~0.975, t=0.420, p=0.689) lengthening cases. Only one case of minor complication (track infection) occurred.Conclusion Plating after lengthening is an ideal method for phalanges and metacarpals deficiency. Its advantages include shorter duration of external fixation, lower complication rate, and early functional recovery.

Accelerated cranial distraction protocol for one-piece fronto-orbital distraction osteogenesis without bandeau in patients with craniosynostosis

This study aimed to compare the bony relapse ratios of standard and accelerated distraction protocols (ADP) in one-piece fronto-orbital distraction osteogenesis (DO).Patients with unilateral or bilateral coronal synostoses who underwent one-piece fronto-orbital DO were included. The accelerated cranial distraction protocol included a 3-day latency period and a distraction rate of 1–2 mm/day, followed by a 4-week consolidation period. Intracranial volume was measured using computed tomography (CT) before the surgery, at the end of the consolidation period, and 1 year after the removal of distractors. The intracranial volume changes and relapse ratios were calculated.This study included 32 patients; of these, 16 were included in each of the ADP and standard protocol (SP) groups. The mean ages were 1.4 years and 1.6 years in the ADP and SP groups, respectively (p = 0.895). In the ADP and SP groups, the expanded volumes were 270.9 ± 90.3 cm3 and 284.6 ± 149.7 cm3 (p = 0.91) and the growth-corrected expanded volumes were 162.1 ± 67.5 cm3 and 177.1 ± 105.2 cm3, respectively (p = 0.867). The relapse and growth-corrected relapse ratios showed no significant differences between the two groups, suggesting similar stability between the two protocols. The relapse ratios were 7.1 ± 4.8% and 7.3 ± 5.0% (p = 0.91) and the growth-corrected relapse ratios were −3.0 ± 3.3% and −2.4 ± 2.7%, respectively (p = 0.498).Within the limitations of the study, it seems that the ADP can shorten the distraction period without compromising stability. This may contribute to resolving the disadvantages and highlighting the advantages of DO.

Tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique in the treatment of distal tibial defect—preliminary outcomes of 12 cases and a description of the surgical technique

ObjectiveTo evaluate the preliminary outcomes of tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique for the treatment of distal tibial defect and describe the surgical technique. MethodsA total of 12 eligible patients with distal tibial defect > 6 cm caused by direct trauma or posttraumatic osteomyelitis who were admitted to our institution from January 2017 to January 2019 were treated by tetrafocal or pentafocal bone transport using Ilizarov technique. Detailed demographic data, including age, sex, etiology, defect size, number of osteotomies (three or four), external fixation time (EFT) and external fixation index (EFI), were collected, and the bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during the surgery and the follow-up period were recorded and evaluated by the Paley classification at a minimum follow-up of two years after removal of the fixator. ResultsThere were 9 men and 3 women with an average age of 37.4±7.8 years. The etiology included posttraumatic osteomyelitis in 8 cases and posttraumatic bone loss in 4 cases. The mean bone defect after radical debridement was 7.1±0.6 cm. Tetrafocal bone transport was applied in 9 cases, and pentafocal bone transport was applied in 3 cases. The average EFT and EFI were 5.2±0.8 months and 0.7±0.2 months/cm, respectively. The average time of follow-up after removal of the external fixator was 28.5±3.3 months without recurrence of osteomyelitis. The bone results were good in 7 cases, fair in 4 cases, and poor in 1 case, and the functional results were good in 5 cases, fair in 6 cases, and poor in 1 case. The most common complication was pin tract infection, which occurred in all cases, but there were no major complications, such as nerve or vascular injury. ConclusionTetrafocal and pentafocal bone transport using Ilizarov technique could be an alternative treatment option in selected cases with distal tibial defect > 6 cm. It could shorten the distraction period, fasten regeneration, and reduce the associated complications.

Alveolar ridge augmentation in mandible by use the modified distractor.

Objective: The aim of the present study was to evaluate the horizontal and the vertical alveolar distraction osteogenesis using modified alveolar distractor.Study design: The sample consisted of 7 patients presenting horizontally and vertically deficient edentulous ridges were treated by distraction osteogenesis with a modified Alveolar distractor. The surgical procedure was carried out with the patient under local anesthesia. After the osteotomy was performed with pizosurgery, the distractor was placed on the segmental bone over the gingiva for 3 months. The rate of distraction was 0.5 mm/twice a day.Results: The mean of horizontal alveolar before using the distractor was 4.70 mm (SD 0.31 mm) The mean of horizontal alveolar after using the distractor was 8.30 mm (Sd 0.59 mm). The mean of actual gain in bone horizontal at the end of the distraction period was 3.58 mm (SD 0.15 mm). The mean of height alveolar before using the distractor was 6.67 mm (SD 0.46 mm) The mean of height alveolar after using the distractor was 12.59 mm (SD 0.52 mm). The mean of actual gain in bone height at the end of the distraction period was 5.92 mm (SD 0.25 mm).Conclusion: It was concluded that the modified alveolar distractor seems to be an effective to treat horizontal and vertical alveolar ridge deficiencies, and distraction osteogenesis can be considered a safe and effective procedure for gaining bone in the horizontal and the vertical dimension of the alveolar.

Influence of cannabis use history on the impact of acute cannabis smoking on simulated driving performance during a distraction task

Objective: This research explores the driving performance of people who use cannabis daily or occasionally during distraction tasks performed following acute cannabis use. Methods: Healthy adults aged 25 to 45 years with different cannabis usage histories were recruited to participate in a within-subjects controlled experiment using a car-based driving simulator. Participants were classified as having daily use (n = 31), occasional use (1 or 2 times per week; n = 24), or no-use (n = 30). Participants completed a practice drive followed by four 5–10 minute driving scenarios during the baseline period. Participants then smoked self-procured cannabis flower ad libitum for up to 15 minutes. Thirty minutes later, they completed four additional 5–10 minute scenarios. Scenarios were paired according to difficulty and randomized across the baseline and post-use periods. Each scenario contained between 0 and 3 repetitions of a distraction task where the participant was prompted by an audio message to select an app from a 4 × 5 grid displayed on a mounted tablet, a step that would require briefly looking away from the roadway. Measures of driving performance (lane departures, standard deviation of lateral position) were assessed during the five-second period following the audio trigger and analyzed using generalized linear mixed models. Results: Those with a pattern of occasional use were significantly more likely to experience a lane departure during distraction periods after acute cannabis use relative to baseline (OR = 3.71, p = 0.04, CI = 1.04, 13.17), while those with daily use did not exhibit a similar increase (OR = 1.56, p = 0.43, CI = 0.52, 4.64). Changes in departure risk were significantly greater for the occasional use group compared to no-use (p = 0.02), but not for the daily use group compared to no-use (p = 0.18). However, following acute use, those who use daily exhibited decreases in speed relative to baseline in comparison to the changes observed in the no-use group (p = 0.02), while differences between occasional and no-use did not reach statistical significance (p = 0.052). Differences in standard deviation of lateral position were not statistically significant, likely due to the short duration of tasks. Conclusions: These results find the largest potential safety concerns associated with a pattern of occasional use, who displayed an increase in lane departures after acute cannabis smoking. Those in the daily use group decreased their speed, which may be interpreted as compensation for drug effects. Further research is needed to understand the effects during longer and more complex secondary tasks.

Effect of bone morphogenic protein-2 and desferoxamine on distraction osteogenesis

BackgroundAngiogenesis is crucial for formation of a stable regenerate during distraction osteogenesis (DO). This experimental study evaluates if bone morphogenic protein-2 (BMP-2) and desferrioxamine (DFO), two agents which are known to induce neoangiogenesis in vivo, would increase angiogenesis and osteogenesis, and improve mechanical properties of bone regenerate in DO model. MethodsTwenty-four tibias of 24 New Zealand rabbits were osteotomized and fixed with semi-circular fixators. Three groups of 8 animals were formed. BMP-2 soaked scaffolds were used in the first group, whereas daily local DFO injections were made in the second group. Subjects in the control group did not receive any agents during the surgery or in the distraction period. The rabbits in all three groups underwent distraction at a rate of 0.6 mm/day for 15 days following the 7-day latent period. Animals were sacrificed on day 38, and the tibia were harvested for histological and mechanical examination of the regenerate. ResultsAll 24 rabbits survived the surgical procedure, and there were no side effects against the BMP-2 and local DFO. Three-point bending tests revealed a higher force (361 ± 267 N.) required for fracture in Group 1 (p: 0.018). Similarly, the bending moment in Group 1 (5.4 ± 4.0 Nmm) was significantly higher than the other groups (p: 0.021). There was no significant difference between the groups in terms of deflection and stiffness (p ˃ 0.05). Histologically, there was no statistical difference between the groups in terms of endochondral, periosteal, and intramembranous ossification and VEGF activity (p ˃ 0.05). ConclusionBMP-2 and DFO stimulate angiogenesis by increasing VEGF activity. Angiogenesis is one of the most important mechanisms for the initiation and maintenance of new bone formation. Stimulation of angiogenesis in unfavorable biomechanical conditions may not be sufficient for ideal bone formation.