Ilizarov Technique Research Articles

Gradual distraction on hinged-based Ilizarov ring fixator to correct fixed flexion deformity of knee: description of the surgical technique

Knee deformity in flexion is the most disabling deformity. Surgical correction can be attempted with soft tissue release, osteotomy, or both. However, acute correction can cause serious complications. Ilizarov technique has become an appealing alternative to open surgery, where skeletal traction is used to distract the joint gradually and steadily in order to reduce the risk of skin problems or neurovascular injuries. Two patients and three limbs, male aged 28-42 (mean=35 years) with severe fixed flexion deformity were corrected by a hinged-based Ilizarov ring fixator. Mean flexion of the knee was pre-operatively 86.66 degrees (80-90 degrees). The mean extension angle at the last follow-up was 168.3 degrees (165-170). The mean knee society score (KSS) was 44.3 (35-50), mean KSS functional score was 43.3 (0-65). One patient had satisfactory outcomes and could stand without walking aids and walks on extended knee with walking aids. Arthrodesis of knee or creating a stiff knee in the most extended position may be most effective for severe, fixed contractures.With the gradual, calculated distraction, the Ilizarov apparatus is an effective tool for treating severe cases of knee contracture.

Clubfoot Deformity Treatment with Ilizarov Apparatus in the Paediatric Population without Corrective Osteotomies and Soft Tissue Release: A Cross-Sectional Study.

Neglected Club Foot deformity is not an uncommon limb anomaly encountered by orthopaedic surgeons. Many treatment methods have been proposed. Ilizarov apparatus is one of the techniques used to correct this deformity. In this cross-sectional study 47 patients (56 feet) between the ages of 5 and 10 years with clubfoot deformity were treated using the Ilizarov external fixator. Age, sex, type of deformity, and radiographic parameters were measured on foot radiographs. Also, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Dimeglio classification were recorded for each patient before and after treatment. The treatment was unilateral in 38 patients and bilateral in 9 patients. 39 patients (69.6%) were male, and 17 patients (30.4%) were female with a mean age of 7.86 ± 1.4 years. Plantar angles of ankle flexion and ankle flexion curve increased from 20.12±6.52 and -16.51±8.36 to 25.89±6.44 and 6.19±6.42, respectively. There was also an improvement in the talocalcaneal and tibiocalcaneal angles. Also, the angle between the first metatarsus and the talus in the front and side views improved (P<0.00). Additionally, the mean AOFAS score and Dimeglio classification significantly improved. Three cases were complicated with distal tibial physeal separation that were treated with additional open surgeries. Ilizarov technique without osteotomies and soft tissue release could be considered a less invasive and successful method of treatment for neglected clubfoot deformity in patient five to ten years old that are not good candidate for Ponseti method.

Outcomes of Management of Severe Clubfoot among Children by Ilizarov External Fixator.

Clubfoot remains the most common birth defect involving the musculoskeletal system. There are various surgical and non-surgical treatment options available for the management of clubfoot. Using the minimally invasive Ilizarov external fixator method has been reported to have good success rates and fewer complications. This study aimed at analysing the morphological and functional outcomes of treating severe clubfoot by Ilizarov external fixator among children from July 2017 to March 2020. Thirty-two children who had either failed Ponseti / surgery or neglected with 44 clubfeet of Dieglio type III and type IV were included in the study. A short-leg walking cast was applied for an additional six weeks after removing of Ilizarov frame and additionally followed by an orthosis for another six weeks. Outcomes were measured by the functional rating system by Laaveg and Ponseti and interpretation done at 1 month and 12 months after the ankle-foot arthrosis. About 86.4% of the patients had good or excellent outcome scores. Pre and post-Demeglio scores and functional rating scores were statistically significant (p<0.001) by using Paired t-test. Complications included superficial pin site infections in 13 feet (29.54%), 5 feet (11.36%) had claw toes, 3 feet (6.81%) had linear skin necrosis and 2 feet (4.54%) had calcaneal fractures which were manageable with minor interventions. The study findings highlighted that the Ilizarov external fixator method can correct complex foot deformities of severe clubfoot with minimum morbidity. Further larger and long-term studies are needed to investigate the effects of the stiff hindfoot and possible degenerative changes on the function and symptoms of these patients as adults.

Combination of flexible intramedullary nailing and Ilizarov frame for salvage of femur and humerus nonunion in a girl with osteogenesis imperfecta

Background Fixation of pathological long bones with telescopic intramedullary rods is well known to be a technically challenging procedure even in specialist centres, with a high complication rate due to rod migration, hardware failure, nonunion or malunion. However there is very little guidance in the literature regarding salvage treatment options when failure occurs.Aim We demonstrate a surgical technique that can be used for salvage treatment of both femoral and humeral complex nonunions following Fassier-Duval (FD) rodding in a child with osteogenesis imperfecta (OI).Case description A 13 year-old girl with OI type VIII presented sequentially with nonunion and deformity of the femur then the humerus following previous FD rods in those segments. The femur was also complicated with metallosis between the steel rod and an overlying titanium plate. Both segments were treated with pseudarthrosis debridement, removal of metalwork and stabilisation with hydroxyapatite (HA)-coated flexible intramedullary nails, with temporary Ilizarov frame to provide enough longitudinal and rotational stability to allow immediate weight-bearing. The femur Ilizarov frame was removed after 64 days, and the femur remained straight and fully healed at 2.5 years. The frame time for the humerus was 40 days, complete union was achieved and upper limb function restored and maintained at 9 months.Discussion The transphyseal telescopic rod is the traditional implant of choice in terms of treating fractures and stabilising osteotomies for deformity in OI. However, it does not provide enough torsional or longitudinal stability by itself to allow early weight-bearing which is detrimental to bone healing in this vulnerable patient group. The incidence of delayed union or nonunion at osteotomy site in telescopic rod application is not negligible: up to 14.5-51.5 %. Although the technique we have shown in this case may not be applied to all complex OI patients, we believe that the combination of flexible intramedullary nails and Ilizarov frame provides a favourable environment for bone healing in complex or revision cases. As a secondary learning point the initial revision surgery to the left femur demonstrated the perils of using a steel rod and a titanium plate in a biologically active environment which in this case lead to metallosis and lysis.Conclusion We found the technique of HA-coated flexible intramedullary nails combined with the Ilizarov frame effective in the salvage of failed telescopic rods in both femur and humerus and feel this technique can be used as a salvage option in similar cases worldwide. This case also demonstrates the perils of using different metals in combined internal fixation.

Circular frame fixation of complex tibial plateau fractures in the elderly: Functional and radiological outcomes for Schatzker V and VI type fractures

Tibial plateau fracture fixation in the elderly poses a unique challenge due to poor bone stock, comminution and co-morbidities. There is limited evidence available in older patients sustaining multiple column Schatzker type V and VI injuries. In our institutions these injuries have traditionally been managed with circular frame fixation, often augmented with cross knee frame extension, internal screw fixation +/- bone graft substitutes. This study has reviewed the over 60-year-old cohort to better understand this complex injury. MethodsElectronic fracture databases were queried for ‘tibial plateau fracture’ and ‘Ilizarov frame’ between July 2009 and 2019. Inclusion criteria; age >60 years; CT identified multiple column (Schatzker V or VI) injuries; Ilizarov fixation; adequate follow-up data. Patient demographics, fixation technique, time to frame removal, residual radiological tibial deformity, joint incongruity, significant peri‑operative complications and progression to salvage TKA were reported. Results35 patients >60 years were treated with Ilizarov frame techniques for multiple column injuries. 84 % were female. Average age was 68 (62–81) with a follow-up of 6.6 years (2.3–11.3). 33 of the 35 patients investigated for osteoporosis had evidence of decreased bone mass (94 %). 94 % were Schatzker VI injuries. 22 cases required cross knee extension with a frame duration 155 days (range 103–317). Those without had a frame duration 128 days (range 93–212). 20 cases had a combined internal/external fixation technique and 9 cases required allograft or bone substitute. There was one case of non-union requiring salvage to constrained TKA. Three cases (9 %) of metalwork removal, two for prominent metalwork and one for deep infection. There were no VTE events and there was 0 % mortality in the two post-operative years. Oxford knee scores and SF-12 scores demonstrate that minimal residual deformities in the coronal and sagittal planes following frame removal are tolerated well within this age group. This study demonstrates Ilizarov techniques are highly successful at permitting early weight bearing and achieving union with associated low morbidity rates in an older population.

The successful treatment of a Gustilo–Anderson type IIIc distal leg injury with a large bone defect in elderly patient with severe osteoporosis: a case report

BackgroundGustilo–Anderson type IIIc tibial open fracture with large bone defects in elderly patients with severe osteoporosis is a rare injury that may be a challenging clinical scenario.Case presentationThis study presents the case of a 68-year-old Japanese man who sustained a Gustilo–Anderson type IIIc open tibial fracture with a large bone defect. The patient had severe osteoporosis and the bone was contaminated; therefore, we determined that the bone could not be returned to the tibia. The patient underwent acute limb shortening and gradual lengthening with an Ilizarov external fixator combined with low-intensity pulsed ultrasound and teriparatide administration for limb reconstruction, which allowed immediate full weight-bearing capacity. The fixator was removed at 12 months postoperatively, and by this time, the fracture had completely healed. At the most recent 5-year follow-up after the injury, the patient reported full weight-bearing capacity without walking aids and had full knee and ankle range of motion.ConclusionsTo the best of our knowledge, this is the first study to report the use of combined Ilizarov technique, low-intensity pulsed ultrasound, and teriparatide for limb reconstruction of Gustilo–Anderson type IIIc open tibial fractures with large bone defects in elderly patients with severe osteoporosis.

Treatment of Complicated Clubfoot Using External Fixation: A Scoping Review

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The treatment of relapsed, resistant, or neglected clubfoot presents a challenge — some patients may not respond to the traditional Ponseti method. Studies involving gradual distraction using external fixators for treatment of these cases have been performed, but no systematic review has been conducted on the subject. Methods: A comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science according to PRISMA guidelines. Only articles that pertained to the treatment of pediatric patients with clubfoot using external fixation and contained three or more human subjects were included. Reviews, professional opinions, and studies with non-human subjects were excluded. Results: Of 6,469 articles generated from the initial search, 25 met inclusion criteria. 609 total feet (490 total patients) were included, and 533 of these feet (445 patients) were treated with external fixation. The mean age of patients was 8.5 [2-18] years with a mean follow-up length of 40.9 [5-126] months. 21 (84%) studies used the Ilizarov apparatus, two used Joshi’s external stabilization system, and one used the Taylor spatial frame. The most reported primary scoring systems were the 60-point International Clubfoot Study Group (ICFSG) score (20%), Dimeglio classification (12%), Pirani score (8%), and Reinker and Carpenter scales (8%). All but one study found significantly improved primary outcomes for the majority of respective patients. Conclusion: External fixation, which may or may not include open surgery, is a promising intervention for neglected or relapsed clubfoot. However, encouraging more standardized outcome measurements would allow for more thorough comparisons between studies.

Peritalar Osteotomy for Rigid Pes Cavus and Cavovarus

Category: Other; Hindfoot Introduction/Purpose: Pes cavus and pes cavovarus deformities create varus loading during stance phase of gait that often presents as lateral ligament instability, peroneal tendon rupture or lateral column overload. When flexible, management ranges from the use of custom foot orthoses or an ankle-foot orthosis, to a combination of soft tissue releases, tendon transfer and/or corrective osteotomy. When rigid, clinical management involves corrective osteotomies or triple arthrodesis. The Ilizarov method of gradual correction of structural bony deformities provides a powerful tool to achieve a stable plantigrade foot in patients with complex multiplanar structural deformities. This investigation presents a method of a continuous multiple bone “peri-talar” osteotomy, combined with acute correction of the multiplanar deformity, for treating severe rigid structural pes cavus and pes cavovarus. Methods: Following IRB approval, patients were identified based on a combination of CPT (Current Procedural Terminology) codes and confirmed by chart review. Standard demographics, etiology of deformity and weight-bearing radiographs (before and after surgery) were reviewed. Perioperative complications, clinical evaluation and type of footwear used were recorded. A favorable clinical outcome was defined as a foot that is ulcer and infection-free, and able to walk in the community with standard oxford shoes. Surgical technique involved an osteotomy from the dorsal calcaneus, carried anterior and inferior for approximately fifty percent of the calcaneus, and then carried anteriorly into the mid cuboid. A second osteotomy through a separate medial incision is made from medial to lateral, splitting the navicular, and connecting to the initial lateral osteotomy. Acute correction of the multiplanar deformity is accomplished. Maintenance of the correction is then achieved with the use of an Ilizarov-like “mitre” circular external fixation construct. Results: 17 patients (three bilateral) were included, with average follow-up of 58.3 (range 12-183) months. One patient developed a postoperative wound infection that required formal surgical debridement. He died of unrelated causes before removal of the external fixator. A second postoperative wound infection was managed with local wound care. One pin-site infection required debridement following removal of the external fixator. Due to the rotational component of the deformities, meaningful measurement of deformity correction could not be accomplished. This clinical outcome was based primarily on the ability to walk without complex bracing. Sixteen of the twenty feet achieved ambulation with standard oxford footwear. Three patients required a short AFO, but were unrestricted community ambulators. A review of the non-standardized x-rays was not able to yield meaningful data. Conclusion: There have been very few clinical reports of surgical correction of patients with severe rigid pes cavovarus or equinovarus deformities. This small series of patients underwent correction of complex rigid pes cavovarus type deformities with a peritalar osteotomy, acute correction of deformity and maintenance of correction with a “mitre frame” circular external fixator. Several proponents of the Ilizarov method have described individual patients with very similar methodology. This small series of patients suggests that one can achieve an acute, or gradual, correction of complex deformity with multiple related osteotomies, and maintenance of that correction with an adjustable circular external fixator.

Comparing the mechanical characteristics between leg lengthening using only an Ilizarov external fixator and leg lengthening over a nail using an external fixator manufactured in Vietnam.

The mechanical characteristics of leg lengthening over a nail (LON) using an external fixator are not well known; specifically, the number of rings and K-wires required for this method has not been determined. This study aimed to compare the mechanical characteristics of leg LON using the simplest configuration for a domestic frame and those of leg lengthening using the Ilizarov frame alone. The mechanical characteristics of cow tibial samples for lengthening over an intramedullary nail in combination with a domestic external fixator (LON samples) and for lengthening with the Ilizarov frame (Ilizarov samples) were evaluated by assessing axial compression, bending load, and torsional load. The research indices were compression stiffness, bending stiffness, torsion stiffness, yield axial load, ultimate axial load, yield bending load, and ultimate bending load. No statistically significant differences were observed in the compression stiffness, ultimate axial load, bending stiffness, and ultimate, yield bending forces between the Ilizarov samples and LON samples. The compressive stiffness, yield axial load, and ultimate axial load of the LON samples were 98 ± 1.31 N/mm, 915 ± 23.89 N, and 1032 ± 29.86 N, respectively. The anterior-posterior bending stiffness and lateral bending stiffness of the LON samples were 122.48 ± 2.92 N/mm and 116.34 ± 3.95 N/mm, respectively. The yield anterior-posterior bending and ultimate anterior-posterior bending forces of the LON samples were 616.4 ± 3.64 N and 753.2 ± 3.49 N, respectively. The yield lateral bending and ultimate lateral bending forces of the LON samples were 624.6 ± 4.04 N and 759.0 ± 3.39 N, respectively. The axial torsional stiffness of the LON samples was 1.73 ± 0.05 N m/°, which was significantly lower than that of the Ilizarov samples (2.63 ± 0.03 N m/°). No statistically significant differences were observed in the mechanical fixation characteristics of axial compression and bending between the Ilizarov samples and LON samples. However, the axial torsional stiffness of the Ilizarov samples was statistically greater than that of the LON samples. We recommend using the simplest configuration for domestic frames in combination with LON for limb lengthening. Partial weight-bearing is permitted in the distraction stage. Case-control study.

Observation on Curative Effect of Minimally Invasive Osteotomy Combined with Ilizarov Technique in the Treatment of Knee Osteoarthritis with Varus Deformity

This paper aims to analyze the clinical efficacy of minimally invasive osteotomy combined with Ilizarov technique in the treatment of knee osteoarthritis with varus deformity. 80 patients with knee osteoarthritis and varus deformity who were treated in our hospital from January 2022 to May 2023 were selected, all of whom were affected by one knee. They were randomly divided into groups, including the study group and the control group, each with 40 patients. Patients in the control group were treated with fibula-tibial osteotomy and internal fixation, and patients in the study group were treated with minimally invasive osteotomy combined with Ilizarov technique. The operation time of the patients in the study group was significantly longer than that of the control group (P &lt; 0.05). The intraoperative blood loss of the patients in the study group was significantly more than that of the control group (P &lt; 0.05). The hospitalization expenses of the patients in the study group were significantly more than those of the control group (P &lt; 0.05). The postoperative femorotibial angle and mechanical axis offset distance in the study group were significantly smaller than those in the control group (P &lt; 0.05). The postoperative New York Hospital for Special Surgery (HSS) scores of the study group were significantly higher than those of the control group (P &lt; 0.05). The postoperative visual analogue scale (VAS) score of the study group was significantly lower than that of the control group (P &lt; 0.05). The range of motion of the knee joint in the study group was significantly greater than that in the control group (P &lt; 0.05). The incidence of tendon injury, infection, and nerve injury in the study group (2.50%) was significantly lower than that in the control group (30.00%) (P &lt; 0.05). Minimally invasive osteotomy combined with Ilizarov technique can be applied in the treatment of knee osteoarthritis with varus deformity, although the operation time is longer, with more intraoperative blood loss and higher treatment cost, but it has no effect on the femorotibial angle and mechanical axis deviation of the patient. It can significantly improve the movement distance, knee joint function, and knee joint range of motion, and significantly reduce the postoperative pain of patients, reduce the incidence of complications, and thus has high clinical application value.

Tibial cortex transverse transport potentiates diabetic wound healing via activation of SDF-1/CXCR4 signaling.

The current treatments for diabetic foot ulcers have disadvantages of slow action and numerous complications. Tibial cortex transverse transport (TTT) surgery is an extension of the Ilizarov technique used to treat diabetic foot ulcers, and can shorten the repair time of diabetic foot ulcers. This study assessed the TTT technique for its effectiveness in healing diabetic foot ulcer skin lesions and its related molecular mechanisms. Diabetic rat models were established by injecting healthy Sprague-Dawley rats with streptozotocin (STZ). The effects of TTT surgery on the model rats were assessed by recording changes in body weight, analyzing skin wound pictures, and performing H&E staining to assess the recovery of wounded skin. The numbers of endothelial progenitor cells (EPCs) in peripheral blood were analyzed by flow cytometry, and levels of CXCR4 and SDF-1 expression were qualitatively analyzed by immunofluorescence, immunohistochemistry, qRT-PCR, and western blotting. Both the histological results and foot wound pictures indicated that TTT promoted diabetic wound healing. Flow cytometry results showed that TTT increased the numbers of EPCs in peripheral blood as determined by CD34 and CD133 expression. In addition, activation of the SDF-1/CXCR4 signaling pathway and an accumulation of EPCs were observed in skin ulcers sites after TTT surgery. Finally, the levels of SDF-1 and CXCR4 mRNA and protein expression in the TTT group were higher than those in a blank or fixator group. TTT promoted skin wound healing in diabetic foot ulcers possibly by activating the SDF-1/CXCR4 signaling pathway.

Limb salvage and functional recovery in infected nonunion of the distal tibia treated with the Ilizarov techniques

IntroductionTreatment of infected nonunion of the distal juxta-articular tibia is a challenge due to a short distal fragment, deformity, thin soft-tissue envelope, and active infection. There is still no consensus on the approach that is able to maximally salvage the limb and ankle function. Material and methodsInfected juxta-articular nonunion of the distal tibia was managed with two Ilizarov techniques, monofocal compression (MC) used in 12 patients and bifocal compression-distraction (BCD) in 6 patients. The choice of the technique depended on the size of the postresection defect, ≥3 cm or ≤3 cm, respectively. The tactics of functional approach were careful debridement, insertion of wires in the distal fragment so that they do not penetrate the ankle joint, stable fixation, and temporary bridging of the ankle and forefoot. MSCT was used along with regular radiography to assess the union and regeneration. Ankle functions were evaluated with AOFAS ankle-hindfoot score system. ResultsBone consolidation, infection arrest and ankle function improvement were achieved in all patients. External fixation continued 221.7 ± 15.1 days for MC and 235 ± 25.8 days for BCD. Complications were wound divergence, wire-tract infection, premature consolidation of the fibula, and hypoplastic regeneration in one case. The mean functional AOFAS score after treatment was 90.7 ± 2.5 points in MC and 89.7 ± 1.3 in BCD patients. Residual limb discrepancy after MC ranged 0–4 cm. Bone shortening was compensated in BCD patients. ConclusionLimb-salvage and functional approach to the treatment of infected nonunion of the juxta-articular distal tibia with the Ilizarov techniques achieves good outcomes. It provides bone infection arrest, consolidation, defect compensation and significantly improves the ankle joint function.

Possible protective role of neutraceuticals in chronic intervertebral disc degeneration – A histological study

The aim of the study was to observe the effects of immobilization on the histomorphology of rats’ intervertebral disc (IVD) and observe the protective effects of widely used neutraceuticals, Omega 3 fatty acids and Co-enzyme Q 10 (CoQ10) on it. The animal experimental study was carried out in the National Institute of Health, Islamabad in collaboration with the Anatomy Department, Army Medical College, Rawalpindi. Forty Sprague Dawley rats, weighing 250-300g, were chosen and grouped into 4 equal sets. Control group A was fed normal lab diet. In experimental group B, along with the lab diet, an Ilizarov apparatus was applied to the rats’ tails for immobilization. In experimental groups C and D, the rats’ tails were immobilized and given Omega 3 fatty acids (260 mg/kg body weight) and CoQ 10 (150 mg/kg body weight) through oral gavage. At completion of the study, IVDs of rats were analysed to see the histologic changes in the nucleus pulposus (NP) and annulus fibrosus (AF). All the samples showed normal findings for NP in control group A. Degenerative changes were more significant in group B (p-value = 0.001) as compared to group C (p-value=0.005) and D (p-value=0.003). All the samples showed normal findings for AF in control group A. Degenerative changes were more significant in group B (p-value =0.000) as compared to group C (p-value=0.011) and D(p-value=0.003). Chronic immobilization of vertebral column induces degenerative changes in the cellular and matrix content of Intervertebral discs. However, consumption of neutraceuticals mitigates the consequences.

Bone Transport through Induced Membrane versus Conventional Bone Transport in Management of Infected long bone defects of Lower Limbs: a randomized controlled trial.

To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in management of infected long bone defects. prospective randomized controlled study. tertiary level center. 30 patients with infected non-united long bone fractures of lower limbs. 15 patients treated by BTM in group (A) and 15 patients treated by BT in group (B). External fixation time (EFT), External fixation index (EFI), Docking time (DT). Bone and functional outcomes evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Postoperative complications evaluated according to Paley's classification. The mean docking time (DT) was significantly lower in BTM group in comparison to BT group (3.6 ± 0.82 months vs 4.8 ± 0.86 months respectively; P value 0.001). Docking site non-union and infection recurrence were significantly lower in BTM group in comparison to BT group (0% vs 40%; P value 0.02 and 0% vs 33.3%; P value 0.04 respectively) with no significant difference in EFI (P value 0.08). This is the first prospective randomized controlled study comparing BTM and BT techniques showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site non-union and infection recurrence rates and lower number of additional procedures needed at the expense of two staged operation in comparison to BT.

Features of organotopic remodeling of bone tissue and implanted osteoplastic material in Charcot neuro/osteoarthropathy

Introduction Despite the recognition of MRI as the gold diagnostic standard for Charcot arthropathy, there is evidence in the literature that MSCT is more informative for objective qualitative and quantitative diagnosis of the condition, primarily of the bone skeleton of the Charcot foot, in comparison with standard radiography. The sensitivity and specificity of these methods are different.Purpose To reveal the features of organotopic remodeling of bone tissue and implanted osteoplastic material in the course of midfoot and hindfoot subtotal defects management in Charcot neuro-osteoarthropathy.Materials and methods The analysis of bone tissue and implanted osteoplastic material density was carried out in a case series that included 11 patients with Charcot neuro-osteoarthropathy who underwent a two-stage procedure for bone defects in the hindfoot and midfoot with the Ilizarov apparatus. We studied CT and MRI scans and measured bone regenerate density before treatment, at the stages of transosseous osteosynthesis, and 3, 6, and 12 months after surgery.Results In all patients, varying increase in the amount and volume of bone tissue was visualized due to intensive periosteal bone formation along with the formation of bone ankylosis in the joints along combined with a consistent increase in the optical density of bone regenerates. The formation of the new bone tissue ran without the signs of lysis or sequestration. The conducted studies indicate that the sizes and architectonics of bone fragments are more differentiated in CT than in MRI scans.Discussion It is known that the bone, despite its high mineralization, continuously rebuilds, restores and adapts itself to certain functional conditions. This constant dynamic process of adaptive remodeling depends mostly on optimal blood supply, metabolic activity and the coordinated work of bone cell elements. The data obtained show angiogenesis in the compromised tissues in patients with Charcot foot and consistent remodeling of the graft into the new bone tissue.Conclusion The allobone in the composition of the combined bone graft does not reduce the likelihood of complete remodeling of the newly formed bone tissue. Higher bone density by filling in a bone defect with a graft differs from distraction regenerate that initially has low bone density. CT and MRI are highly effective and informative diagnostic methods for surgical treatment. In reconstructive interventions in the patients with Charcot foot under the conditions of transosseous osteosynthesis, preference among radiological study methods should be given to CT.

Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis

Relevance Diabetic neuroosteoarthropathy (DNOAP) complicated by chronic osteomyelitis (CO) is one of the most common complications (up to 7.5 %) in patients with diabetes mellitus. Treatment failure of such patients leads to amputation of the segment, and in some cases, to death. The use of the method of transosseous osteosynthesis is the only alternative method in the struggle for the limb salvage.Purpose Based on X-ray morphological criteria for assessing bone quality, to determine the optimal assembly of the external fixation device (EFF), which provides favorable conditions for restoring limb weight-bearing capacity in the treatment of patients with DNOAP complicated by infection.Materials and methods The analysis of radiographs and the clinical course of the reparative process in 49 patients (mean age 55.5 ± 9.4 years) with DNOAP complicated by chronic osteomyelitis was carried out. Two groups were distinguished based on the Ilizarov apparatus assembly: wire-based (WB) used in 25 patients; hybrid construct (HC) in 24 patients. The X-ray obtained in Jpeg format were analyzed using specialized Hi-scene software. The density of the bones of the foot was studied by MSCT.Results Comparison of the indicators of bone optical density in both study groups showed that there was an insignificant increase in the postoperative period Od of the calcaneus by 25 % after treatment in patients from the HC group, and in the WB group by 43 % in the distal tibia. At the same time, we noted a significant increase in the Od values of the tibia in the postoperative period in patients from the HC group and in the body of the calcaneus in patients from the WB group. MSCT showed that the density of the calcaneus before treatment in patients with DNOAP in the region of the calcaneal tubercle was 194.37 ± 49.05 HU, in the region of the body it was 205.47 ± 38.36 HU, in the region of the distal tibia 280.00 ± 40.30 HU. The analysis of the results of bone osteosynthesis of the affected segment showed that the rate of satisfactory outcomes after dismantling the device in patients from the HC group was significantly higher than in the WB group (56 %) and amounted to 75 %.Discussion As is known, pronounced osteoporosis of the bones of the lower leg and foot is often characteristic of patients with diabetes mellitus complicated by DNOAP and chronic osteomyelitis. A possible arsenal of treatment methods that allow solving the problems of stable arrest of the osteomyelitic process and restoring limb support in such patients is very limited. The optimal choice of the Ilizarov apparatus assembly type has an impact on the outcome of treatment of patients with this pathology.Conclusion Based on X-ray morphological criteria for assessing bone quality, our study showed a decrease in optical and densitometric bone density in patients with DNOAP complicated by chronic osteomyelitis compared to the norm. The use of wire-based assembly of the apparatus does not provide sufficient conditions for the solution of the set of the surgical tasks in this category of patients. The introduction of half-pins into the apparatus system provides the necessary fixation time with the possibility of functional load on the operated segment in patients in the postoperative period.

Analysis of results of huge segmental bone loss of tibia treated with Ilizarov external fixator: our experience in Indian population

Background: Orthopaedic surgeons face challenges in treating complex tibial fractures with bone loss due to complications like infection, repeat surgeries, and patient psychological burden. The Ilizarov external fixator approach offers better clinical and radiological results, addressing these issues. The purpose of this study was to examine the outcome of tibial segmental loss treated with the Iliazrov external fixator. Methods: The study was done between January 2015 to December 2021. It’s a prospective as well as retro-prospective study. The age group of 18-65 years was considered. Patients were monitored monthly, up to nine months post-surgery, or until bone union. Functional and bone outcomes of the patients were evaluated using ASAMI criteria, knee society score, and St. Pierre ankle scoring system. Results: The study included 20 patients, all of them were male and had a mean age of 34.1±10.1. Bone union was achieved in all cases. After ilizarov application, the average bone defect was 82.6±42.9 mm. The final regeneration attained was 75.1±47.5 mm. The average limb length difference was 20.41±6.55 mm after achieving union. Out of 20 patients, 13 and 4 had good and fair ASAMI score, 1, 4, and 13 had fair, good, and excellent knee society score, and17 had fair St. Pierre score and 3 patients were lost to follow-up. Conclusions: Ilizarov technique is an excellent way for treating complicated tibial fractures. The difficulties, challenges, and complications associated with Ilizarov external fixation are negligible compared to the significant difficulties associated with open techniques.

Systematic Review for Evaluation of Ilizarov External Fixator in Treatment of Open Fracture of Tibial Shaft

Background Tibial shaft fractures are one of the most common long bone fractures. Open fracture tibial shaft is common between those fracture. The Ilizarov external fixator (IEF) is a minimally invasive method that permits effective wound management, early weight-bearing, and bone lengthening. Aim of the Work We aim to systematically review the Ilizarov external fixator in the treatment of open fracture of the tibial shaft. Material and Methods Regarding the methodology of our study, we followed the PRISMA statement guidelines during this study preparation and performed all steps according to the Cochrane handbook of systematic reviews of intervention. We searched PubMed, Scopus, Cochrane, and Web of Science, Embase, and Science Direct in June 2021 and updated the search in July 2021 using relevant Keywords. Results We found a significant difference regarding the outcome of operation time. IEF consumed more time than the other different approaches. The analysis favored IEF over other different approach regarding the overall postoperative excellent to good improvement. No significant different was found between both IEF and other approaches regarding the union time (per months) as well as the risk of reoperation. The postoperative superficial infection was the at the same risk between IEF and other different approaches, However, there is no significant difference regarding risk in postoperative deep infection after IEF. The overall postoperative infection rate was increased after IEF. No significant difference was found regarding the risk of either non-union or malunion rate, postoperative healing, and deep venous thrombosis (DVT). Conclusion We concluded that the IEF can be considered reliable alternative techniques over other techniques. The analysis demonstrated that it is possible to successfully treat diaphyseal tibial fractures using the Ilizarov method, a minimally invasive technique allowing immediate weight-bearing.

Mono-Focal Distraction Osteogenesis in Management of Traumatic Bone Loss (Systematic Review of Literature)

Background Traumatic bone loss poses a serious problem for orthopedic surgeons added to the long standing risk of infection implied by open type fractures. Aim of the Work This study aims to assess the efficacy of distraction osteogenesis in compensating bone defects using the Paley score for functional and radiological outcomes. Methodology We searched the literature through PubMed database with publication date restricted to 10 years range from 2009-2019 English literature of prospective studies only were selected with strict inclusion criteria where repeated articles were excluded unless they presented follow up with functional outcome data about cases. Seven studies were included satisfying the predetermined inclusion criteria with total of 242 cases. Patients’ data were collected and analyzed with only: 176 cases mentioned demographic data with average age of ‘37’ and no comorbidities to decrease the risk of bias in our results. 125 patients had fractures in tibia without soft tissue loss and 51 patients needed skin grafting, 3.4% of total cases underwent late amputation, 14.2% experienced pin tract infection. Results Our results appear to demonstrate the efficacy of mono-focal distraction osteogenesis technique in compensating long bone defects of the lower limbs in traumatic events. We isolated studies reporting exclusively on either proximal tibia or distal tibia bone defects compared the respective outcomes of interest in the absence of statistical heterogeneity. The only significant difference that could be established was a four-fold decrease of the likelihood of fair functional results in the ‘distal tibia’ subgroup compared with the ‘proximal tibia’ subgroup. In distal tibial defects, we explored the impact of the size of a bone defect and duration of external fixation on outcomes of interest. We noticed a 3.7-times increase in the odds of re-fracture when the size of the distal tibial defect exceeded 8 cm Conclusion Mono-focal distraction osteogenesis (Ilizarov method) is effective in managing bone defects larger than 3 cm² however for defects larger than 8cm² there’s increased risk of re-fracture.

Debridement-Reconstruction-Docking Management System Versus Ilizarov Technique for Lower-Extremity Osteomyelitis.

Osteomyelitis causes marked disability and is one of the most challenging diseases for orthopaedists to treat because of the considerable rate of infection recurrence. In this study, we proposed and assessed the debridement-reconstruction-docking (DRD) system for the treatment of lower-extremity osteomyelitis. This procedure comprises 3 surgical stages and 2 preoperative assessments; namely, pre-debridement assessment, debridement, pre-reconstruction assessment, reconstruction, and docking-site management. We evaluated the use of the DRD system compared with the Ilizarov technique, which is defined as a 1-stage debridement, osteotomy, and bone transport. This retrospective cohort included 289 patients who underwent either DRD or the Ilizarov technique for the treatment of lower-extremity osteomyelitis at a single institution between January 2013 and February 2021 and who met the eligibility criteria. The primary outcome was the rate of infection recurrence. Secondary outcomes included the external fixator index (EFI), refracture rate, and the Paley classification for osseous and functional results. An inverse-probability-weighted regression adjustment model was utilized to estimate the effect of the DRD system and Ilizarov technique on the treatment of lower-extremity osteomyelitis. A total of 131 and 158 patients underwent DRD or the Ilizarov technique, respectively. The inverse-probability-weighted regression adjustment model suggested that DRD was associated with a significant reduction in infection recurrence (risk ratio [RR], 0.26; 95% confidence interval [CI], 0.13 to 0.50; p < 0.001) and EFI (-6.9 days/cm, 95% CI; -8.3 to -5.5; p < 0.001). Patients in the DRD group had better Paley functional results than those in the Ilizarov group (ridit score, 0.55 versus 0.45; p < 0.001). There was no significant difference between the 2 groups in the rate of refracture (RR, 0.87; 95% CI, 0.42 to 1.79; p = 0.71) and Paley osseous results (ridit score, 0.51 versus 0.49; p = 0.39). In this balanced retrospective cohort of patients with lower-extremity osteomyelitis, the use of the DRD system was associated with a reduced rate of infection recurrence, a lower EFI, and better Paley functional results compared with the use of the Ilizarov technique. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.