Ilizarov Technique Research Articles

Integrating 3D-printed customized guides with hemicorticotomy bone transport: clinical outcomes in chronic osteomyelitis management.

Chronic osteomyelitis with large bone defects remains a challenging condition in orthopedic surgery. This study aimed to evaluate the clinical efficacy of hemicorticotomy bone transport assisted by 3D-printed customized guides in the treatment of chronic osteomyelitis with bone defects. A retrospective analysis was conducted on 21 patients with chronic osteomyelitis treated with hemicorticotomy bone transport with 3D-printed guide assistance between January 2015 and January 2021. Preoperative planning utilized 3D CT reconstruction for precise guide design and osteotomy placement. The surgical technique involved hemicorticotomy, placement of the 3D-printed guide, and gradual bone transport using a monolateral external fixator. Clinical outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. The external fixation time (EFT), external fixation index (EFI), and complications evaluated using the Paley classification were recorded. The mean bone defect size was 7.9 ± 2.0cm. The average follow-up period was 28.6 ± 6.4 months. The mean external fixation time was 289.4 ± 52.7 days, with an external fixation index of 36.8 ± 4.2 days/cm. According to the ASAMI criteria, the bone results were excellent in 17 patients (81%), good in 3 (14%), and fair in 1 (5%). The functional results were excellent in 15 patients (71%), good in 4 (19%), and fair in 2 (10%). Complete eradication of the infection and union at the docking site were achieved in all patients. The complication rate was 38% and all of which were successfully managed. Hemicorticotomy bone transport assisted by 3D-printed customized guides is an effective treatment for chronic osteomyelitis with bone defects. This technique offers excellent bone healing, favorable functional results, and a relatively low complication rate. Further studies with larger sample sizes are warranted to validate these findings.

Second-look arthroscopy after ankle distraction arthroplasty

Background: Ankle distraction arthroplasty (ADA) is a method of treating terminal osteoarthritis of the ankle joint, which allows delaying fusion or total replacement. Aims: The aim of the study was to research the macroscopic image of the articular cartilage before and after ADA using second-look arthroscopy. Methods: A total of 17 ADA surgical interventions were performed. The average age was 48.5±13.57 years, among them 7 females (38.89%) and 10 males (61.11%). 4 patients underwent second-look arthroscopy of the ankle joint after ADA at different times. Results: All patients showed a statistically significant change in the functional outcome by 12 months from the moment of surgery, on the FAAM scale (p-value = 0.00060) and the AO FAS Ankle-hindfoot scale (as well as after removing the Ilizarov frame after 1, 3, 6, and 12 months). The reduction in pain was from 6.17 1.32 cm before surgery to 2 (1.4, 2.1) cm after 12 months. Conclusions: There were signs of regeneration of cartilaginous defects with their covering with cartilage-like soft tissue, which was probably responsible for the analgesic effect of ADA.

Clinical and radiological assessment of the Polish modification of the Ilizarov external fixator for the treatment of intra-articular calcaneal fractures.

There is currently no established gold standard for the treatment of calcaneal fractures. To conduct a clinical and radiological evaluation of patients following intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method. This was a 2-center retrospective study. We evaluated 27 patients (2 women and 25 men) aged 28-73 years (mean age 50.5 years) after treatment of intra-articular calcaneal fractures with the Polish modification of the Ilizarov method. We assessed pain using a visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scores, patient satisfaction with treatment, use of analgesics, duration of Ilizarov treatment, length of hospital stay, duration of surgery, patient's declared willingness to choose the same treatment again, complications, degenerative changes, Böhler angle, inflection angle, and Gissane angle. The mean follow-up period was 3 years and 2 months. Following treatment, the mean VAS pain score was 2.3. Prior to surgery, all patients were taking analgesics in comparison with only 2 patients (7.4%) at long-term follow-up. The treatment was rated as satisfactory by 11 patients, with 16 patients rating it as highly satisfactory. The mean post-treatment AOFAS score was 76.6 points. The Ilizarov fixator was removed after a mean period of 88 days. The mean duration of hospital stay was 7.4 days. The mean duration of the procedure was 44 min. All patients would choose the same treatment again. Complications were observed in 5 patients. The long-term follow-up visit revealed degenerative changes in the talocalcaneal joint in 8 patients. The median Böhler angle was 5.5° preoperatively and 28.5° postoperatively, p < 0.001. The median preoperative inflection angle of 160° decreased to 145°, p < 0.001. The median preoperative Gissane's angle of 119° increased significantly to a median postoperative value of 143°, p < 0.001. The patients achieved good clinical and radiological outcomes.

Open segmental tibial bone defects treated with Ilizarov frame: a radiological and functional outcome study with average ten year follow-up.

Surgical reconstruction of large post-traumatic tibial bone and soft tissue defects following high-energy trauma presents a significant challenge for orthopaedic surgeons. This study aimed to evaluate the functional and radiological outcomes of large post-traumatic tibial bone and soft tissue defects managed by single or double-level bone transport using the Ilizarov technique. 13 patients who underwent treatment for large tibial bone defects (Gustillo IIIa, IIIb, IIIc) along with soft tissue defects with Ilizarov from 2010 to 2020A.D were included. ASAMI functional and radiological outcomes were assessed at the final follow-up to report the outcome. The mean age was 27.38 (18-48). An average bone defect was 7.69cm (5-13cm). Based upon the Gustillo-Anderson classification (GA), 2 (15%) of them were GA - 3A, 7 (54%) were GA - 3B, and 4 (31%) were GA - 3C. The average time of distraction was 11.76 weeks (8-16). The average time for the union was 37 weeks (27-48 weeks). The average bone lengthening was 7.69cm (5-13cm). The mean final leg length discrepancy (LLD) at the final follow-up was 1.96cm (0-4cm). The primary union was achieved in eight cases, and five required bone grafting at the docking site. Using the ASAMI (Association for the Study of the Method of Ilizarov) scoring system, the functional results were excellent in six and good in seven cases, while the bony results were excellent in eight, good in four and fair in one case. Good to excellent functional and radiological scores (ASAMI) can be expected when using the Ilizarov frame for simultaneous treatment of the large tibial bone and soft tissue defect when this method is applied with correct principles.

Distraction of longitudinally split fragments using the Ilizarov method: a series of clinical cases of treating partial bone defects

Background. The Ilizarov method is a recognized technique for treating severe skeletal injuries, allowing for a comprehensive restoration of both bone and soft tissue components. Despite the fact that bone lengthening and transport are widely known techniques, distraction of a longitudinally split fragment is still used extremely rarely. The aim of the study is to describe a series of clinical cases involving patients operated on using this technique. Methods. We present a series of observations of five patients who underwent distraction of a longitudinally split fragment using the Ilizarov method between January 2006 and December 2022. Clinical information was obtained from case histories, all surgical interventions were documented. Postoperative examination was performed using radiography. Results. A case series demonstrates the successful application of this technique for reconstruction of partial bone defects resulting from trauma or osteomyelitis. The study included five patients (4 men and 1 woman) who underwent surgery 4.8-34.0 months after trauma for a partial defect of the proximal tibia ranging from 4 to 8 cm in length. Distraction was performed in different directions along the sagittal and longitudinal axes. The time of external fixation ranged from 3.5 to 4.8 months, the external fixation index ranged from 0.49 to 1.22. The ASAMI (Association for the Study and Application of the Methods of Ilizarov) functional score at the follow-up examination was excellent in all five patients. The ASAMI bone tissue assessment showed excellent results in all patients, except for one patient with residual equinus (good result). No other complications were reported. Conclusions. The Ilizarov method provides a minimally invasive and comprehensive approach to the elimination of partial bone defects, affecting simultaneously the skeletal and soft tissue components. Due to the longitudinal splitting during fragment transport and distraction osteogenesis, this method promotes bone and tissue regeneration and helps to avoid a volumetric bone defect and more complex segmental bone transport. Moreover, the role of transverse transport of the tibial cortex increases in the treatment of peripheral arterial diseases.

Lowering of the Patella — prevention and treatment of a rare complication during leg lengthening: a case report

Background. Changes in the level of the patella position are a well-known complication of knee replacement, reconstruction of the anterior cruciate ligament, high tibial osteotomy and consequences of injuries. However, this problem has not been disclosed in the literature in relation to distraction osteogenesis using the Ilizarov method. The aim of the study is to describe such a rare iatrogenic complication as patella baja during limb lengthening by the Ilizarov method using a clinical case as an example. Case description. In 2017, a 17-year-old teenager was injured in a head-on collision of cars at high speed. The patient was diagnosed with an open fracture of the left femur and fibula and tibia of the left leg. He was treated in another clinic using the Ilizarov apparatus for osteosynthesis of the femur, tibia and proximal osteotomy of the tibia to move the bone to fill the distal bone defect. At the end of the treatment, the patient had a moderate limitation of the knee flexion (180-80°). In 2018, the patient was admitted to our clinic due to osteomyelitis at the level of the consolidated fracture. A new resection of the osteomyelitis lesion and proximal osteotomy for bifocal osteogenesis were performed. During the treatment, limitation of knee flexion (180-120°) was developed and radiographic signs of low position of the patella were obtained. Given the progression of patella baja (the Caton-Deschamps index = 0.51), we were forced to return the patient to the operating room to restore the correct height of the patella. Conclusions. The presented clinical case emphasizes the need for a more thorough assessment of the patella height after surgical treatment on the proximal tibia using the Ilizarov method. It is also noted that it is important to conduct a control MRI, which allows for a more detailed study of the initial position of the anterior tibial tubercle. In our case, early detection of complications allowed us to achieve complete recovery without any consequences.

History and formation of “Limb lengthening and reconstruction surgery — LLRS” as a subspecialty of orthopedic surgery

In 1998, the first meeting of members of the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was held in the USA to introduce and popularize the methods developed in Kurgan by Professor G. Ilizarov and his staff. During 2005-2016, other communities worked in parallel with ASAMI, which went beyond the use of only the Ilizarov apparatus. Since 2017, the joint meetings have been called “Combined congress of the ASAMI-BR and ILLRS societies”. This actually became the basis for the definition of “Limb Lengthening and Reconstruction Surgery (LLRS)” as a subspecialty of orthopedic surgery that treats patients with nonunions, congenital and acquired long bone, large joints deformities of the upper and lower extremities. LLRS is based on the Ilizarov method and discovery (“Ilizarov effect”) with the rational use of external and internal fixation, osteotomy and soft tissue procedures. It takes at least three years for an orthopedic surgeon to become a specialist in the field of LLRS, and the education must be staged. A significant role in this is played by the ASAMI-BR ILLRS congresses, ExFix LLRS courses held in many countries, ExFix modules integrated into courses provided as part of the education of AO Trauma, as well as extensive world literature.

Artificial deformity creation in treatment of soft tissue wounds and lower leg bones defect: a case report

Background. The problem of treating wounded patients with defects of soft tissues and bones of the extremities continues to be relevant. One of the ways to close soft tissue defects, especially in case of bone tissue loss, after open fractures of the extremities is acute shortening and creation of artificial angular deformity of the segment. The aim of the study — to demonstrate the possibilities of acute shortening and angulation of the segment as a technique to replace soft tissue and bone defects in treatment of a patient with a gunshot wound to the lower leg. Case description. A 30-year-old wounded man was admitted to the clinic with an extensive defect in soft tissues and bones of the lower leg in the middle third. To reduce the wound size, acute shortening and angulation of the lower leg was performed. The intentional angular deformation was 24º, shortening — up to 8 cm. The residual soft tissue wound defect was closed with local tissues and split skin autograft. The tibia was fixed by the Ilizarov hinge-distraction apparatus with following gradual correction of the angular deformity. After that, one performed osteotomy of the tibia in order to eliminate shortening with the Ilizarov method (the distraction rate of 1 mm per day). After restoring the length of the lower leg, in order to replace the defect along the anterior surface of the tibia, a marginal “flake” was formed from a displaced fragment. At a follow-up examination, in 18 months after the injury the patient walks with full weight bearing on the injured limb without any additional means of support, continues to perform military service duties in accordance with his position. Conclusions. The presented clinical case demonstrates that acute shortening of a limb segment with creation of artificial angular deformity is an effective method for temporary closure of a gunshot defect of soft tissues. The technique allowed closing critical soft tissue defect of the lower leg and restoring the anatomy (length) of the segment. Consequently, one was able to achieve satisfactory treatment results and restore the functions of an injured limb. Besides, acute temporary shortening technique eliminated the need to perform technically sophisticated and lengthy microsurgical reconstructions, which are associated with a flap replacement for closure of soft tissue defects in a shotgun fracture area.

The need for state-of-the-art orthopedic surgical technology in low- to middle income countries : The case of distraction epiphyseolysis for limb lengthening in children with fibular hemimelia in Uzbekistan.

Amongst low- to middle income countries (LMIC), outdated and poorly documented orthopedic interventions may pose patients at risk for complications, serious adverse events (SAE) and unsatisfactory results, contradicting the World Health Organization's (WHO) Safe Surgery mandates. Use cases of conditions managed inadequately in LMIC environments are necessary to increase awareness of stakeholders and overcome deficiencies in collaboration with high-income countries (HIC). Methodological and clinical experts from the BG Kliniken and the Charité, Berlin, Germany, were invited to investigate established processes for musculoskeletal disorders and injuries in Tashkent, Uzbekistan. Congenital lower leg discrepancy due to fibular hemimelia was recognized as an illustrative example to prove the effectiveness of local treatment guidelines, still relying on distraction epiphyseolysis (chondrodiatasis) via an Ilizarov frame. Routine data from hospital records, images and outpatient follow-up examinations were compared to estimates from a review of studies of limb-lengthening by other techniques. Data from 16 of 49 immature patients (10 males, 6 females, mean age at surgery, 4.2 ± 2.3 years) undergoing chondrodiatasis between 2017 and 2021 showed a mean limb elongation of 2.4 (95% confidence interval [CI], 1.9 to 2.9) cm after a median follow-up of 29 (range, 24 to 36) months. While no complications or SAE were noted, findings are compatible with a risk of 21% under an upper 97.5% confidence limit for null events. No reproducible classification of hemimelia, surgical or general complications, assessment of functional outcomes or health-related quality of life were available. The pooled average length gain from 21 studies on different other interventions with osteotomy enrolling 458 limbs was 5.1 (95% CI, 5.0 to 5.3) cm. Limb lengthening for hereditary fibular hemimelia in Uzbekistan revealed rather obsolete surgical algorithms, inadequate documentation, and unreliable outcome assessment. Resource limitations notwithstanding, knowledge transfer, implementation of current procedures and hardware, and international collaboration is vital to improve quality of care in this scenario and for the benefit of LMIC in general.

Methods and Strategies of Microsurgery Combined with Ilizarov Technique in the Treatment of Amputation of Limbs in Renji Hospital: A Report of 51 Cases.

Severe limb amputation trauma often results in bone and soft tissue defects after debridement. Traditional replantation aims to save the limb by shortening the ischemic period and using autologous transplantation for repair, but it can lead to surgical trauma, donor site damage, and prolonged operation time. Due to contusion, pollution, and complex injury, there is no unified standard for replantation and fixation. Improper operation can easily lead to complications such as bone infection, nonunion, bone defect, and joint stiffness. This study introduces the Ilizarov technique into microsurgery to improve limb lengthening after reconstruction and standardizes the steps of replantation fixation for complex limb avulsion injuries, with a focus on clinical efficacy. A retrospective analysis was performed on 51 patients with complex limb amputation who were treated in Zhengzhou Renji Hospital from June 2009 to March 2021. On the basis of microsurgical limb replantation, Ilizarov technology was introduced to innovate the internal and external combined stepwise fixation method for replantation. Patients' gender, age, height, weight, BMI, and other general information were collected. X-ray films were reviewed regularly to observe the surgical healing of fracture, that is, the degree of limb shortening. The lengthening time, carrying time after lengthening, follow-up time, Dahl classification, Paley fracture healing classification, and Chen Zhongwei's replantation function score were used to evaluate the recovery of the affected limb. A total of 51 patients were included in this group, including 36 male patients and 15 female patients. All the amputated wounds were single limb amputation. In this group of patients, the hind limbs were shortened by 2-12.5 cm (5.32 ± 2.24) after replantation. A total of 44 patients whose hind limbs were shortened by more than 2.5 cm were treated with two-stage Ilizarov lengthening for 1.5-5.5 months (3.19 ± 1.03). The carrying time was 3-7.5 months (4.25 ± 0.94), and the follow-up time was 1-7.8 years (3.76 ± 1.69). Among the 49 survived patients, the Dahl grade of external fixation was less than Grade 2 in 89.8%. The excellent and good rate of Paley fracture healing classification was 89.8%. The excellent and good rate of Chen Zhongwei's limb replantation function classification was 79.6%. Microsurgery combined with Ilizarov technique in the treatment of limb amputation injury, limb salvage reconstruction with internal and external combined step-by-step combined fixation, and one-stage shortening and two-stage limb lengthening can reduce the occurrence of osteomyelitis, bone defect and nonunion, expand the indications of limb replantation, improve the success rate of limb replantation, with satisfactory results, and facilitate the promotion of clinical techniques.

Ertl surgery on the short fibula stump after war injury.

To propose a new technique of Ertl-type surgery for significantly shortened and valgus deviated fibula stump. We present the case of a 26-year-old patient who underwent reamputation surgery to replace a significantly shortened fibula stump using a distraction regenerate formed after tibial stump osteotomy and dosed distraction of the autograft using the Ilizarov apparatus. Its advantage is the elimination of valgus deviation of the fibula remnant, its lengthening, formation of bone synostosis, and increase of the bearing surface, which provides the possibility of total contact prosthetics. Radiography, ultrasound and MRI were used to monitor the regeneration. The observation period was 28 months. Within 98 days after the operation, a regenerate was formed, replenishing the length of the fibula stump, the end of the fibula stump was consolidated with the regenerate, increasing the area of the bearing surface of the tibia stump by 2.5 times, which allowed for temporary and then permanent prosthetics. The proposed technique can be useful in reconstructive operations on the stump of the tibia.

Preliminary Outcomes of Calcaneal Body Lengthening for the Calcaneus Shortening.

For lengthening irregular bones, such as calcaneus, there are few reports in the literature. This study aimed to introduce the treatment strategy and preliminary outcomes for calcaneus shortening using calcaneal body lengthening. From January 2017 to January 2022, calcaneal lengthening was conducted for three patients (two males and one female) who suffered from traumatic calcaneal shortening. The Achilles tendon was lengthened in one patient. After osteotomy of the calcaneus, an Ilizarov frame was used to gradually (1 mm/day) distract the calcaneal fragment. The lengthening procedure was stopped when the calcaneal height and length were restored based on radiography. The fixator was removed after bone union. The average follow-up length was 18 months (range, 14-24 months). X-ray was used for radiological assessments. Patients reported satisfaction using the 100-mm visual analog scale (VAS). Clinical outcome was evaluated following the American Orthopedic Foot and Ankle score. All data were assessed by two physicians blind to clinical assessments. The wound healed primarily in three cases. The bone got solid union without refracture and malunion. The distraction time was 30 days (range, 25-45 days). The fixation time was 113.3 days (average, 80-150 days). Calcaneal lengthening was 26 mm (range, 15-43 mm). The height and length of the calcaneus were restored nearly to the same as the opposite foot. The mean preoperative calcaneal pitch angle increased from 2.6 degrees to an average of 19.0 degrees after the surgery. The AOFAS score increased from 60.0 to 86.0. One patient experienced pin infection. The infection healed after changing the dressing. Calcaneal lengthening using an Ilizarov external fixator is a preferable technique to restore the length and height of the calcaneus and can achieve satisfactory foot function.

The Ilizarov Technique: A Dynamic Solution for Orthopaedic Challenges.

The Ilizarov technique is one of the most important tools that is currently employed in bone reconstruction surgeries. Its inception dates back to the mid-20th century and involves various bone reconstruction methodologies implemented using a circular external fixator system devised by G. A. Ilizarov. The key advantages of this approach include the generation of viable new bone via distraction osteogenesis, high union rates, and the functional utilization of the limb during the treatment process. The exploration of distraction osteogenesis phenomenon triggered by tensile stress with the Ilizarov device served as a catalyst for progress in bone reconstruction surgery. Subsequently, the original technique has been utilized alongside several adaptations resulting from the introduction of novel fixation tools and methods of their application, such as hexapod external fixators and motorized intramedullary lengthening nails. It is crucial to possess a precise comprehension of the Ilizarov principles of deformity correction in order to effectively utilize this fixation system. In this article, we will discuss the history of Ilizarov frame, the basic sciences behind it, the mechanical principles governing its use, and the clinical application of the fixation system in our daily practice.

Treatment of Fourth Metatarsal Brachymetatarsia Using Distraction Osteogenesis with External Fixator: Surgical Techniques, Outcomes and Complications.

Surgical technique in distraction osteogenesis for the treatment of brachymetatarsia can influence the final prognosis. However, there are currently no standardized guidelines for surgical procedures and complication management. The aim of this study is to investigate the effect of bone lengthening with external fixation by minimally invasive osteotomy based on Ilizarov technique in the treatment of congenital brachymetatarsia. A retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening, from June 2017 to December 2020. There were 11 patients with 17 shorted fourth metatarsals, including 10 females and 1 male, with age of 24.6 ± 4.5 years (16-31 years). Six patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth MTP joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scores, metatarsal length, complications were recorded. Statistical comparison was performed using the paired t-student test for pre- and postoperative AOFAS MTP-IP scores. Patients were followed up for 55 ± 10.8 months. The mean length of the fourth metatarsal bone was 49.9 ± 2.9 mm preoperatively. The mean metatarsal shortage was 18.8 ± 3.1 mm. The mean lengthening achieved was 19.8 ± 3.3 mm, with a lengthening ratio of 39.7% ± 6.6%. The lengthened callus ossified completely at 3-4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 83.7 ± 4.2 preoperatively to 93.2 ± 2.7 postoperatively (t = -10.27, p < 0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes. Metatarsal lengthening by minimally invasive osteotomy with external fixator had satisfactory results in the treatment of congenital brachymetatarsia.

Focal Dome Osteotomy Combined with Ilizarov Technique for Treating Femoral Multiplanar Deformity.

The management of femoral multiplanar deformity remains a great challenge for orthopaedic surgeons. The focal dome osteotomy (FDO) combined with Ilizarov technique is a theoretically ideal method for treating femoral multiplanar deformity, but the clinical evidence is limited. The aim of this study is to assess the clinical and radiological outcomes of this combined strategy for correcting femoral multiplanar deformities. A retrospective analysis was conducted to analyze 20 patients (29 limbs) with femoral multiplanar deformities treated by FDO combined with Ilizarov external fixation in our limb deformity center between 2017 and 2022. Preoperative and postoperative radiographical parameters were measured, including lateral proximal femoral angle (LPFA), mechanical lateral distal femoral angle (mLDFA), middle diaphysis angle (MDA), anatomic posterior distal femoral angle (aPDFA), mechanical axis deviation (MAD), and limb length discrepancy (LLD). Clinical assessments included a self-made questionnaire for exercise capacity score (ECS), visual analog scale (VAS), and the 36-Item Short-Form Health Survey (SF-36) score. There were eight males and 12 females, with a mean age of 32.8 years (14-61 years). All patients completed follow-up with a mean follow-up duration of 41.5 (27-81) months. The mean EFT was 8.9 (1.4-20.2) months. At final follow-up, significantly improvement was noted regarding mean LLD (from 1.8 to 0.4 cm, p < 0.05), MDA (from 31.8° to 10.4°, p < 0.05), aPDFA (from 97.6° to 91.8°, p < 0.05), MAD (from 22.4 to 5.3 mm, p < 0.05), CORA on the true deformity plane (from 32.4° to 6.8°, p < 0.05). The mean VAS was decreased from 4.03 (2.0-6.0) preoperatively to 1.38 (0-3.0) at final follow-up (p < 0.05). The mean score of each item of SF-36 was significantly improved at final follow-up (p < 0.05). The mean ECS was improved from 8.2 (5-12) preoperatively to 11.4 (8-13) at final follow-up (p < 0.05). During the follow-up, one patient underwent pin exchange. One patient underwent internal fixation to replace the Ilizarov fixation 1.4 months after the first surgery. Residual LLD (>0.5 cm) was noted in four patients but without significant symptoms. No serious complications occurred. The strategy of FDO combined with Ilizarov fixation could provide powerful ability and good flexibility for correcting femoral multiplanar deformities without significant complications.

The Gradual Correction of Rigid Pes Cavus Using Midfoot Osteotomy Combined with Ilizarov Methods.

Midfoot osteotomy combined with Ilizarov methods of correction is a rarely reported treatment that is particularly well-suited for severe rigid pes cavus. The study aimed to assess the radiological and clinical results of patients who had been treated for rigid pes cavus using this method. The study retrospectively analyzed the clinical and radiological data of 15 pes cavus in 12 patients who were corrected by midfoot osteotomy with Ilizarov external frame in our department from March 2020 to September 2022. Radiologic outcomes were measured using the Meary angle (MA), talus-first metatarsal angle (TM1A), calcaneal varus angle (CVA) and foot length with weight-bearing radiographs. Functional assessments were evaluated in terms of pain, function, and quality of life by using the visual analogue scale (VAS), the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), and 36-item Short Form Health Survey (SF-36). Additionally, the postoperative satisfaction of patients was investigated by a questionnaire. The clinical and radiological results were evaluated by a paired t-test. All patients received plantigrade feet and pain relief. The mean follow-up was 33.1 ± 5.0 months (range from 25 to 41 months). The etiology included poliomyelitis (4), idiopathic (3), trauma (2), spina bifida (2) and tethered cord syndrome (1). The duration of gradual correction was 30.4 ± 10.6 days, and the external fixation time was 116.3 ± 33.3 days. The bony union rate was 100%. The VAS, AOFAS, and SF-36 scores significantly improved (p < 0.05). The MA, TM1A, and CVA were close to or reached the normal range postoperative (p < 0.01). The length of each foot was well preserved, which was increased more than 0.8 cm than preoperative. No major complications were reported except two cases of mildly hindfoot varus deformity. The results of the questionnaire showed that patients' satisfaction was 92% (11/12). Midfoot osteotomy combined with Ilizarov external frame proved to be a reasonable procedure with satisfying mid-term results for the gradual correction of rigid pes cavus.

Modification of proximal row carpectomy (PRC) technique for adaptive wrist collapse (pilot study)

Introduction Proximal carpal row resection has been used for many decades as a “salvage procedure” for progressive wrist collapse. Improving the technique of its implementation, as well as introducing various modifications of the technique into practice are an important area for achieving better results of surgical treatment.The purpose of this work was to demonstrate aspects of the modified proximal row carpectomy (PRC) technique and the immediate results of its use.Materials and methods Eight patients aged from 24 to 57 years (seven men and one woman) were treated with the modified PRC technique. Treatment results were assessed using an adapted QuickDASH questionnaire, a visual analogue scale (VAS), based on patient satisfaction and radiographic results.Results The average duration of surgical intervention was (149.0 ± 35.5) minutes. In the postoperative period, six patients (75 %) underwent fixation with an Ilizarov apparatus, the rest with a plaster splint. The average range of motion of flexion and extension was (67.5 ± 18.3)°, range: 40–95°. The patients had an average of (35.6 ± 16.13)° extension, range: 10–65° and (31.87 ± 10.9)° flexion, range: 10–45°. Patients reported decreased grip strength after surgery. Pain syndrome according to VAS at rest was equal to 0–1 points and 3–4 points when the affected limb was loaded. Six patients completed the QuickDASH survey, with a mean score of (14.83 ± 4.25) points. All patients are satisfied with the result of treatment and the absence of pain at rest. Patients returned to their usual work.Discussion Unlike the conventional dorsal approach through the III–IV tendon canals, the use of two mini-approaches provides a better cosmetic effect and makes it easier to restore the integrity of the tendon canals, which are important for the prevention of desmogenic contractures. The use of the Ilizarov apparatus has proven to be the method of choice, providing absolute stability and reduction of pain in the postoperative period. For patients under 45 years of age with increased functional demands, a balanced approach is required when choosing PRC or intercarpal arthrodesis, depending on which functional parameters are more important to the patient.Conclusion The analysis of short-term results of using the modified PRC technique shows that it reduces the invasiveness of the operation, improves its esthetic result, provides pain relief and a satisfactory range of motion and grip strength.

Long-term results of treatment of Gustilo-Anderson type 3A-B tibia fractures due to combat-related high-energy ballistic injuries treated with external circular fixator: Experience of the Military Medical Academy.

The aim of this study was to evaluate the longterm outcomes of open tibia fractures treated using the Ilizarov external circular fixation (ECF) technique in the Military Medical Academy. Between January 1992 and December 2011, a total of 134 male military personnel (median age: 22.5 years; range, 18 to 36 years) with Gustilo-Anderson type 3 open tibia fractures treated with ECF were retrospectively analyzed. All patients underwent multiple surgeries and eventually Ilizarov fixation surgery. The radiological and functional outcomes were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, and complications were noted. The median follow-up was 17.7 (range, 10 to 29) years. The median time to union was 4.7 (range, 3 to 8) months. All frames were removed from the limb, when union was observed. No re-fracture, limb length discrepancy more than 2.5 cm, or below-knee amputation after Ilizarov treatment was seen in any patient. Chronic osteomyelitis was observed at in 40% (n=54) of the patients at a median time ranging from 17 to 148 months. The overall ASAMI bone scores were excellent in 40 (30%), good in 20 (15%), fair in 20 (15%), and poor in 54 (40%) patients with osteomyelitis. The ASAMI functional scores were excellent in 40 (30%), good in 40 (30%), and fair in 54 patients (40%). No poor score was observed. Minor pin site infections were observed in 63 patients (47%). Our long-term study results showed that all patients returned to their social life and were mobilized without support after treatment with the use of Ilizarov ECF method of open tibia fractures caused by high-energy ballistic injuries. However, complications such as pin tract infections and osteomyelitis after several years must be kept in mind in the treatment of comminuted bone fractures caused by firearms and ballistic missiles injuries.

Assessment of Function in Patients after Calcaneal Fracture Treatment with the Ilizarov Method.

Background: Up to 75% of calcaneal fractures are intra-articular fractures, which may severely impair foot function and lead to disability. Methods: We retrospectively analyzed 21 patients with intra-articular calcaneal fractures who had been treated with the Ilizarov method in the period 2021-2022. The mean patient age was 47 years (range 25-67 years). We analyzed the following functional parameters: foot function with a revised foot function index (FFI-R) questionnaire and the level of physical activity, with the University of California Los Angeles (UCLA) activity scale, a visual analog scale (VAS), and a Grimby physical activity level scale; and ankle range of motion. Results: We observed a significant improvement in the UCLA activity scores and Grimby activity score at long-term follow-up. Functional outcomes based on the FFI-R questionnaires showed an improvement, from 292 points prior to surgery to 127 points at follow-up, p = 0.013. The post-treatment follow-up measurements revealed a median dorsiflexion at the treated ankle joint of 20 degrees, whereas that at the intact ankle was 40 degrees, p = 0.007. The plantar flexion showed asymmetry, with a median 15 degrees at the treated ankle and 30 degrees at the intact ankle, p = 0.007. The median range of inversion at the ankle joint was 5 degrees in the treated limb and 15 degrees in the intact limb, p = 0.039. Conclusions: Patients with calcaneal fractures treated with the Ilizarov method are recommended to have a longer and more intensive rehabilitation. The range of ankle motion in the treated limb was limited in comparison with that in the intact limb; however, this did not greatly affect the patients' return to their earlier, pre-injury level of physical activity.

Bone Bridge Transtibial Amputation by an Innovative Technique.

We present a case report of synostosis after transtibial amputation because of distraction regenerate formation after decortication of the lateral surfaces of the tibia and fibula, sequential compression, and distraction using the Ilizarov apparatus. Its advantage is that there is no need to shorten bone. The establishment of distal tibia-fibula synostosis (Ertl) in patients with transtibial amputation has been advocated to improve function and prosthetic wear. There are a variety of techniques to create a bone block. This case reports the successful use of an innovative technique to establish bone block. A patient with transtibial amputation underwent revision of residual limb by decorticating the lateral aspect of the distal tibia and the medial aspect of the distal fibula and acutely compressing the distal ends of the 2 bones with the Ilizarov apparatus. The distal fibula is then slowly and progressively distracted laterally, and the bone is formed in the space between the distal fibula and tibia, creating synostosis with an increased distal bone cross-sectional surface area for improved function and prosthetic wear. The follow-up period was 24 months. Within 3 months, synostosis was formed, which increased the area of the supporting surface and allowed temporary and then permanent prosthetics. After 24 months, synostosis did not differ from the structure of tibial stump bones.