Ilizarov Technique Research Articles

SELECTIVE REMOVAL OF ILIZAROV FRAMES WITHOUT A PERIOD OF DYNAMIZATION APPEARS SAFE

IntroductionTraditionally, radiological union of fractures treated with an Ilizarov frame is confirmed by a period of dynamization - destabilisation of the frame for a period prior to removal. Reduced clinic availability during the COVID-19 pandemic caused a shift to selective dynamisation in our department, whereby lower risk patients had their frames removed on the same day as destabilisation. This study investigates the effects of this change in practice on outcomes and complication rates.Materials & MethodsAdult patients treated with circular frames between April 2020 and February 2022 were identified from our Ilizarov database. Patients were divided into 2 groups: - “dynamised” if their frame was destabilised for a period to confirm union prior to removal; or “not dynamised” if the decision was taken to remove the frame without a period of dynamisation, other than a short period in the clinic. A retrospective review of clinical notes was conducted to determine outcome.Results175 patients were included in the final analysis, 70 in the dynamised and 103 in the not dynamised groups, median follow-up was 33 months. 3 patients in the dynamised group failed dynamisation and had their period of fixation extended, subsequently having their frames removed without complication. Two patients suffered a refracture or non-union after frame removal in the dynamised group and none in the not dynamised group, this difference was not statistically significant.ConclusionsIn our practice, selective frame removal without a period of dynamisation appears safe. This has the potential to shorten frame time and reduce the number of clinic appointments and radiographic investigations for these patients. Some patients find the period of dynamisation uncomfortable and associated with pin site infection, which can be avoided. We plan to continue this practice and collect further data to confirm these findings in a larger dataset.

MIDFOOT CHARCOT ARTHROPATHY: BUTT FRAME CORRECTION FOLLOWED BY BEAMING FOR SEVERE DEFORMITY

IntroductionCharcot neuroarthropathy is a limb threatening condition and the optimal surgical strategy for limb salvage in gross foot deformity remains unclear. We present our experience of using fine wire frames to correct severe midfoot deformity, followed by internal beaming to maintain the correction.Materials and MethodsNine patients underwent this treatment between 2020–2023. Initial deformity correction by Ilizarov or hexapod butt frame was followed by internal beaming with a mean follow up of 11 months. A retrospective analysis of radiographs and electronic records was performed. Meary's angle, calcaneal pitch, cuboid height, hindfoot midfoot angle and AP Meary's angle were compared throughout treatment. Complications, length of stay and the number of operations are also described.ResultsMean age was 53 years (range:40–59). Mean frame duration was 3.3 months before conversion to beaming. Prior frame-assisted deformity correction resulted in consistently improved radiological parameters. Varying degrees of subsequent collapse were universal, but 5 patients still regained mobility and a stable, plantargrade, ulcer-free foot. Complications were common, including hardware migration (N=6,66%), breakage (N=2,22%), loosening (N=3,33%), infection (N=4,44%), 1 amputation and an unscheduled reoperation rate of 55%. Mean cumulative length of stay was 42 days.ConclusionsAggressive deformity correction and internal fixation for Charcot arthropathy requires strategic and individualised care plans. Complications are expected for each patient. Patients must understand this is a limb salvage scenario. This management strategy is resource heavy and requires timely interventions at each stage with a well-structured MDT delivering care. The departmental learning points are to be discussed.

THE RESULTS OF TWO-RING HEXAPODS IN THE LOWER LIMB AT KING'S COLLEGE HOSPITAL

IntroductionClassical fixation using a circular frame involves two rings per segment and in many units this remains the norm whether using ilizarov or hexapod type frames. We present the results of two ring circular frame at King's College Hospital.Materials & MethodsA prospective database has been maintained of all frames applied since 2007. Radiographs from frames applied prior to July 2022 were examined. Clinic letters were then used to identify complications.Included: two ring hexapod for fracture, malunion, nonunion, arthrodesis or deformity correction in the lower limb.Excluded: patients under 16 years old, diabetic feet, Charcot joints, soft tissue contractures, arthrodiastasis, correction of the mid/forefoot, plate fixation augmentation, fixation off a third ring.Results518 two ring hexapods were identified. Mean age was 46 (16–89). 55% were for fracture, 18% for malunion, 11% for nonunion. Mean frame time was 7 months (2–29 months).All clinic letters from 384 patients showed 203 patients (52%) had at least one pin site infection, 27 nonunions (7%), 16 frame revisions (4%), 25 bone grafting procedures (7%), 5 cases of septic arthritis (1%), 3 periprosthetic fractures (0.8%),), 12 malunions (3%), 4 Amputations (1%).ConclusionsThese results demonstrate the efficacy of a two ring hexapod for patients requiring reconstruction of the lower limb.

POSTOPERATIVE OUTCOMES OF ILIZAROV FRAME FIXATION IN THE LOWER LIMB: AN EVALUATION OF PATIENT-REPORTED OUTCOME MEASURES AND ALIGNMENT

IntroductionBy utilising the inherent variability achievable with circular frames, surgeons can manage a wide spectrum of complex injuries, and can deal with deformity at multiple levels, in multiple planes. The aim of this study was to assess functional outcomes utilising patients reported outcome measures (PROMs) of patients being treated with circular (Ilizarov) frame fixation for complex lower limb injuries and assess these results in conjunction with the observed postoperative alignment of the patients’ limbs.Materials & MethodsCases were identified using a prospectively collected database of adult patients presenting between July 2018 and August 2021. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS), the 5-level EQ-5D (EQ5D5L), the Lysholm Knee Scoring Scale (LKSS), the Olerud-Molendar Ankle Score (OMAS), and the Tegner Activity Scale (TAS). Postoperative radiographs were analysed for fracture union and to quantify malunion (as described in Dror Paleys Principles of Deformity Correction).ResultsThe mean AOFAS, EQ5D5L, LKSS and OMAS scores showed an initial drop from pre-op to early time points and then steady increase over the early, mid, late and frame-off time points, with a resultant score higher than pre-op. Malunion was found in 35 (41.7%) patients, 7 patients had a malunion within 5 degrees of normal, 15 from 5–10 degrees of normal, 12 from 10–15 degrees of normal and 2 out with 15 degrees of normal.ConclusionsCircular frame fixation is an attractive option in complex lower limb trauma where alternative fixation methods are unsuitable. Whilst post-operative success to the surgeon might be determined radiographically, patient reported outcomes give a functionally important, objective measure of the success of the surgery to the patient.

Soft-tissue origin joint contractures treated with the Ilizarov fixation method

Introduction Soft-tissue origin joint contractures are a common orthopedic problem. It could be due to various etiologies. Treatment options are available from conservative to surgical methods. These joint contractures slowly become irreversible causing impairment in activities of daily routine. The Ilizarov method is a well established and time-tested method used for management of bone pathologies, but its use in the management of soft-tissue origin contractures is also possible. It has an established role in neoosteogenesis and histogenesis. Fixator assisted soft-tissue stretching done at sustained slow pace leads to histoneogenesis that avoids stretching of neurovascular structures and reduces the possibility of recurrence.Aims To determine usefulness of the Ilizarov method in management of joint contractures of soft tissue origin; to meet functional requirements of patients; to study complications of Ilizarov method in management joint contractures due to soft tissue origin.Material and methods A total of 6 cases of soft-tissue origin joint contractures due to tuberculosis, post‑traumatic stiffness, post-burn contracture, deformity due to a snake bite in the age group from 3 to 55 years were treated with gradual distraction of joint with the Ilizarov method from January 22 to October 23. Two cases were of triple knee deformity, two were post-traumatic elbow stiffness, one was post-burn great toe contracture and one was post snake bite valgus foot contracture. All cases were operated with transarticular Ilizarov frame application and gradual distraction of joints and soft tissue with the help of hinge- and rod distractor assembly done. All cases completed follow up of 1 year. Aggressive physiotherapy was given postoperatively.Results All cases obtained a reasonable functional outcome, with no recurrence of deformity. All patients walk independently.Conclusion The Ilizarov method can be used for treating joint contractures due to traumatic and non‑traumatic pathologies.

Evaluation of the effectiveness of ankle arthrodesis options

Introduction Treatment methods for late stages of ankle osteoarthritis are varied, but the issue of assessing the long-term results of various fixation methods has not yet been studied, and this issue is of great importance in clinical practice.Purpose To compare the effectiveness of the fixation methods commonly used for ankle arthrodesis in patients with advanced ankle osteoarthritis.Materials and methods Eighty-two patients with advanced ankle osteoarthritis were treated with ankle fusion between 2019 and 2023 at three major medical institutions. All patients underwent 12-month follow-ups. The patients were divided into four groups depending on the method of surgical fixation of bone fragments.Results Most patients showed a significant improvement in the function and a decrease in pain intensity after the arthrodesis operation. The comparison of the effectiveness of various surgical fixation methods found that external apparatus screw fixation is characterized by lower blood loss and a relatively short duration of the operation. Plate and screw fixation resulted in higher AOFAS and VAS scores at 3 months postoperatively. However, by the 12th month after surgery, the differences in these two indicators were insignificant.Discussion Despite the various complications that occur in ankle arthrodesis, it remains effective for most patients. Among them, the Ilizarov apparatus is more suitable for patients with compromised conditions in the surgical area. Each method of surgical fixation has its own advantages and shortcomings, but the difference in long-term effectiveness is small. Conclusion Ankle arthrodesis is an effective treatment for advanced ankle osteoarthritis. The choice of surgical method is still subject to the principle of individual approach.

Design and Testing of an Intramedullary Nail Implant Enhanced with Active Feedback and Wireless Connectivity for Precise Limb Lengthening

This comprehensive study presents a pioneering approach to limb lengthening, leveraging the advancements in wireless technology to enhance orthopedic healthcare. Historically, limb lengthening has been a response to discrepancies caused by fractures, diseases, or congenital defects, utilizing the body’s innate ability to regenerate bone and surrounding tissues. Traditionally, this involved external or internal fixation devices, such as the Ilizarov and Taylor Spatial frames or the Precice nail and Fitbone. The focal point of this research is the development and testing of a wireless intramedullary nail implant prototype, controlled remotely via a mobile application. This implant comprises a microcontroller, Bluetooth Low Energy module, a brushed DC motor controlled through an H-bridge, and a force sensor, all powered by medical-grade batteries. The integration of wireless technology facilitates patient autonomy in managing limb lengthening, reducing the need for frequent clinical visits. The methodology involves a detailed block diagram for our proposed work, outlining the process from treatment planning to the initiation of limb lengthening via the mobile application. Osteogenesis, the formation of new bone tissue, plays a crucial role in this procedure, which includes pre-surgery assessment, osteotomy, latency, distraction, consolidation, and removal phases. Key challenges addressed include custom battery design for efficient operation, size constraints, and overcoming signal interference due to the Faraday cage effect. Attenuation testing, simulating human tissue interaction, validates the implant’s connectivity. In conclusion, this research marks a significant stride in orthopedic care, demonstrating the feasibility of a wireless implant for limb lengthening. It highlights the potential benefits of reduced clinical visits, cost efficiency, and patient convenience. Despite limitations such as battery requirements and signal interference, this study opens avenues for future enhancements in patient-centered orthopedic treatments, signaling a transformative shift in managing limb length discrepancies.

Modern Technologies for Bone Defect Replacement (Literature Review)

Information is provided regarding the materials used to replace bone defects caused by gunshot wounds. Materials and various techniques for replacing bone defects of the limbs are described. Goal. Conduct an analysis of surgical technologies and materials for the replacement of bone defects, by analyzing literary sources. Methods. In three reputable databases (PubMed, Scopus, and Web of Science), an analysis of the latest scientific studies devoted to the treatment of defects of long tubular bones in the period from 2015 to 2022 was carried out. The search was carried out using the keywords "bone defects", "autograft", "allograft", "Ilizarov method", "Masquelet method", "biocomposite materials". The results. Analysis of osteoinductive and osteoconductive properties of auto- and allografts, modern biocomposite materials. Established advantages and disadvantages. The contemporary analysis of literary sources does not provide an objective comparative assessment of the effectiveness of the treatment of bone defects according to the Masquelet and Ilizarov method due to the lack of a sufficient number of randomized studies, which is the basis for further targeted research. Conclusions. Treatment of bone tissue defects of various genesis is an urgent problem of modern orthopedics and traumatology. The wide range of treatment options is proof that no single strategy works for every patient, just as there is no perfect universal material to fill and ensure bone regeneration in the defect site. A promising direction is the search for new or a combination of known materials and methods, which are able to maximally provide compensation for these pathological conditions.

Semi-focal bone transport versus traditional bone transport technique for the management of large tibial bone defects after trauma

How to deal with large tibial bone defects is still controversial. The purpose of this research was to compare the semi-focal bone transport (SFBT) technique with traditional bone transport (TBT) technique for treating such patients. Sixty-two patients were included and retrospectively analyzed. In all cases, after radical debridement large tibial bone defects remained. Patients were treated by the SFBT or TBT technique. The distraction, consolidation duration and complications were recorded by the patients’ medical files. Based on the Association for the Study and Application of Methods of Ilizarov (ASAMI) standard, the bone and functional results were evaluated. The mean bone defect size was 7.7 ± 1.6 cm and 7.5 ± 2.1 cm for SFBT and TBT patients. The mean external fixation index (EFI) was 1.51 ± 0.14 months/cm and 1.89 ± 0.25 months/cm for SFBT and TBT patients (p < 0.05), respectively. With respect to bone and function results, there was no significant differences between the two groups (p > 0.05). The mean number of complications per patient was 1.1 ± 0.6 and 1.6 ± 0.7 for SFBT and TBT patients (p < 0.05). Compared to the traditional bone transport technique, patients using the semi-focal bone transport technique achieved better clinical effects, including shorter EFI and less complications. Therefore, the SFBT technique could be a new option for patients with large tibial bone defects.

Comparative Analysis of Complication Rates in Tibial Shaft Fractures: Intramedullary Nail vs. Ilizarov External Fixation Method.

Background: The external fixation (EF) Ilizarov method, shown to offer efficacy and relative safety, has unique biomechanical properties. Intramedullary nail fixation (IMN) is an advantageous alternative, offering biomechanical stability and a minimally invasive procedure. The aim of this study was to assess outcomes in patients undergoing tibia fracture fixation, comparing the Ilizarov EF and IMN methods in an early phase of IMN implementation in Serbia. Methods: This was a retrospective study including patients with radiologically confirmed closed and open (Gustilo and Anderson type I) tibial diaphysis fractures treated at the Institute for Orthopedic Surgery "Banjica'' from January 2013 to June 2017. The following demographic and clinical data were retrieved: age, sex, chronic disease diagnoses, length of hospital stay, surgical wait times, surgery length, type of anesthesia used, fracture, prophylaxis, mechanism of injury, postsurgical complications, time to recovery, and pain reduction. Pain intensity was measured by the Visual Analog Scale (VAS), a self-reported scale ranging from 0 to 100 mm. Results: A total of 58 IMN patients were compared to 74 patients who underwent Ilizarov EF. Study groups differed in time to recovery (p < 0.001), length of hospitalization (p = 0.007), pain intensity at the fracture site (p < 0.001), and frequency of general anesthesia in favor of intramedullary fixation (p < 0.001). A shorter surgery time (p < 0.001) and less antibiotic use (p < 0.001) were observed when EF was used. Additionally, we identified that the intramedullary fixation was a significant predictor of pain intensity. Conclusions: The IMN method offers faster recovery and reduced pain intensity in comparison to EF, while the length of surgery predicted the occurrence of any complication.

A novel capitate bone Ilizarov external fixator for treating Kienböck’s disease: an anatomical and biomechanical study

This study aims to measure anatomical data of the capitate bone, develop an external fixator for treating late-stage osteonecrosis of lunate through Ilizarov technique, and evaluate its biomechanical performance. We selected eight wrist joint specimens to measure various parameters of the capitate bone, including its length, the distance from the junction of capitate head and body to the proximal end, as well as the width of its proximal head and distal body. Additionally, we measured these same indicators in 107 patients who had undergone wrist X-ray examination. Based on our measurements, we categorized the capitate bone into two groups and designed two types of capitate bone Ilizarov external fixator (CIEF) for it. Then, we compared it with the orthofix external fixator (OEF) through dynamic fatigue biomechanical experiments and pull-out resistance experiments. The results of the measurement revealed two categories of general patterns in the capitate bone. The first type maintains a consistent longitudinal axis between the proximal and distal ends. The second type is characterized by its proximal end being close to the radial side and its distal end being close to the ulnar side. In the dynamic tensile fatigue test, CIEF-A and CIEF-B had smaller maximum displacement values compared to the OEF (P < 0.05). In the anti-pull-out experiment, both CIEF-A and CIEF-B exhibited higher maximum pull-out force than the OEF (P < 0.05). CIFE is a treatment for advanced osteonecrosis of the lunate bone. It is specifically designed to align with the anatomical characteristics of the capitate bone, providing excellent biomechanical properties and a simple clinical procedure. However, additional clinical experiments are needed to confirm its effectiveness in the future.

Comparison of functional outcome of locking plate technique versus hybrid Ilizarov technique for complicated tibial plateau fractures

&lt;p&gt;This study compares the functional outcomes of two approaches, the locking plate technique and the hybrid Ilizarov technique, in managing complicated tibial plateau fractures. Enrolling 78 patients at Jinnah Hospital, the research explores a nuanced difference in results. In Group A (Hybrid Ilizarov Technique), 84.6% males and 15.4% females participated, while Group B (Locking Plate Technique) had 82.1% males and 17.9% females. The locking plate approach demonstrated superior outcomes, suggesting its efficacy in treating tibial plateau fractures.&amp;nbsp;&lt;/p&gt;&#x0D; &lt;p&gt;Study design: Cross sectional study.&lt;/p&gt;&#x0D; &lt;p&gt;Study setting was department of Orthopedic Surgery, Jinnah Hospital Lahore&lt;/p&gt;&#x0D; &lt;p&gt;Objective/purpose of the study was to evaluate the functional results of locking plate and hybrid Ilizarov procedure for tibial plateau fractures using Rasmussen's knee functional score.&lt;/p&gt;

Distraction Osteogenesis by Ring Fixator in Post Traumatic Tibial Bone Loss

Background: Reconstructing segmental bone loss defects presents a significant challenge within the field of orthopedics. The purpose of this study is to assess the clinical and radiological results of using the Ilizarov technique for tibia reconstruction following traumatic bone loss. Methods: This study was a prospective study involving 30 patients who experienced tibial bone loss in the diaphysis or metaphysis following trauma. These patients were treated with a ring fixator (Ilizarov) from March 2021 to February 2023. Unfortunately, five patients were lost to follow-up, leaving a cohort of 25 patients who were observed for a duration ranging from 9 to 12 months. Results: The current study involved 25 patients with post-traumatic tibial bone loss. The age range was 14 to 48 years, with a mean age of 28.4±8.8 years. Among the cases, 18 had a moderate defect (72%), which was significantly higher than those with a minor defect (20%) (P ≤ 0.05). Deformity was less than 7° in most cases (96%), while only one case had deformity greater than 7° (4%) (P ≤ 0.05(. Leg length discrepancy was less than 2.5 cm in the majority (96%), with only one case having a 3 cm length discrepancy (4%) (P ≤ 0.05). By the end of the follow-up period, all patients showed perfect union, enabling them to engage in daily activities post-operatively. Conclusion: The success of corticotomy and solid docking relies on well-vascularized bone and soft tissue. Soft tissue compromise at the corticotomy site can hinder healthy tissue regeneration.

Current perspective on medical management, orthopedic treatment, and the use of the Ilizarov method in children with X-linked hypophosphatemic rickets

Hypophosphatemic rickets encompasses a group of rare metabolic diseases that cause lower limb bowing and growth impairment. The mainstay of its management rests in frequent dosages of oral phosphate salts and active vitamin D derivatives. Recent developments in therapy reduced severe pathology progression. However, there remains a substantial number of patients suffering from persisting or recurring deformities. Treatment of those resistant to conventional therapy is the domain of orthopedic surgery. Although multiple recommended approaches exist, no single method has been proven superior to others. In this article, the authors review the effectiveness of several surgical techniques, with a focus on the Ilizarov frame. The method allows for a noninvasive and accurate correction but is technically demanding and imposes a prolonged treatment period. Modern alterations of both the procedure and the original construct aim to improve patient compliance while maintaining the same healing index. Nevertheless, research carried out on small groups of patients and the utilization of different assessment tools for each technique hinders the determination of standardized guidelines. The choice of a given method boils down to an individual approach and strongly depends on the surgeon’s experience and preferences.

Balance and Weight Distribution over the Lower Limbs Following Calcaneal Fracture Treatment with the Ilizarov Method.

Background: The biomechanical outcomes of intra-articular calcaneal fracture treatment have not been fully explored. The purpose of this study was to analyze pedobarographic assessments of balance and body weight distribution over the lower limbs in patients following calcaneal fracture treatment with the Ilizarov method and to compare the results with those of a control group. Materials and Methods: The data for our retrospective study came from cases of intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method in the period between 2021 and 2022. The experimental group (21 patients; 7 women, 14 men) included Sanders classification calcaneal fractures type 2 (n = 3), type 3 (n = 5), and type 4 (n = 13). The control group comprised 21 sex-matched healthy volunteers, with no significant differences from the experimental group in terms of age or BMI. The examination included an assessment of balance and weight distribution over the lower limbs. The device used was a FreeMED MAXI pedobarographic platform (SensorMedica). Results: The mean displacement of the center of gravity in the experimental group was significantly higher at 1307.31 mm than in the control group (896.34 mm; p = 0.038). The mean area of the center of gravity was not significantly different between the groups. An analysis of weight distribution over the operated and uninjured limb in the experimental group and the non-dominant and dominant limb, respectively, in the control group revealed no significant differences. We observed no significant differences in the percentage of weight distribution over the lower limbs between the operated limb in the experimental group and the non-dominant limb in the control group, or between the uninjured limb in the experimental group and the dominant limb in the control group. Conclusions: The use of the Ilizarov method in calcaneal fracture treatment helps normalize the percentage weight distribution in the lower limbs, with the results comparable with those obtained in the healthy control group. The mean displacement of the center of gravity was worse in the experimental group than in controls; whereas the mean area of the center of gravity was comparable between the two groups. Treatment of calcaneal fractures with the Ilizarov method does not help achieve completely normal static parameters of lower-limb biomechanics. Patients treated for calcaneal fractures with the Ilizarov method require longer and more intense rehabilitation and follow-up.

Outcome of Bone Transport Using Ilizarov External Fixator in Infected Non-union of Tibia with Large Bone Defects: Comparison of Those with 5-10cm Bone Defect with Those Having ≥ 11cm Bone Defect.

Ilizarov external fixation has become the treatment of choice for infected non-union of tibia. Varying degrees of bone loss and different strategies of treatment in the published reports make comparingoutcomes difficult. This study hopes tobridge thisgapin the literature by focussing exclusively on bone transport in patients with bone loss of 5cm or more. Thisis a prospective case series conducted at a tertiary level orthopaedic speciality hospital. Outcomes are measured by Association of the Study and Application of Method of Ilizarov (ASAMI) bony scores, ASAMI functional scores, Lengthening Index and by assessing complications encountered. There were 49 patientsin this study withan average of 9.57cm bone gap. Among these,29 patients had a bonegap of 5-10cm and 20 patientshad a bone gap of ≥ 11cm.According to the ASAMI bony score, 42 patients had excellent or good outcomes with two fair results and five poor results. The ASAMI functional scores were 45 excellent to good outcomes, four fair and no poor results or failures. Fixed flexion deformity of the knee of more than 5°, ankle stiffness and soft tissue interposition were significantly more frequent in those with bone gap of ≥ 11cm. Trifocal transport and bone grafting at docking significantly improved the lengthening index. Even massive bone defects of 11cm or more can be reliably healed by bone transport using Ilizarov external fixation, but with a significantly higher rate of complications. Level IV.

Management of infected gap non-union of the tibia with bone transport over plate

Compound tibia fracture with bone loss is common presentation in Orthopaedics, treatment for which is well described in the literature. Ilizarov technique is commonly used to fill the bone defect with its different modifications which include additional stabilization with IMIL or Plate. We report a case of infected gap nonunion of proximal tibia shaft which was managed with Ilizarov technique along with a stabilizing plate. The purpose of this report is to provide an alternative mode of management for infected of tibia shaft fracture with bone defect.

Surgical treatment of nonunion of the lateral humeral condyle in children using combined methods of bone grafting and the Ilizarov fixation

Introduction Elbow trauma is common accounting for 40-50 % of all musculoskeletal injuries in children. From them, lateral condyle fractures are the second most common fractures in the pediatric elbow with complications ranging from 3.3 to 54.8 %.The objective was to determine the effectiveness of nonunion of the lateral humeral condyle (LHC) treated with bone grafts harvested from the patient's fibular shaft and the Ilizarov apparatus.Material and methods We report surgical treatment of bone defect repaired with bone graft and the Ilizarov apparatus in 57 children with nonunion of the LHC. Maintained articulation between the non-united bone and the radial head, magnitude and direction of displacement, visible resorption of the epimetaphysis, bone deficiency, malaligned upper limb, late ulnar neuritis were the parameters used for outcome assessment. Depending on the type of surgical treatment the patients were divided into 3 groups: Group 1 (n = 13) included patients who underwent open osteosynthesis and bone fixation using 2-3 Kirschner wires; Group 2 (n = 30) consisted of patients who underwent surgery to repair the bone defect between the humerus metaphysis and an non-united fragment of the LHC fixed with wires and immobilized with a cast; Group 3 (n = 12) included patients who were treated with bone graft followed by fixation of the bone and the graft using Ilizarov wires and frame. Two patients underwent supracondylar osteotomy.Results The outcomes were evaluated based on criteria to include non-union consolidation, joint function, limb alignment and condition of the growth plate. Long-term results were explored in 49 (85.9 %) patients out of 57 over a period of 6 months to 10 years. The results were rates as good in 39 (79.6 %) patients, as fair in 9 (18.36 %) and poor in one (2.04 %) case.Discussion Various types of operations are reported for non-united fractures and non-unions of the cervical spine to include surgeries from open osteosynthesis to complicated reconstructions.Conclusion Surgeries aimed at repair of bone defects using fibular autograft facilitated consolidation of non-unions and engraftments.

The effect of various modes of electrical influence on the skeletal muscles of the lengthened ­segment during distraction of the lower leg according to Ilizarov

BACKGROUND: When using electrical muscle stimulation in clinical practice, it is important to select the optimal mode of this effect, since muscles largely determine the movement of the limb during the rehabilitation period.&#x0D; AIM: Study of the tibialis anterior muscle reaction during Ilizarov distraction of the tibia in combination with the direct effect of direct electric current on the regenerated area in the experiment.&#x0D; MATERIAL AND METHODS: The tibialis anterior muscle and biochemical parameters of blood serum (creatin kinase activity, lactate concentration) of 27 male Soviet chinchilla rabbits aged 12 months, weighing 3.85±0.18 kg, tibia length 11.2±0.13 cm, were studied. The animals were divided into three groups: control (n=9), first (n=9) and second experimental (n=9). The right tibia was fixed with an Ilizarov apparatus, a transverse osteotomy was performed in the middle third of the diaphysis, and from the 5th day, distraction began at a rhythm of 0.125 mm in 4 steps to an amount of 10% of the original length for 26 days. Fixation lasted 40 days, the period without the device was 30 days. For electrical stimulation, wire-electrodes were inserted into the diaphysis, and electrical stimulation of the bone regenerate was performed for 1 minute with a current intensity of 150 mAm. In the first group, electrical stimulation was performed starting from the day of surgery and on days 2, 4, 6, 8, 10 of the experiment. In group 2, electrical stimulation began on the 10th day after surgery and on the 12th, 14th, 16th, 18th, and 20th days of the experiment. In the control group, no electrical stimulation was applied. Using the methods of stereometric analysis of digitized images of tibialis muscle’s cross sections, the volumetric density of myosymplasts, microvessels, endomysium and nuclear component, the numerical density of myosymplasts and microvessels were determined, and the vascularization index was calculated. For statistical processing of data, the Wilcoxon W test and the Mann–Whitney T test were used; numerical data were presented in tables.&#x0D; RESULTS: A positive effect of electrical stimulation on the muscles of the experimental groups was established in comparison with the control group, where fibrosis of muscle tissue at the end of the experiment was 0.2777±0.0055 mm3/mm3, which was 230% relative to the parameter of the first group (0.1217±0.0121 mm3/mm3) and 370% relative to the second group (0.0752±0.0062 mm3/mm3). An advantage was noted for the second group, where electrical stimulation was carried out from the 5th day of distraction and at the end of the experiment the histostructure of the muscle, characteristic of the intact norm, prevailed.&#x0D; CONCLUSION: Electrical impact on bone regenerate from the 5th day of distraction stimulates reparative processes in the tibialis anterior muscle and serves as an organ-saving method.

Methodological principles of diagnosis verification and treatment tactics determination in combat limb injuries with bone defects

Objective. To develop a classification system for long bone defects resulting from combat limb injuries, establish criteria for predicting pathological fractures, and determine indicators for assessing the feasibility of converting the fixation method in combat-related injuries. Methods. The modern literature regarding the treatment of combat-related long bone defects resulting was analyzed in three databases: PubMed, Scopus, and Web of Science. The analysis was conducted using keywords such as combat injuries, bone defect, non-union, auto- and allograft transplantation, Ilizarov method — bone transport, Masquelet method — induced membrane, and fixation method replacement. The clinical material used for this study was derived from the evaluation and treatment of 457 patients with long bone defects at the III–IV medical intervention stage. Results. The determination of modern perspectives on the fundamental issues of combat injuries, combined with the analysis of treatment outcomes for such patients, enabled the development and validation of a classification of bone defects that incorporates the volume of bone tissue loss. Furthermore, a prognostic table for the risk of pathological fractures in cases of bone defects and a scoring scale for assessing the feasibility of fixation method conversion have been introduced and applied. Conclusions. The proposed classification allows the verification of all types of long bone defects. Its application in clinical practice offers the possibility of obtaining optimal and standardized treatment methods for different types of bone defects, thus improving outcomes by choice of appropriate technologies for their replacement. The objectification of fracture risk factors identification for bone defects enables the choice of the method and means of segment stabilization. The assessment of the feasibility of the fixation method change allows the evaluation of the patientʼs condition and the local status, facilitating the determination of the potential for method conversion — transition from external fixation devices to intramedullary osteosynthesis, significantly reducing complications during this stage.