Ilizarov Treatment Research Articles

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.

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.

Function of Infected Nonunion of the Distal Humerus Using Ilizarov Treatment-A Prospective Study

Introduction: Infected nonunion of the distal humerus is a challenging condition to treat, and Ilizarov treatment may be a viable option in some cases. Ilizarov treatment involves the use of an external fixation device to stabilize the bone and promote bone healing. Aim of the Study: The aim of this study was to evaluate the function of infected nonunion of the distal humerus using Ilizarov treatment. Methods: This prospective study was conducted in Department of Orthopedics, Dhaka Medical College Hospital, Dhaka, Bangladesh, during the period from June 2003 to June 2007. Total 203 patients with infected nonunion of the distal humerus were included in this study. Result: In our study, mean age of the sample is 41.9 (SD±16.31) years. Majority of the study subject (58.6%) were female. The mean value of time to union was 8.1 months, with a standard deviation of 2.34 months. Mean follow up period was 35.5 months, with a standard deviation of 15.7 months. In bone results, majority of the study subject (63.1%) had an excellent outcome. In the functional results, most of the study subject (69.5%) had an excellent outcome. Regarding complications, majority of the study population (41.4%) had pin tract infection. For the elbow ROM arc parameter, there is a statistically significant difference between the preoperative and postoperative values (P=0.0016). The mean shoulder abduction reduced from 128.02° (SD±32.56°) to 123.75° (SD±24.25°) after treatment. For the shoulder abduction parameter, there is no statistically significant difference between the preoperative and postoperative values (P=0.1348). The DASH score decreased from a mean of 31.14 to 9.61 after treatment. For the DASH score, there is a highly statistically significant difference between the preoperative and postoperative values (P&lt;0.0001). The mean preoperative VAS score was 7.05. After completion of treatment, the mean VAS score dropped to 2.21. For VAS score, there is a highly statistically significant .......

Primena Ilizarovljeve tehnike u lečenju višekomadnih preloma donjeg okrajka golenjače

Introduction. High-energy distal tibia fractures are characterized by great comminution and extensive lesions of the surrounding soft tissues. The risk of developing complications during treatment is high. The application of the Ilizarov's technique reduces the risk of complications significantly, and provides good final treatment results. Methods. In our prospective observational study 41 patients were included. Clinical characteristics were evaluated by Gustillo-Anderson, Checketts-Otterburns and AO/OTA classification. The ASAMI protocol was used to assess bone union. Functional treatment results were represented using the modified Karlström-Ollerud scoring system. Analysis and monitoring time (follow up) was 18 months. Results. Using radiographic and clinical parameters, we recorded complete healing in all fractures. In the group of 43B intra-articular fractures, circular fixator was removed after 16 weeks (range 13 -31), while in the 43C fracture type group, it was removed after 18 weeks (range 13 -29). The ASAMI evaluation of bone healing showed 31 (75%) excellent, 76 (15%) good, 3 (8%) satisfactory, and 1 (2%) poor result. Functional recovery results obtained after 6 months showed the mean value of 24.7 using the modified Karlström-Ollerud scoring system in three follow-up periods, which represents recovery. The results present 12 months after surgery showed the mean value of 27.6, representing satisfactory recovery, while during the last parameter measurement performed after 18 months, the value was 29.5, which indicates good functional recovery. Conclusion. Transosseous osteosynthesis Ilizarov treatment applied in closed and open comminuted distal tibia fractures showed good final bone and functional results with minimal complications, and contributed to better patient's quality of life.

Kinematic parameters after tibial nonunion treatment using the Ilizarov method

BackgroundAnalysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an important measure for assessing musculoskeletal disorder treatments that aim to restore normal gait. The purpose of our study was to compare the kinematic parameters in patients with tibial nonunion treated using the Ilizarov method and those in a control group of healthy volunteers.MethodsThe study population consisted of 23 patients (age 54.9 ± 16.4 years) who were treated for tibial nonunion using the Ilizarov method, as well as 22 healthy adult controls (age 52.7 ± 10.6 years). Kinematic parameters were measured using a Noraxon MyoMOTION System. We measured hip flexion and abduction, knee flexion, ankle dorsiflexion, inversion, and abduction during walking.ResultsOur analysis showed significant differences between the patients’ operated limbs (OLs) and the controls’ nondominant limbs (NDLs) in the ranges of hip flexion, hip abduction, and knee flexion. We observed no significant differences in knee flexion between the OL and the NOL in patients or between the dominant limb (DL) and NDL in controls. Our evaluation of the kinematic parameters of the ankle joint demonstrated significant differences between the patients’ OLs and the controls’ NDLs in the ranges of ankle dorsiflexion, ankle inversion, and ankle abduction. There were also significant differences in the range of ankle dorsiflexion and ankle abduction between the patients’ NOLs and the controls’ DLs.ConclusionTibial nonunion treatment using the Ilizarov method does not ensure complete normalization of kinematic parameters assessed 24–48 months following the completion of treatment and rehabilitation.

Measurement of Wire Deflection on Loading may Indicate Union in Ilizarov Constructs: A Pilot Study.

IntroductionNo entirely reliable method to assess union during Ilizarov treatment exists. Premature frame removal results in treatment failure, and alternative methods of assessment warrant investigation. Wire deflection might provide an indication of fracture site deformation on weight-bearing, indicating progress towards union. A previous in vitro study from our group demonstrated this approach may be clinically applicable. We investigated translation of this method into clinical practice in an observational pilot study.Materials and methodsPatients with tibial shaft fractures treated with Ilizarov frames were recruited. A prototype depth gauge was used to measure wire deflection on weight-bearing. Investigators undertaking the measurement were blinded to the clinical stage of treatment, and clinicians caring for the patient were blinded to deflection results. Patient records were reviewed at the end of treatment to determine likely fracture stability at each time point. Deflection per kg of weight applied, per mm from the ring was compared between stable and unstable situations.ResultsThirty-one measurements were obtained in 14 patients. The situation was deemed stable at 13 and unstable at 18 measurements. The median deflection in the stable group was 0.030 microns/kg/mm (IQR 0.005–0.104) and 0.165 microns/kg/mm (IQR 0.072–0.328) in the unstable group. This difference was statistically significant (Wilcoxon Mann–Whitney test p = 0.0014). ROC curve analysis revealed that wire deflection was able to predict clinical stability (AUC 0.84, p <0.0001). Various technical problems were encountered when using the device which would potentially limit its clinical utility in its current form.ConclusionIn this set of observations, wire deflection was significantly associated with clinically and radiologically determined stability. Though various practical limitations were encountered in using the prototype measurement device, this proof-of-concept study supports further development of this approach. The research group plan to develop a smaller, more reliable device for further clinical testing in a larger group of patients.How to cite this articleLineham B, Stewart T, Ward J, et al. Measurement of Wire Deflection on Loading may Indicate Union in Ilizarov Constructs: A Pilot Study. Strategies Trauma Limb Reconstr 2021;16(3):132–137.

Dynamic Gait Parameters in Patients With Nonunion of the Tibia Following Treatment With the Ilizarov Method.

The purpose of this study was a comprehensive assessment of the dynamic parameters of gait in patients who underwent Ilizarov treatment for nonunion of the tibia. The experimental group consisted of 24 individuals treated with the Ilizarov method for nonunion of the tibia. The control group comprised 31 healthy individuals, matched for BMI, sex, and age. The dynamic gait parameters in patients and in the control group were measured with a Zebris pedobarographic platform. The treatment group and the control group showed statistically significant differences in terms of the following gait parameters: maximum force during braking nonoperated-limb (NOL), time maximum force during braking operated-limb (OL), time maximum force during braking NOL, maximum force during push-off NOL, time maximum force during push-off OL, and maximum force forefoot OL. Most of the evaluated gait parameters were bilaterally similar in patients group. The only significant differences between the operated and nonoperated limb were seen in terms of Time maximum force during push-off and Maximum force forefoot. The most pronounced abnormalities in dynamic gait parameters were observed in the forefoot (maximum force forefoot OL was 13.3% lower than in the control group, maximum force forefoot OL was 12.4% lower than in NOL). The patients treated with the Ilizarov method did not achieve a complete normalization of dynamic gait parameters, as their gait parameters did not equal those measured in the control group. The Ilizarov method for the treatment of tibial nonunion helps restore a symmetrical distribution of gait parameter values between the affected limb and the healthy limb. Patients continue to show the following abnormalities in their dynamic gait parameters after treatment: higher values maximum force during braking NOL, Time maximum force during braking OL, time maximum force during braking NOL, maximum force during push-off NOL, contact time forefoot NOL, contact time midfoot NOL, contact time heel NOL and smaller values of time maximum force during push-off OL.

Assessment of Gait after Treatment of Tibial Nonunion with the Ilizarov Method.

Background: Tibial nonunion is a common bone union disorder leading to abnormal gait, and thus reducing quality of life in the social dimension. Research question: The aim of our work was to comprehensively assess gait parameters of patients who had undergone Ilizarov treatment for tibial nonunion compared to a control group of healthy individuals. Methods: This study evaluated patients treated for aseptic tibial nonunion with the Ilizarov method. 24 patients with a mean age of 55.0 years were included in the study. The control group consisted of 32 healthy volunteers with no significant medical history who were selected to match the gender and age of patients in the study group so that the groups were homogeneous. A Zebris Medical GmbH pedobarographic platform was used to assess the gait parameters. Results: For all gait parameters examined, force forefoot max, force backfoot max, step length, stance phase, swing phase and step time, we observed statistically significant differences between the group that had undergone treatment and the control group. In the group of patients, statistically significant differences between the operated lower limb and the non-operated limb were only observed for the force forefoot max and step time parameters (p = 0.029 and p = 0.045, respectively). Patients presented a longer loading of the operated limb (0.720 s) than the non-operated limb (0.635 s). For the stride time, step cadence and gait velocity parameters, healthy subjects achieved much better results during locomotion, and these differences were statistically significant at p < 0.001. Significance: Treatment of tibial nonunion with the Ilizarov method did not restore normal gait parameters in our group of patients. In fact, the gait parameters of patients were significantly worse than the healthy individuals in the control group. Furthermore, gait parameters following treatment were not symmetrical, and the dynamics of the musculoskeletal system remained impaired.

The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques

Nonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques. A total of 75 patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients’s mean age at the beginning of treatment was 46 years. The mean follow-up period was 10 years and 11 months. The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression. The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay. Bone union was achieved in all of the 75 evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me = 6.00 vs. Me = 4.00). We observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group. The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union, length of hospital stay, duration of Ilizarov treatment, or ASAMI bone scores. For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression. The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia

IntroductionThe purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature.Materials and methodsThis study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008–2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit.ResultsThe mean age at the start of treatment was 46.7 years (11–84 years). The mean follow-up period was 7 years (2–12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8–20.7 months). The rate of union maintained at the last follow-up visit was 95.1%.ConclusionsAll patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7–100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia\u2014a retrospective comparative analysis

IntroductionThis study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia.Material and methodsIn a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity.ResultsUnion rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827).DiscussionOur study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia.

This prospective study compared bifocal acute shortening and relengthening (ASR) with bone transport (BT) in a consecutive series of complex tibial infected non-unions and osteomyelitis, for the reconstruction of segmental defects created at the surgical resection of the infection. Patients with an infected tibial segmental defect (>2 cm) were eligible for inclusion. Patients were allocated to ASR or BT, using a standardized protocol, depending on defect size, the condition of soft tissues and the state of the fibula (intact or divided). We recorded the Weber–Cech classification, previous operations, external fixation time, external fixation index (EFI), follow-up duration, time to union, ASAMI bone and functional scores and complications. A total of 47 patients (ASR: 20 patients, BT: 27 patients) with a median follow-up of 37.9 months (range 16–128) were included. In the ASR group, the mean bone defect size measured 4.0 cm, and the mean frame time was 8.8 months. In the BT group, the mean bone defect size measured 5.9cm, and the mean frame time was 10.3 months. There was no statistically significant difference in the EFI between ASR and BT (2.0 and 1.8 months/cm, respectively) (p = 0.223). A total of 3/20 patients of the ASR and 15/27 of the BT group needed further unplanned surgery during Ilizarov treatment (p = 0.006). Docking site surgery was significantly more frequent in BT; 66.7%, versus ASL; 5.0% (p < 0.0001). The infection eradication rate was 100% in both groups at final follow-up. Final ASAMI functional rating scores and bone scores were similar in both groups. Segmental resection with the Ilizarov method is effective and safe for reconstruction of infected tibial defects, allowing the eradication of infection and high union rates. However, BT demonstrated a higher rate of unplanned surgeries, especially docking site revisions. Acute shortening and relengthening does not reduce the fixator index. Both techniques deliver good functional outcome after completion of treatment.

Insufficiency fracture of the distal femur during ilizarov treatment for congenital pseudarthrosis of the tibia

Background: Patients with congenital pseudarthrosis of the tibia (CPT) usually have significant limb length discrepancy that requires lengthening. In the presence of generalized osteopenia in CPT patients, insufficiency fractures of distal femur can occur during lengthening. No reports in the literature have described this complication and its management. Patients and Methods: We report three cases of CPT with distal femur insufficiency fracture during the treatment by Ilizarov frame. The fracture was minimally displaced. Under general anesthesia, traction and manipulation for fracture reduction were done. A cast was wrapped around the thigh, then three rods were added to the proximal ring to surround the thigh, and then another cast was used to connect the rods and the first cast. Results: In these three cases, healing of the fracture was achieved within 7 weeks without any complications, and the management of CPT continued as planned. Conclusion: The new technique provides a stable construct based on the already mounted frame; thus, healing of the fracture is achieved in a simple, easy, and cheap way with no documented complications.

The importance of the quality of power supply of treating fractures of the bones of the leg according to the ilizarov method

Annotation: The aim of the work was to analyze the impact of the deterioration in the quality of nutrition of the population during the economic crisis that occurred after 1990 on the treatment of bone fractures. The technique: In the period from 1970 to 2008, the impact of the deterioration in the nutrition quality of the population in particular of the Kurgan Region of Russia, expressed in preserving the caloric component due to an increase in the consumption of vegetables and bread and a decrease in the consumption of meat products by more than 35%, was analyzed. bone fragments in Ilizarov treatment in 1923 patients with closed diaphyseal fractures of the bones of the leg. Results: The increase in the periods of fixation of bone fragments began in 1976 among a group of socially most vulnerable patients of retirement age, then among people over 50, among students, and after 1986 it became apparent in groups of patients of working age and reached by 2000 38% with helical and 111% (p≤0,001) for comminuted fractures. Keywords: Fractures of shin bones, Ilizarov method, patient age, meat consumption

Dynamics of the speed of blood flow in the arteries of the bone regenerate of the limbs and in the brain arteries during functional tests and changes in the treatment mode

The results of a comparative study of the linear velocity of blood flow in the arteries of the bone regenerate in patients with fractures of the leg and shoulder bones and in the process of Ilizarov treatment are analyzed. Studies were conducted at rest and when performing a number of functional tests (orthostatic, muscular and with a dosed axial load on the limb). The effect of stress on the state of regional and cerebral blood flow in the conditions of inpatient treatment and after the transfer of patients to the outpatient treatment regimen was assessed.Material and methods. 41 adult patients with a closed diaphyseal fracture of the humerus and 57 patients with a fracture of the tibia bones during Ilizarov treatment were examined. The blood flow in the regenerate and along the middle cerebral arteries was determined by the method of ultrasonic doppler sonography.Results. With an increase in the functional load on the limb in patients with fractures of the humerus and tibial bones, respectively, up to 10 and 30 kgf, a temporary increase in the blood flow velocity in the arteries of the bone regenerate was observed. Large values of the load on the lower leg, accompanied by the acceleration of blood flow, indicate a better protection of the vascular bed of the tibial regenerate. The magnitude of the decrease in blood flow velocity in the regeneration of the lower leg arising from the behavior of an orthostatic test in the course of treating patients increased from 21 to 37 %, and indicated an increase in the reactivity of the vascular bed. In patients with injuries of the shoulder and lower leg, the transfer to the outpatient treatment regimen was accompanied by a statistically significant (p≤0.001) increase in the duration of the fixation period, respectively, to 82±3 and 94±7 days, a decrease in the increased blood flow velocity in the middle cerebral artery on the contralateral side by 43 % and 57 % and an increase in the magnitude of changes in cerebral blood flow rate during functional muscle test by 50 and 67 %.

Ankle Arthrodesis with Simultaneous Lengthening of the Lower Limb Using the Ilizarov Fixator.

Patients with advanced ankle arthrosis or joint deformities and co-existing lower limb shortening present a complex therapeutic problem. This paper presents the Ilizarov treatment as a comprehensive method of simultaneous ankle arthrodesis and equalisation of lower limb length in 18 patients. Eighteen patients with arthrosis, deformities or other conditions of the ankle joint and ipsila-teral lower limb shortening were treated with the Ilizarov method. The patients were assessed with the Foot and Ankle Outcomes Questionnaire before the treatment and one year after Ilizarov Fixator removal. The Ilizarov Fixator allows early weight-bearing of the operated limb, which is undoubtedly convenient for the patient. The mean treatment duration was 8.2 months (range 4-18 months). Lower limb lengthening was 4.1 cm on ave-rage (range 2.5-8.5 cm). Bone union was achieved in all cases. Radiological and clinical outcomes were satisfactory in all 18 cases. Prolonged regenerate calcification was recorded in 1 patient. Ten patients developed soft tissue pin-tract infec-tions and in 1 patient the Kirschner wire broke. According to the Foot and Ankle Outcomes Questionnaire, patients achiev-ed a notable improvement in daily functioning and quality of life. 1. The outcomes of a comprehensive treatment con-sisting of ankle arthrodesis and lower-leg leng-then-ing using the Ilizarov method confirm its effec-tiveness. 2. The Ilizarov Fixator allows early weight-bearing of the operated limb and evaluation at all treat-ment stages, creating an optimal biological envi-ron-ment for bone healing. 3. The patient recovers functionally to allow satis-fac-tory and pain-free functioning as well as re-sum-ption of daily responsibilities. The low inci-den-ce of complications adds to the attractiveness of the method.

��������������, ���������������, ���������� � ����������� ������� � ������� �������� ������� ������� �������������� �� ������ ���������

Introduction Achondroplasia is the most common skeletal dysplasia with limb shortening that can be symptomatically be treated with the Ilizarov method developed in the 20th century. Achondroplasia patients were shown to have medical and surgical possibilities for height increase with indications being controversial, and psychological and social implications to be considered. Objective The purpose of the study was to review our own data and reported findings on possibilities, results and complications of Ilizarov treatment of achondroplasia patients. Material and methods Outcomes of 750 achondroplasia patients treated at the Kurgan Ilizarov Center between 1976 and 2017 were reviewed. The patients’age ranged from 4 to 23 years. Results Long-term outcomes were followed up in all the cases. Radiography was used to assess limb elongation at follow-ups and MRI, MSCT and US were optional. Ten-to-fifteen-year follow-ups showed persisted length gain, early osteoarthritis of the hip and knee joints due to baseline articular changes, completely restructured femur and tibia at the distraction site, normal anatomy and area of muscle cross-section, normal structure and thickness of tibial muscles. Social and psychological profile appeared to improve. We have data from the patients who underwent limb lengthening 30 years ago. Many of them are employed, have family and children. Conclusion The findings suggest that achondroplasia patients, a comparatively small group of short statured people, have good reasons to feel empowered, get social support, make parents happy and contribute to the success of the country. The Ilizarov method has turned the idea of height increase into an accomplishment for benefits of doctors and patients being an achievement of orthopaedic world to address orthopaedic, social, psychological and philosophical issues.

Flap transplantation combined with Masquelet technique in the treatment of bone and soft defect

Objective To explore the effect of the use of flap transplantation combined with Masquelet tech- nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March, 2013 to March, 2016, 13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm, while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection: 3 cases of Staphylococcus aureus (including 1 MRSA) , 2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi- otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled. After 8- 12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic -impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat- ment exclusive of the case with MRSA. As the condition of the patient with MRSA relapse, we changed to onvention- al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique.All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4 -6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently. Key words: Masquelet technique; Perforator flap; Composite defect; Stage treatment

Measurement of wire deflection on loading may indicate union in Ilizarov constructs, an in vitro model

No entirely reliable method exists for assessing union during Ilizarov treatment. Premature removal results in potential treatment failure; hence, alternative methods warrant investigation. Wire deflection might provide an indication of fracture site deformation on weight bearing, indicating progress towards union. This study aimed to test a method for assessing wire deflection within an Ilizarov frame. (1) To assess the repeatability of our novel measurement method in measuring wire deflection within an Ilizarov frame in vitro. (2) To compare the amount of wire deflection in an unstable model with that in an intact bone model. (3) To assess accuracy of this method by comparing wire deflection measured with overall machine extension. Tests were performed on clinical grade-tensioned fine wire 4-ring Ilizarov constructs stabilising a simulated fracture, with and without an unstable defect. Models were sequentially loaded to 700 N using an Instron testing machine. A digital depth gauge attached to the superior ring measured relative wire displacement at the ring closest to the fracture. Tests were repeated 3 times. (1) Both unstable and stable bone models produced highly repeatable load deformation curves (R2 = 0.98 and 0.99). (2) In the unstable model, wires tensioned at 882 and 1274 N produced mean maximum deflections of 2.41 and 2.69 mm compared with 0.05 and 0.04 mm in the intact bone model (significant p < 0.0001). (3) Wire deflection and machine extension results were strongly correlated (r = 0.99). A measurable difference in wire deflection between stable and unstable situations exists using this method which appears accurate and repeatable, with clear correlation between displacement and load and displacement and machine extension. This approach might be clinically applicable, and further clinical testing is required.

Influence of age factor in the treatment of Ilizarov orthopedic diseases and injuries of the limbs.

Background: The review of the author's own research, containing the analysis of the influence of age factor on the growth and development of children, including during the surgical treatment of diseases and injuries of limbs by Ilizarov. Method: The data are based on a complex anthropometric and physiological examination of 3150 healthy newborns, 523 children in the postnatal period. In addition, 445 children with achondroplasia and congenital growth retardation of one of the limbs, 230 patients with closed helical fractures of the Shin bones during Ilizarov treatment, and 159 female patients aged 18 to 75 years with initial stages of gonarthrosis were examined. Results and Discussion: As the age of the sick children increases, periods of adaptive changes aimed at compensating for developmental delays are observed, in particular, the role of arterial hypertension in accelerating growth and microcirculation in tissues is shown. Conclusion: The relationship between cerebral hemodynamics and motor activity of patients was revealed. It was found that the reduction of motor activity in elderly people can be beneficial in the treatment of bone fractures.