Ilizarov Technique Research Articles

Neglected Monteggia Fractures in Children—A Retrospective Study

(1) Background: A Monteggia fracture is an infrequent injury in children. It can be missed during an initial consultation in 20–50% of patients. Chronic radial head dislocation may lead to several complications. Thus, surgical reconstruction of chronic Monteggia injuries is justified. The aim of this study is to analyze the single tertiary center experience in the treatment of neglected Monteggia fractures. (2) Methods: A retrospective study of patients treated for missed Monteggia fractures was conducted. Hospital records, operative charts, follow-up records and a set of X-rays were analyzed for each patient. Radiographic results were graded as good, moderate or poor. The functional status of elbows was estimated using the Mayo Elbow Performance Index. (3) Results: A total of 13 patients (8 boys and 5 girls) aged 4–12 years (mean 7.15) were treated during the study period. An angulation osteotomy of the ulna was performed in ten patients and a radial shortening osteotomy in three patients. A Bell–Tawse annular ligament reconstruction was performed in five patients, and a direct repair was performed in two patients. Eight patients had radiocapitellar trans-fixation. There were nine good radiographic results, three moderate and one poor. The functional result was excellent in nine patients, good in three and poor in one. (4) Conclusions: Our work has many limitations (only 13 patients and different types of operations), and conclusions should be drawn very carefully from such a small and diverse group. The surgical reconstruction of neglected Monteggia fractures in children should be attempted in all patients. Angulation and elongation osteotomies of the ulna are suitable for most patients. If there is a marked overgrowth of the radius, gradual ulnar lengthening and radial head reduction using the Ilizarov method may be a better option. Annular ligament reconstruction is not mandatory.

Management of segmental fractures of tibia by Ilizarov technique

Management of segmental fractures of tibia by Ilizarov technique

Bone Tissue Engineering in the Treatment of Bone Defects.

Bones play an important role in maintaining exercise and protecting organs. Bone defect, as a common orthopedic disease in clinics, can cause tremendous damage with long treatment cycles. Therefore, the treatment of bone defect remains as one of the main challenges in clinical practice. Today, with increased incidence of bone disease in the aging population, demand for bone repair material is high. At present, the method of clinical treatment for bone defects including non-invasive therapy and invasive therapy. Surgical treatment is the most effective way to treat bone defects, such as using bone grafts, Masquelet technique, Ilizarov technique etc. In recent years, the rapid development of tissue engineering technology provides a new treatment strategy for bone repair. This review paper introduces the current situation and challenges of clinical treatment of bone defect repair in detail. The advantages and disadvantages of bone tissue engineering scaffolds are comprehensively discussed from the aspect of material, preparation technology, and function of bone tissue engineering scaffolds. This paper also summarizes the 3D printing technology based on computer technology, aiming at designing personalized artificial scaffolds that can accurately fit bone defects.

Management of calcaneus fractures by a new "Below-the-ankle" ilizarov frame: A series of 10 cases.

The optimal management of intra-articular calcaneal fractures is still controversial. Open reduction and internal fixation are always associated with serious complications. Various alternative methods have been used with variable effects. This retrospective study aimed to analyze the clinical efficacy and safety of a new "below-the-ankle" Ilizarov frame in patients with calcaneal fractures caused by high-energy trauma. We retrospectively explored ten patients with calcaneal fractures, of which four, five, and one were Sanders type II, III, and IV, respectively. All fractures were caused by high-energy trauma and were followed up for an average period of 21 months (range: 9-29 months). Clinical outcomes were primarily assessed by radiological criteria, functional scores of the foot and ankle, rate of complications, and ankle range of movement. The Ilizarov frame was removed after an average period of 12 weeks (range: 11-15 weeks). Only two patients developed pin-tract infections, and none developed osteomyelitis, deep infections, neurovascular injury, malunion, and ankle arthrodesis. Based on the radiological assessment of the reduction of the subtalar joint and fracture fragments, all patients had excellent restored joint structure, with eight and two patients having good-to-excellent and fair ankle scores, respectively. The ranges of plantarflexion and dorsiflexion were 25°-43° and 8°-22°, respectively. The Ilizarov frame could be safe and effective for calcaneal fractures caused by high-energy trauma. This treatment protocol provides an effective approach to treat severe calcaneal fractures caused by high-energy events; however, long-term outcomes are still unknown.

Masquelet–Ilizarov technique for the management of bone loss post debridement of infected tibial nonunion

PurposeMasquelet and Ilizarov techniques have their advantages and shortcomings in the reconstruction of bone defects. The aim of this study was to evaluate the effectiveness of the combination of both techniques for the management of infected tibial nonunion to combine the advantages of both techniques with avoidance of shortcomings of both of them.Patients and methodsA prospective single-centre study was performed during the period from 2012 to 2019. Patients with the infected nonunion of the tibia with bone defect were included. Patients with pathological fractures or non-infected bone loss were excluded. Management protocol for all patients consisted of two stages. The first stage was Masquelet induced membrane technique and the second stage was Ilizarov bone transport. The results were assessed based on both objective (clinical and radiographic evaluation) and subjective criteria (limb function and patient satisfaction).ResultsThirty-two patients were included in this study. The mean size of the defect was 6 cm. Ilizarov bone transport was done through the induced membrane chamber in all cases with an average follow-up of 28 months. Successful reconstruction without recurrence of infection was achieved in 30 cases (94%). No other bone or soft tissue procedure was needed with satisfactory functional outcome in 27 out of 30 cases (90%). Three cases had unsatisfactory results due to leg length discrepancy, joint stiffness, and persistent pain.ConclusionsMasquelet–Ilizarov technique can be used for the management of infected nonunion tibia with high satisfactory results without the need for complex soft tissue procedures.

Reconstruction Using an Osteofasciocutaneous Fibula Free Flap for a Distal Tibial Defect in Refractory Chronic Osteomyelitis: A Case Report

The fibular free flap (FFF) is an option used for tibial defect reconstruction in post-traumatic chronic osteomyelitis (PCOM). However, as the tibia is a weight-bearing bone, there exists a risk of compression fracture risk after FFF. This complicates reconstructing distal tibial defects adjacent to the articular cartilage. We report a successful case of reconstruction using FFF for a bone defect adjacent to the distal tibial articular surface in refractory PCOM. The patient was a 73-year-old woman with refractory PCOM in the right distal tibia secondary to a tibial fracture from a traffic accident that occurred 28 years ago. After bone debridement, the tibial bone defect was 8 cm in length, and its distal margin was located 0.5 cm above the articular surface of the tibiotalar joint. Tibial bone and soft tissue defects were reconstructed using a contralateral FFF consisting of an 8-cm fibula bone and a 14×5-cm-sized skin paddle. After 2 months, an Ilizarov apparatus was applied and maintained for 3 months. After 6 months, she started weight-bearing. The follow-up period was 15 months. Imaging studies revealed bone block union. The patient displayed no difficulty in ambulation and had no additional infections or flap necrosis.

Safety and Effectiveness of Using Double-Ended Allograft in the Repair of Large Defects of Bi-Epiphyseal Bones in Experiment

BACKGROUND: The repair of large defects in the long bones remains one of the most pressing problems in traumatology and orthopedics.
 AIM: To evaluate the effectiveness and technological safety of the repair of large defects of the long bi-epiphyseal bones including the use of double-ended bone allografts to demarcate the defect cavity from the surrounding tissues and fixation of bone fragments using an external fixation device.
 MATERIALS AND METHODS: Experiments were conducted on 14 adult nonpedigree male and female dogs aged 12 years. The double-ended allograft was used to demarcate the formed defect of the tibial bones at 1.5 diameter length of the shinbone. The bone fragments were fixed with Ilizarov apparatus adapted for experiments on dogs. The maximal follow-up period was 2 years after the surgery. In the dynamics of the experiment, life-time observations, X-ray examination, and laboratory control were conducted. After euthanasia, the implantation zone was examined histologically.
 RESULTS: The visual signs of the restructure of the transplants were identified starting from day 35 after surgery. The bone regenerates in the defect zone completely formed within 3 months after the surgery. This permitted the removal of the external fixation apparatus in 3 months after the surgery. The restructuring of the newly formed part of the bone continued for 2 years after the operation. No significant changes in the laboratory parameters in the dynamics of the experiment were observed. No changes could be evaluated as negative phenomena. No serious unwanted events were recorded either.
 CONCLUSION: The proposed technique for the repair of large defects of long bi-epiphyseal bones demonstrated safety and sufficient effectiveness in the speed of regeneration of the defect and quality of the bones formed.

Treatment of Extension Knee Contractures with Ilizarov Apparatus Versus Orthopedic Hexapod Ortho-SUV Frame

Background. In case if it is impossible to eliminate the knee contracture by soft tissue release, external fixation is additionally used. Most often, the Ilizarov apparatus with a uniaxial hinge is used for this purpose. Orthopedic hexapods, unlike the Ilizarov frame, are able to reproduce the kinematics of movements in the knee joint.
 Aim of the study to evaluate the effectiveness of orthopedic hexapod for the treatment of patients with knee extension contractures in comparison with the Ilizarov apparatus.
 Methods. We analyzed 64 cases of combined treatment of extension knee contractures, which were divided into two groups. In the 1st group (31 patients) in addition to the soft tissue release, the orthopedic hexapod Ortho-SUV Frame (OSF) was used. In the 2nd group (33 patients) the Ilizarov apparatus with an uniaxial hinge was used. In a comparative analysis between groups, the number of flexion-extension cycles, the time required to complete them, and the time needed for complete knee range of motion (ROM) restoration were evaluated. Functional results were assessed using specialized scales-questionnaires KSS, Lysholm, LEFS in 2 days, 6 and 12 mon. after frame dismantling.
 Results. Comparing the total external fixation period, as well as the time needed for ROM restoration, no significant difference between groups was found (р0.05). When using the orthopedic hexapod, in comparison with the Ilizarov apparatus, fewer flexion-extension cycles were required. When assessing the amplitude of movements in 12 mon. in the first group, excellent results were found in 27 patients and good results in 4. In the second group, in all 33 patients good ROM was evaluated. On average, the ROM in the 1st group was 20 more than in the 2nd group. The knee function in 12 mon. was 16 points higher on the KSS in the 1st group, 5 points higher on the Lysholm scale, and 15 points higher on the LEFS scale than in the 2nd group. When analyzing the frequency of complications, no significant differences were found (р0.05).
 Conclusions. The results obtained indicate the effectiveness of the orthopedic hexapod in the treatment of patients with knee extension contractures.

Microbiological Profile of the Implantation Zone under Different Mechanical Compression of Percutaneous Implants: Experimental Study

Background. Infection of percutaneous implants in patients with limb amputation is the most common complication.
 Aim of the study evaluation of the microflora in the implantation zone depending on the mechanical compression of the implant in conditions of its additional external fixation.
 Methods. The study was performed on 36 male rabbits. The tibia of all the rabbits was sawn at the border of the upper and middle parts. The medullary canal was reamed and a percutaneous implant was placed in the tibial stump. The segment and the implant were fixed with an Ilizarov apparatus. An additional compression device was installed in 30 animals. We used 5 compression modes, accordingly, 6 experimental groups were formed, 6 animals in each: group 1 without compression, group 2 compression on the implant with force of 0.053 N/mm2, group 3 compression on the implant with force of 0.105 N/mm2, group 4 compression on the implant with force of 0.158 N/mm2, group 5 compression on the implant with force of 0.211 N/mm2, group 6 compression on the implant with force of 0.263 N/mm2. The restraint was removed 6 weeks after implantation for a total follow-up of 26 weeks. The microflora of the place where the implant enters the skin (the implant / skin interface) was investigated, the level of blood leukocytes and the level of C-reactive protein in blood serum were determined.
 Results. On days 9-10 after implantation, significant differences in the microbial landscape were found at the site of the exit of the metal implant in animals of different groups. The largest number of strains was found in animals of groups 1, 5 and 6, the smallest in groups 2 and 3. The most frequently detected strains: S. saprophyticus and Enterococcus spp. It was found that the greatest statistically significant increase in the level of CRP in the blood serum was observed in animals of group 6. The level of leukocytes in animals of all groups did not change statistically significantly relative to preoperative values. Animals with better osseointegration (groups 2 and 3 no cases of implant loss) showed a minimal number of growing strains.
 Conclusions. The microbiological profile of the implantation zone of percutaneous implants changes depending on the amount of mechanical compression. The optimal mode is 0.053-0.105 N/mm2.

Aggressive giant cell tumour of the talus: a rare case report and challenges faced during its management

<p>Giant cell tumour (GCT) of the bone is a locally aggressive benign tumour that commonly occurs in the epiphyseal ends of long bones. Its occurrence in the small bones of the foot like the talus is rare. In this case report we described a case of aggressive GCT of the talus (Campanacci grade 3) in a twenty-one years old male diagnosed by the presence of a well-defined osteolytic lesion seen involving the talar body with cortical breach and soft tissue extension confirmed to be a GCT by closed needle biopsy. The patient was managed surgically by excision of the tumour mass in-toto along with the talus followed by tibio-calcaneal fusion using free fibular strut graft and Ilizarov frame. At 3 months follow up no evidence of fusion was seen and therefore secondary augmentation with a cortico-cancellous graft from the iliac crest was done to aid fusion and Ilizarov fixator was removed 6 months after the surgery. The patient at one year follow up had shown no signs of recurrence of the tumour and has a pain free, stable fused tibiocalcaneal joint with a bipedal unassisted gait. Our case report found excision of talus combined with tibio-calcaneal fusion using free fibular strut graft along with cortico cancellous iliac bone graft to have a good outcome in terms of aiding tibio-calcaneal arthrodesis and thereby providing pain relief and providing a stable foot to the patient.</p>

Ilizarov Ankle Arthrodesis: A Simple Salvage Solution for Failed and Neglected Ankle Fractures.

Infection around theankle joint after fracture fixation, or septic arthritis with active discharging sinuses is often challenging to manage with conventional procedures of arthrodesis. The Ilizarov method of arthrodesis gives a better alternative for salvage in such cases. This was a retrospective study including 20 patients who were subjected to tibiotalar arthrodesis with Ilizarov method. The major pathologies included internal fixation of ankle fractures complicated by infection, posttraumatic infected ankle arthritis, and osteomyelitis. The patients were evaluated on the basis of Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. The aim of the surgery was to achieve plantigrade, stable, and painless foot with no signs of infection. A total of 20 patients were operated and reviewed at our institute. The study comprised of 15 male and 5 female patients with a mean age of 43.9years (range 33-55years). Out of 20 patients, 4 patients had complications of pin-tract infection and one had wire breakage of the forefoot ring. According to the ASAMI criteria, 17 patients had excellent bone scores and 18 patients had good functional scores. Union was achieved in all patients with resolution of infection and the mean limb length discrepancy was 1.92cm (range 1-2.5cm). The Ilizarov fixator for ankle arthrodesis provides an excellent way for strong bone fusion, infection eradication, early weight-bearing, and the added benefits of compression atthe arthrodesis site post-operatively.

Matched comparative study of trifocal bone transport versus induced membrane followed by trifocal bone transport in the treatment of segmental tibial defects caused by posttraumatic osteomyelitis

ObjectivesTo compare the efficacy and clinical outcomes of trifocal bone transport (TBT) versus induced membrane followed by trifocal bone transport (IM + TBT) in the treatment of tibial defects > 6 cm caused by posttraumatic osteomyelitis.MethodsA total of 69 eligible patients with tibial defects > 6 cm who were treated between January 2010 and January 2018 were retrospectively reviewed. Overall, 18 patients treated by IM + TBT and 18 treated by TBT were matched by propensity score analysis. The mean tibial defect after radical debridement was 6.97 ± 0.76 cm (range, 6.0 to 8.9 cm). The measurements, including demographic data, external fixation index (EFI), external fixation time (EFT), duration of docking union, bone and functional outcomes evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification during follow-up were recorded.ResultsAge, gender, injury mechanism, affected side, defect size, previous operation time, and follow-up time were not significantly different between the two groups (P > 0.05). The mean EFT was 293.8 ± 12.1 days in the TBT group vs. 287.5 ± 15.3 days in the IM + TBT group. The mean EFI was 36.02 ± 2.76 days/cm vs. 34.69 ± 2.83 days/cm, respectively. The mean duration of docking union was 210.7 ± 33.6 days vs. 179.7 ± 22.9 days, respectively. There was no significant difference in postoperative bone and functional results between the two groups. Delayed union or nonunion and soft tissue incarceration were significantly reduced in the IM + TBT group compared to those in the TBT group.ConclusionBoth TBT and IM + TBT achieved satisfactory postoperative bone and functional outcomes in patients with segmental tibial defects > 6 cm following posttraumatic osteomyelitis, while IM + TBT had a significantly lower incidence of postoperative complication in delayed union or nonunion and soft tissue incarceration, as well as faster docking union.

Impression metadiaphyseal fractures of the proximal end of the leg bones and our experience

Introduction: Impression fractures of the proximal end of the tibia occupy the main place in the appearance of defor-mation of the articular surfaces. The goal is to improve the results of treatment of impression fractures of the proximal end of the shin bones, based on clarifying the volume of impression defects and filling the residual cavities. Materials and methods: The study analyzed the data of 32 patients with impression fractures of the proximal end of the tibia. The volume of the formed cavities was determined according to the program for the MSCT study (per cubic centimeter measurements). V = length *thickness *width *0.52 = cubic cm, the method by which radiation diagnostics doctors work and display the volume of the cavity in cubic centimeters. V cavity volume = cavity length *cavity thickness *cavity width *0.52 = cc / cm (0.52 is the accepted average value, standard). Results: The results were also studied according to the accepted methodology compiled by the crite-ria for evaluating the results, and they turned out to be the following in terms of the totality of the treatment performed: in 25 patients it was from 62 to 76 points, i.e. good, in 7 patients they were satis-factory, i.e. averaged 58 points, there were no unsatisfactory result. Discussion: The combined use of PRP-therapy, bone grafting or bone impregnated with platelet mass proved to be compatible in osteosynthesis of bone fragments using the Ilizarov apparatus. Conclusion: The use of modern visualization diagnostic tools determines the volume and calculations for filling bone defects.

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

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

Use of the PRECICE nail for distraction osteogenesis after tumor resection

ABSTRACT Introduction Reconstructing long bone defects following intercalary tumor resection presents an exciting challenge with a greater range of surgical solutions than more typical situations requiring arthroplasty. Segmental bone transport (distraction osteogenesis) is the least utilized option for intercalary reconstruction; however, it arguably provides patients with the most desirable result. Distraction osteogenesis can be used in the management of multiple skeletal conditions including deformity (congenital or acquired), or in the presence of bone defects (by trauma or planned surgical excision). Lack of broader adoption of transport is likely due to the highly technical demands and common complications of utilizing fine-wire fixators via the Ilizarov method. More recently, internal lengthening nails such as the PRECICE nail have been employed to facilitate distraction osteogenesis without the added complexity of external fixation. Areas covered This review will examine the literature on the indications, design, and safety of the PRECICE nail (NuVasive) for intercalary reconstruction after tumor resection. Expert opinion Bone transport using the PRECICE nail represents a viable alternative to Ilizarov distraction and has the benefit of avoiding the complications of an external fixator. For large defects, the PRECICE nail can be supplemented with a locking plate for additional stability and maintenance of limb length.

Изменение антиоксидантно/прооксидантного равновесия у пациентов с приобретенными укорочениями костей голени на этапах удлинения по Илизарову

Introduction Optimization of the conditions of distraction osteogenesis using the method of G.A. Ilizarov remains an important challenge to ensure a reduction in the number of complications and an increase in the effectiveness of this technology. The aim of the study was to study the changes in the antioxidant/prooxidant balance in patients with acquired shortening of the lower leg bones at the stages of the Ilizarov lengthening procedure. Methods The antioxidant/prooxidant status was studied in 12 patients with shortening of one of the lower legs resulting from hematogenous osteomyelitis (group 1) and in 13 patients with post-traumatic shortening of one of the lower legs (group 2). The level of peroxidation products, the activity of superoxide dismutase and vitamins E and A in the blood of these patients were assessed in the dynamics of monofocal bone lengthening using the Ilizarov method. Results It was found that in patients with acquired shortening of the shin bones, regardless of the shortening etiology, during surgical lengthening, an increase in the level of peroxidation products in the blood was observed with a decrease in the level of vitamin E and an increase in superoxide dismutase activity. Discussion The data obtained, together with the current findings from fundamental research, allow us to note that the use of antioxidants (AOs) in patients undergoing segment length correction using the Ilizarov technology is possible from two positions. 1. The positive effect of AOs in terms of stimulation of distraction osteogenesis has been proven. 2. AOs have a systemic effect in the regulation of the recovery processes in the paraosseous tissues of the limb segment under lengthening. Conclusion Peroxidation is activated in the course of surgical lengthening of the lower leg bones in patients with acquired shortenings, regardless of the shortening etiology. The use of antioxidants in such patients can specifically inhibit peroxidation, thereby reducing the risk of provoking bone formation disorders.

Результаты воздействия электромагнитных волн терагерцового диапазона на ткани локтевого сустава при последствиях его повреждений

Introduction Among the ranges of electromagnetic waves used in clinical practice, electromagnetic waves of the terahertz range (EMWTHR) have promising applications. The experimental and clinical studies show that they are able to provide correction of the main pathophysiological disorders of a living organism such as hypoxia, hypercoagulation, and immunodeficiency. Purpose To study the effectiveness and safety of terahertz electromagnetic waves in the complex treatment of patients with the consequences of fractures of the humeral condyle Methods Clinical, radiological, physiological and laboratory studies were conducted in 30 patients with consequences of fractures of the humeral condyle (post-traumatic deformities, osteoarthritis of the elbow joint). Surgical treatment of patients with consequences of injuries of the elbow joint was classical and consisted of corrective osteotomies and osteosynthesis with the Ilizarov apparatus of the humerus and forearm. The main group consisted of 15 patients who underwent 10 sessions of EMWTHR exposure to the osteotomy zone, and 15 patients did not undergo physiotherapy. Results It was found that in patients of the main group, the average values of the intensity of pain and the deficit in the range of motion were significantly lower than the findings of the comparison group in the short term after treatment. The use of EMWTHR therapy led to differences in metabolic processes in the compared groups. There were no significant changes in radiological, physiological and laboratory parameters, as well as clinical signs that could be attributed to adverse events or complications associated with the use of EMWTHR. Conclusion The results of the comparative study allow us to recommend the EMWTHR therapy in the system of complex treatment of patients with the consequences of fractures of the humeral condyle and can be used as a means for local stimulation of reparative processes in target patients.

Role of proximal tibiofibular fixation in leg lengthening with the Ilizarov method in the achondroplastic patient.

The role of proximal tibiofibular joint (TFJ) transfixion during Ilizarov tibial lengthening is still debated in the literature. The aim of this study was to show that TFJ transfixion can be avoided with no impact on patient outcome. All achondroplastic patients undergoing tibia lengthening from 1999 to 2018 were included. Patients were divided in two groups: group A (11 patients) submitted to proximal TFJ transfixion and group B (22 patients) not submitted to TFJ transfixion. The results showed a statistically significant difference in proximal fibular migration (PFM) between the two groups of patients, with a mean PFM of 9.2 mm (range, 1-20 mm) and of 21 mm (range, 2.7-76 mm) in group A and in group B, respectively. We can state that PFM up to 41 mm in our series did not affect joint function and stability. There are no statistically significant differences in the other radiological parameters. Analysis of functional scores (Knee Society, Tegner-Lhysolm, Association for the Study and Application of Methods of Ilizarov) did not reveal significant differences between the groups. The scores of the Achondroplasia Personal Life Experience Scale were also similar in the two groups, demonstrating a good quality of life. There are no differences between the two groups in terms of clinical-functional outcome of the knee, radiographic results, and quality of life. Transfixion of proximal TFJ may not be necessary, but it is important to avoid premature consolidation of the fibular osteotomy.

Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature.

IntroductionThe presence of massive soft tissue loss in open tibial fractures is a challenging problem. Acute limb shortening is an alternative solution in situations where the use of flaps is limited.Materials and methodsA review was conducted following the Preferred Reported Items for Systematic Reviews and Meta-analyses checklist (PRISMA) guidelines. A complete search of PubMed, EMBASE and MEDLINE was undertaken. Twenty-four articles related to closure of soft tissue defects through acute limb shortening were identified and included in this review.ResultsAll report on restoration of limb function without or with minimal residual shortening. The authors note a decrease in the need for microsurgery. The external fixation devices used for deformity correction after closure of the soft tissue defect by acute shortening, angulation and rotation were the Ilizarov apparatus and circular fixator hexapods mainly.ConclusionAcute shortening is an alternative to microsurgical techniques. A ring external fixator is useful for restoring limb alignment after closing the soft tissue defect through creating a temporary deformity. The use of circular fixator hexapods can enable accurate correction of complex multicomponent deformities without the need to reassembly of individual correction units.How to cite this articlePlotnikovs K, Movcans J, Solomin L. Acute Shortening for Open Tibial Fractures with Bone and Soft Tissue Defects: Systematic Review of Literature. Strategies Trauma Limb Reconstr 2022;17(1):44–54.

Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study.

BackgroundThe purpose of this study is to evaluate the clinical effectiveness and determine the differences, if any, between the trifocal bone transport (TFT) technique and the bifocal bone transport (BFT) technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator.MethodsA total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from the period January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8 ± 12.4 years (range 19–65 years). Out of these, 32 patients were treated by the BFT technique, and the remaining 21 patients were managed by the TFT technique. The demographic data, operation duration (OD), docking time (DT), external fixation time (EFT), and external fixation index (EFI) were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by following the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical visit.ResultsAll patients achieved an infection-free union finally, and there was no significant difference between the two groups in terms of demographic data and both ASAMI bone and functional scores (p > 0.05). The mean defect size and OD in TFT (9.4 ± 1.5 cm, 161.9 ± 8.9 min) were larger than that in BFT (7.8 ± 1.8 cm, 122.5 ± 11.2 min) (p < 0.05). The mean DT, EFT, and EFI in TFT (65.9 ± 10.8 days, 328.0 ± 57.2 days, 34.8 ± 2.1 days/cm) were all less than those in BFT (96.8 ± 22.6 days, 474.5 ± 103.2 days, 60.8 ± 1.9 days/cm) (p < 0.05). Difficulties and complications were more prevalent in the BFT group than in the TFT group (p < 0.05).ConclusionBoth the trifocal and BFT techniques achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. The TFT technique can significantly decrease the DT, EFT, EFI, difficulties, and complications compared with the BFT technique.