Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

Abstract Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

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Efficacy Comparison of Trifocal Bone Transport Using Unilateral External Fixator for Femoral and Tibial Bone Defects Caused by Infection

10.21203/rs.3.rs-799041/v1 ◽

2021 ◽

Author(s):

Kai Liu ◽

Yanshi Liu ◽

Feiyu Cai ◽

Chenchen Fan ◽

Peng Ren ◽

...

Keyword(s):

External Fixation ◽

External Fixator ◽

Lower Limb ◽

Functional Outcomes ◽

Bone Defects ◽

Bone Transport ◽

Limb Bone ◽

The Mean ◽

Fair Poor

Abstract Background: This study aimed to evaluate the clinical and functional outcomes of patients with critical femoral and tibial bone defects treated by trifocal bone transport using the Ilizarov method.Methods: In a retrospective comparative study, 39 patients treated for lower limb bone non-union with bone loss measuring between 6 and 14 cm were included. Depending on the location of bone transport, the patients were divided into the femur group (n =18) and tibia groups (n =21). The demographics data, intraoperative records, and postoperative outcomes were documented and compared between the two groups. At the last follow-up, the bone and functional outcomes were evaluated according to the criterion given by the Association for the Study and Application of the Method of the Ilizarov (ASAMI) and postoperative complications evaluated by Paley classification.Results: The average follow-up time was 26.1 months (range 17–34 months) since the unilateral external fixators were removed. The mean size of the bone defect was 8.3 cm in the femur group, and 7.5 cm in the tibia group. All bone defects were reconstructed successfully. The mean time in external fixation in the femur group was 334.4 days, and in the tibia group was 344.6 days. The external fixation index (EFI) measured 55.9 days/cm in the femur group and 65 days/cm in the tibia group. A statistically significant difference of bone grade was found between the two groups (excellent/good/fair/poor, 3/11/3/1 vs 2/13/4/2, P<0.05), as well as the function grade in two groups (excellent/good/fair/poor/failure, 3/14/1/0 vs 4/13/3/1, P<0.05). According to the ASAMI classification, the clinical and functional results in the femur group were better than in the tibia group. The complication rate of the two groups was 94.4% vs 76.2% (femur vs tibia). One femur and five tibias were performed additional surgery because of delayed union and axial deviation. Conclusions: The trifocal bone transport using the unilateral external fixator is a reliable treatment in the management of post-traumatic and post-infection lower limb bone defects (>6cm). In the comparison of the tibia, the trifocal bone transport treatment period of the femur was shorter, the functional recovery was better and the risk of minor complications was higher.

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Limb lengthening in the treatment of posteromedial bowing of the tibia

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200111 ◽

2020 ◽

Vol 14 (5) ◽

pp. 480-487

Author(s):

J. Eric Gordon ◽

Perry L. Schoenecker ◽

Thomas R. Lewis ◽

Mark L. Miller

Keyword(s):

Skeletal Maturity ◽

Deformity Correction ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Single Institution ◽

Level Of Evidence ◽

Tibial Lengthening ◽

The Mean ◽

Ankle Valgus

Purpose Posteromedial bowing of the tibia is an uncommon but recognized congenital lower extremity deformity in children that can lead to limb length discrepancy (LLD) and residual angulatory deformity. The purpose of this study is to report a series of children at a single institution with posteromedial bowing treated by lengthening. Methods A retrospective review was carried out at our institution identifying 16 patients who were treated with limb lengthening for posteromedial bowing of the tibia and followed to skeletal maturity. Projected LLD was a mean of 7.7 cm (range 5.0 cm to 14.2 cm). Three patients were treated in a staged fashion with lengthening and deformity correction at age three to four years and subsequent definitive tibial lengthening. The remaining 13 patients were treated with limb lengthening approaching adolescence using circular external fixation. Results All patients were pain free and ambulated without a limp at final follow-up. The mean final LLD was 0.3 cm short. In spite of correction of distal tibial shaft valgus in 11 of the 16 patients, eight of the 16 (50%) required later correction of persistent, symptomatic ankle valgus by either hemiepiphyseodesis (seven patients) or osteotomy (one patient). Conclusions Children with posteromedial bowing of the tibial with projected LLD over 5cm can be effectively treated with lengthening. Patients with severe valgus of more than 30° of shaft valgus and difficulty ambulating at age three years can be successfully treated with a two-stage lengthening procedure. Attention should be paid in patients with posteromedial bowing to ankle valgus. Level of Evidence IV

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Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

Foot & Ankle International ◽

10.1177/1071100717735074 ◽

2017 ◽

Vol 39 (1) ◽

pp. 93-98 ◽

Cited By ~ 8

Author(s):

Hani El-Mowafi ◽

Mazen Abulsaad ◽

Yasser Kandil ◽

Ahmed El-Hawary ◽

Samer Ali

Keyword(s):

External Fixator ◽

Intramedullary Nail ◽

Case Series ◽

Poor Quality ◽

Charcot Arthropathy ◽

Hybrid Fixation ◽

Level Of Evidence ◽

Ankle Fusion ◽

The Mean

Background: Ankle fusion is difficult to achieve in the diabetic Charcot ankle Brodsky type 3a because of the poor quality of the bone and the inability to achieve a stable biomechanical construct. The aim of this study was to report the outcome of ankle fusion using a combination of an intramedullary nail and a circular external fixator in patients with diabetic Charcot arthropathy. Methods: We prospectively studied 24 patients with diabetic Charcot arthropathy of the ankle who were treated by fusion of the tibiotalar joint using a combined retrograde intramedullary nail and Ilizarov external fixator. Their mean age was 50.7 ± 6.9 (range, 43-62) years. The mean follow-up after surgery was 36.4 ± 5.8 (range, 24-98) months. Results: Twenty-two patients (92%) achieved clinical and radiographic solid bony fusion. No patients in this series needed amputation. All the patients were pain free, and the mean American Orthopaedic Foot & Ankle Society Score (AOFAS) improved significantly from 34.6 ± 6.8 to 66.4 ± 4.5 at the last follow-up. Two patients developed an ulcer over the heel due to a prominent nail. The ulcer healed after nail removal. Eight patients developed pin tract infection. Conclusion: We report a successful outcomes of ankle fusions using combined intramedullary nail locked only proximally and ring external fixator (hybrid fixation) in patients with diabetic Charcot arthropathy. Level of Evidence: Level IV, case series.

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TREATMENT OF ROLANDO FRACTURE BY CAPSULOLIGAMENTOTAXIS USING MINI EXTERNAL FIXATOR: A REPORT OF 16 CASES

Hand Surgery ◽

10.1142/s0218810413500147 ◽

2013 ◽

Vol 18 (01) ◽

pp. 73-78 ◽

Cited By ~ 4

Author(s):

Shirzad Houshian ◽

Shan Shan Jing

Keyword(s):

External Fixation ◽

External Fixator ◽

Kirschner Wire ◽

Case Series ◽

Pinch Strength ◽

Fracture Union ◽

Minimal Loss ◽

The Mean ◽

Fixation System

Treatment of Rolando fractures remains a challenge for hand surgeons. We present a case series of 16 comminuted Rolando type fractures treated by controlled capsuloligamentous distraction (and over distraction by 2 mm) using the Pennig mini-external fixation system. Additional Kirschner wire(s) were used to maintain fracture reduction and stability. Average time of injury to surgery time was five days. Mean age of patients was 26 years. The mean follow-up was 20 months. Excellent fracture union was achieved in all cases. All except two patients were pain free at the final consultation. The mean grip and pinch strength of the affected thumb was 96% and 93%, respectively, of the unaffected thumb with a minimal loss of movements. This technique is simple and effective. It enables immediate mobilisation of the unaffected joints and prevents stiffness. We recommend this distraction technique for the treatment of significantly comminuted Rolando type fractures.

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Bone Lengthening with a Motorized Intramedullary Nail in 34 Patients with Posttraumatic Limb Length Discrepancies

Journal of Clinical Medicine ◽

10.3390/jcm10112393 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2393

Author(s):

Maxime Teulières ◽

Tristan Langlais ◽

Jérôme Sales de de Gauzy ◽

Jan Duedal Rölfing ◽

Franck Accadbled

Keyword(s):

Weight Bearing ◽

Limb Lengthening ◽

Lower Limbs ◽

Limb Length ◽

Bone Lengthening ◽

Important Conclusion ◽

Pull Out ◽

Significant Difference ◽

The Mean

The Fitbone® motorized nail system has been used to correct limb length discrepancies (LLD) for several years. This study focuses on its application in posttraumatic limb lengthening surgery, its outcome and challenges. Materials and methods: A prospective, single center study was conducted between 2010 and 2019 in patients treated with motorized lengthening nails. The inclusion criteria were symptomatic LLD of 20 mm or more. An imaging analysis was done using TraumaCad® software (Brainlab AG, Munich, Germany) to compare frontal alignment angles and limb length discrepancy (LLD) on preoperative and latest follow-up radiographs of the lower limbs. Results: Thirty-four patients were included with a mean age of 28.8 ± 9.7 years, a mean follow-up of 27.8 ± 13 months and a mean hospital stay of 4.4 ± 1.7 days. The mean LLD was 44 ± 18 mm in 29 femoral and 32 ± 8 mm in 4 tibial cases, which was reduced to less than 10 mm in 25/34 (74%) patients. The mean healing index was 84.6 ± 62.5 days/cm for femurs and 92 ± 38.6 days/cm for tibias. The mean time to resume full weight-bearing without walking aids was 226 days ± 133. There was no significant difference between preoperative and final follow-up alignment angles and range of motion. The mechanical lateral distal femoral angle (mLDFA) was corrected in the subgroup of 10 LLD patients with varus deformity of the femur (preoperative 95.7° (±5.0) vs. postoperative 91.5° (±3.4), p = 0.008). According to Paley’s classification, there were 14 problems, 10 obstacles and 2 complications. Discussion: Six instances of locking screw pull out, often requiring reoperation, raise the question of whether a more systematic use of blocking screws that provide greater stability might be indicated. Lack of compliance can lead to poor outcomes, patient selection in posttraumatic LLD patients is therefore important. Conclusion: Limb lengthening with a motorized lengthening nail for posttraumatic LLD is a relatively safe and reliable procedure. Full patient compliance is crucial. In-depth knowledge of lengthening and deformity correction techniques is essential to prevent and manage complications.

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Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽

10.1024/1023-9332.8.6.255 ◽

2002 ◽

Vol 8 (6) ◽

pp. 255-258 ◽

Cited By ~ 28

Author(s):

Perruchoud ◽

Vuilleumier ◽

Givel

Keyword(s):

Hospital Stay ◽

Pilonidal Sinus ◽

Primary Closure ◽

Average Length ◽

Length Of Hospital Stay ◽

Healing Time ◽

Incision And Drainage ◽

The Mean ◽

Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

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Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

Journal of Neurosurgery ◽

10.3171/2019.5.jns19227 ◽

2020 ◽

Vol 133 (3) ◽

pp. 830-838 ◽

Cited By ~ 1

Author(s):

Andrea Franzini ◽

Giuseppe Messina ◽

Vincenzo Levi ◽

Antonio D’Ammando ◽

Roberto Cordella ◽

...

Keyword(s):

Neuropathic Pain ◽

Lower Limb ◽

Internal Capsule ◽

Posterior Limb ◽

Vas Score ◽

The Mean ◽

Deep Brain ◽

Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

10.2196/preprints.20711 ◽

2020 ◽

Author(s):

Hongfeng Sheng ◽

Weixing Xu ◽

Bin Xu ◽

Hongpu Song ◽

Di Lu ◽

...

Keyword(s):

Retrospective Study ◽

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Theoretical Basis ◽

New Technology ◽

Three Dimensional ◽

Computer Assisted ◽

Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

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Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03896-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yanshi Liu ◽

Maimaiaili Yushan ◽

Zhenhui Liu ◽

Jialin Liu ◽

Chuang Ma ◽

...

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Bone Defects ◽

Bone Transport ◽

Segmental Bone Transport ◽

The Mean ◽

Forearm Bone ◽

Segmental Bone ◽

Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

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