scholarly journals Combination of intramedullary rod, wrapping bone grafting and Ilizarov’s fixator for the treatment of Crawford type IV congenital pseudarthrosis of the tibia: mid-term follow up of 56 cases

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Guang-hui Zhu ◽  
Hai-bo Mei ◽  
Rong-guo He ◽  
Yao-xi Liu ◽  
Kun Liu ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Congenital Pseudarthrosis ◽  
Type Iv ◽  
Intramedullary Rod

scholarly journals Efficacy of the “Eiffel tower” double titanium elastic nailing in combined management of congenital pseudarthrosis of the tibia: preliminary outcomes of 17 cases with review of literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaoyu Wang ◽  
Li Shi ◽  
Rui Zhang ◽  
Wenbo Wang ◽  
Feng Wang ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Bone Union ◽  
Length Discrepancy ◽  
Congenital Pseudarthrosis ◽  
The Mean ◽  
Primary Union ◽  
Ilizarov Fixation

Abstract Background Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed. Methods Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the “Eiffel Tower” double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months. Results The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6–141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01). Conclusions The “Eiffel Tower” double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery. Level of evidence Level IV.

scholarly journals Application of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yaoxi Liu ◽  
Ge Yang ◽  
Guanghui Zhu ◽  
Qian Tan ◽  
Jiangyan Wu ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intramedullary Fixation ◽  
Limb Length ◽  
Combined Surgery ◽  
Congenital Pseudarthrosis ◽  
Intramedullary Rod ◽  
Ankle Valgus ◽  
Primary Union ◽  
Tibial Valgus

Abstract Background The current surgical treatment of choice is the combination surgical technique, involving tibial intramedullary fixation to maintain the mechanical axis and mechanical stability of tibial pseudarthrosis. In traditional combined surgery, the Williams rod is often used. Long-term intramedullary fixation of the foot and ankle will affect the ankle joint function of children. The intramedullary rod is relatively shorter due to the growth of the distal tibia. In addition, there are some complications such as epiphyseal bone bridge and high-arched foot. The use of a telescopic intramedullary rod may avoid these complications. Purposes To investigate the initial effect of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children. Methods A retrospective study including 15 patients with Crawford type IV CPT who were treated using a combined surgical technique and the telescopic rod from January 2017 to May 2018. The average age at the time of surgery was 43.3 months (16–126 months). Of the 15 patients, 7 had proximal tibia dysplasia and 12 exhibited neurofibromatosis type 1. The combined surgical technique using the telescopic rod included the excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov’s fixator, tibia-fibular cross union, and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus, and limb length discrepancy (LLD) in patients were investigated. Results All patients achieved primary union with an average follow-up time of 37.3 months (26–42 months). The mean primary union time was 4.5 months (4.0–5.6 months). Nine cases showed LLD (60%), with an average limb length of 1.1 cm (0.5–2.0 cm). Ankle valgus, proximal tibial valgus, telescopic rod displacement, and epiphyseal plate tethering occurred in 1 case (6.6%) (18°), 3 cases (20%) (10°, 5°, and 6°, respectively), 6 cases (40%), and 2 cases (13%), respectively. There were no refractures during the follow-up periods. Conclusion Although there are complications such as intramedullary rod displacement while using the telescopic rod in a combined surgery, the primary healing rate of congenital pseudarthrosis of the tibia in children is high.

scholarly journals Prebent Titanium Elastic Nailing, Ilizarov Fixation and Bone Grafting for Treating Congenital Pseudarthrosis of the Tibia: Preliminary Outcomes of 15 Cases

2020 ◽  
Author(s):  
Xiaoyu Wang ◽  
Li Shi ◽  
Rui Zhang ◽  
Wenbo Wang ◽  
Feng Wang ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Limb Length Discrepancy ◽  
Bone Union ◽  
Length Discrepancy ◽  
Congenital Pseudarthrosis ◽  
Elastic Nails ◽  
The Mean ◽  
Primary Union ◽  
Ilizarov Fixation

Abstract Background: To report the preliminary outcome of treating congenital pseudarthrosis of the tibia (CPT) by using titanium elastic nails (TENs) combined with other surgical procedures including pseudarthrosis resection, autogenous iliac bone grafting and Ilizarov technique, with a mean follow-up time of 4.5 (3.3 to 6.3) years.Methods: 15 patients with CPT treated by combined surgery including pseudarthrosis resection, titanium elastic nails (TENs) technique, autogenous iliac bone grafting and Ilizarov fixation between 2013 and 2017 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle movement were used to evaluate ankle function. Results: The mean age at index surgery was 110 (24 to 285) months. 13 (86.7 %) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 4.8 (3 to 7) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (13.3%) and 5 (33.3%) patients developed pin infection. The mean limb length discrepancy at the final follow up was 14.6 (4–41) mm. 3 patients (20 %) had ankle valgus deformities with a mean LDTA of 74.3° (range, 68 to 81°). The average AOFAS score improved from 40.3 (27 to 51) pre-operatively to 76.1 (63 to 87) post-operatively. For the patients who received proximal tibial lengthening, the average healing index (HI) was 65.1 (57.3 to 77.8) days/cm.Conclusions: Titanium elastic nails (TENs) technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphyseal and early functional recovery.

scholarly journals Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Tarun Goyal ◽  
Souvik Paul ◽  
Sushovan Banerjee ◽  
Lakshmana Das
Keyword(s):  
Cruciate Ligament ◽  
Lysholm Score ◽  
Activity Level ◽  
Type Ii ◽  
Hamstring Tendons ◽  
Peroneus Longus ◽  
Type Iii ◽  
Type Iv ◽  
Ikdc Score

Abstract Purpose This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts. Methods All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. Results A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Conclusion Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes. Level of evidence Level IV, case series.

MRI analysis and surgical treatment of Wassel Type IV duplicated thumbs

2021 ◽  
pp. 175319342098321
Author(s):  
Anyuan Wang ◽  
Jian Ding ◽  
Long Wang ◽  
Tinggang Chu ◽  
Zhipeng Wu ◽  
...  
Keyword(s):  
Type A ◽  
Surgical Reconstruction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Type D ◽  
Type Iv ◽  
Secondary Operations ◽  
Type C

We present the MRI findings for 39 Wassel Type IV duplicated thumbs in 38 patients. We found that MRI revealed the morphology of the cartilaginous connection between the thumb anlages and the location of the deviation corresponding to the classification of Horii, which allowed precise preoperative planning of corrective osteotomies. All 39 thumbs were available for follow-up after surgical reconstruction at a mean of 29 months (range 25 to 39). Four out of nine Horii Type A cases and all 12 Type B, as well as the six Type C and the six Type D cases, achieved good results according to the Tada scoring system. Five Type A cases achieved fair results with residual stiffness of the interphalangeal joint. No secondary operations were needed. We conclude that MRI proved useful in subclassifying Wassel Type IV duplicated thumbs and may aid in planning the osteotomies needed for their reconstruction. Level of evidence: IV

scholarly journals Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

2020 ◽  
Author(s):  
Yilun Yao ◽  
Xiaoshu Wu ◽  
Lei Wu ◽  
Lei Yang ◽  
Chunzhi Jiang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Clinical Analysis ◽  
Tibial Plateau Fractures ◽  
Artery Injury ◽  
Type Iv ◽  
Schatzker Type ◽  
Schatzker Classification ◽  
Tibial Head ◽  
Type V

Abstract Background To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The outcome was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up, except for the cases undergoing amputation. The outcome was satisfied in 14 cases, unsatisfied in 5 cases.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.

scholarly journals An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

2021 ◽  
Vol 9 ◽  
pp. 205031212110409
Author(s):  
Ali Varol ◽  
Yunus Oc ◽  
Bekir Eray Kilinc
Keyword(s):  
Bone Grafting ◽  
Plate Osteosynthesis ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Type Iii ◽  
Heel Height ◽  
The Mean ◽  
American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

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