Ankle arthrodesis using a retrograde intramedullary rod with fins for highly destructive joints in elderly patients with rheumatoid arthritis: A report of two cases

Here we present two cases in older adult patients with highly destructive changes in ankle joints (Larsen Grade IV) and who underwent retrograde intramedullary nail fixation with fins. In both patients, bony union was achieved, full weight-bearing was attained 3 months after surgery and good functional outcome was acquired.

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

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.

The association between fibular status and frontal plane tibial alignment post-union in congenital pseudarthrosis of the tibia

Purpose Controversy exists regarding fibular status related to tibial alignment after congenital pseudarthrosis of the tibia (CPT) achieves union. We aimed to determine whether fibular status affected frontal plane tibial alignment post-CPT union. Methods Between January 2010 and December 2013, we followed 36 patients treated using a combined surgical technique (mean 6.6 years (2.2 to 9.4)). Outcome measures comprised medial proximal tibial angle, tibial diaphyseal angulation, lateral distal tibial angle (LDTA), relative intramedullary rod length and relative fibula length discrepancy. Results The frequency of proximal tibial valgus deformity and ankle valgus deformity were significantly lower in the fibular integrity group than in the fibular un-integrity group (proximal tibial valgus deformity: 2/17 versus 11/19; p = 0.006; ankle valgus deformity: 10/17 versus 18/19; p = 0.016). The mean LDTA was notably higher in the fibular integrity group than in the fibular un-integrity group (81.2° (sd 6.7°) versus 71.3° (sd 6.6°); p < 0.001). A statistically significant difference was observed in relative fibula length discrepancy between patients with fibular integrity (0.06 (0 to 0.11); Malhotra grade 0, n = 6; Malhotra grade I, n = 11) and those without (0.24 (0.01 to 0.36); Malhotra grade 2, n = 2; Malhotra grade 3, n = 17; p < 0.001). Ankle valgus deformity had a significant positive correlation with proximal tibial valgus deformity (r = 0.402; p = 0.015). Patients with an intact and normal length fibula had a lower frequency of ankle valgus deformity than those with an intact but shortening fibula (1/6 versus 9/11; p = 0.035). Conclusion Shortening or pseudarthrosis of the fibula was associated with ankle valgus and proximal tibial valgus deformities post-CPT union. Level of evidence III

Intraoperative Hardware Failure of the Fassier–Duval Rescue System in a Pediatric Patient with Osteogenesis Imperfecta

The use of telescopic intramedullary rods for the treatment of lower extremity deformity in children with osteogenesis imperfecta has been well described. The reinforcement of these weakened weightbearing bones with intramedullary devices leads to improvements in mobility that progress into adulthood. Although the current telescopic intramedullary rod systems are an upgrade from earlier systems, they are still associated with high rates of reoperation and complication. We describe a unique complication encountered during a revision which involved the male retriever system for the Fassier–Duval rod (FDR) (Pega Medical, Quebec, CA) experienced intraoperatively. To our knowledge, this mechanism of failure has not been previously described in the literature.

Stimulation of Distraction Osteogenesis in Limb Lengthening: Our Concept

Background. Currently, limb lengthening is a widespread operation used in clinical and cosmetic practice. However, in the process of implementing this technology, its main drawbacks were revealed: the duration of treatment and the slowing down of the process of osteogenesis in the elongation zone. Rapid distraction in the external fixator or with an intramedullary rod can lead to a slowdown in osteogenesis and soft tissue complications, including neuropathy and soft tissue eruption.The aim — to develop a present its own concept of stimulating distraction osteogenesis in limb elongation, based on many years of clinical experience.Materials and Methods. This study is based on the long-term experience of the Ilizarov Center in limb lengthening (using data from clinical and experimental studies performed in the institution: more than 200 animals and 8000 patients), as well as literature data.Results. The introduction of the considered methods of stimulation of osteogenesis made it possible to significantly reduce the treatment time of patients and thereby reduce the number of possible complications characteristic of transosseous osteosynthesis. Systemic diseases, congenital malformation of the segment can negatively affect the quality of the new bone.Conclusions. The use of methods of stimulation of osteogenesis allows to reduce treatment time and increase osteogenesis when limb lengthening, which allows, if necessary, to provide re-lengthening of the segment without increasing treatment time.

A Flexible Intramedullary Guide Can Reduce the Anteroposterior Oversizing of Femoral Components Used in Total Knee Arthroplasty in Patients with Osteoarthritis and Severe Distal Femoral Sagittal Bowing

Traditionally, a rigid intramedullary rod has been used as the reference guide for femoral cutting in total knee arthroplasty (TKA). However, correct positioning of this rigid rod is difficult, especially in the knees with severe distal femoral sagittal bowing. A flexible intramedullary rod has been developed to address this problem. This study was performed to compare the sagittal alignment and clinical outcomes of TKAs performed with flexible and rigid femoral intramedullary guides. Thirty-eight knees that underwent primary TKAs with flexible intramedullary rods as femoral cutting guides were matched according to patient height and sex with 38 knees that underwent TKAs using conventional rigid rods. Clinical outcomes, including the range of motion and functional scores, and radiological variables, including the distal femoral bowing angle (DFBA), femoral component flexion angle (FFA), and mediolateral overhang and anteroposterior (AP) oversizing of femoral components, were evaluated. Clinical and radiological outcomes did not differ significantly between the flexible rod and conventional rigid rod groups. A subgroup analysis of knees with severe distal femoral sagittal bowing (DFBA >4 degrees) showed that the FFA was significantly larger in the flexible rod group than in the rigid rod group, with an average difference of 3 degrees (5.2 ± 2.4 vs. 2.2 ± 1.6 degrees, respectively, p = 0.022). In addition, the incidence of AP oversizing of femoral components was lower in the flexible rod group than in the rigid rod group (11.1 vs. 60.0%, respectively, p = 0.027). Relative to TKA with a rigid rod, TKA performed with a flexible femoral intramedullary guide resulted in more flexed sagittal alignment of femoral components in patients with severe distal femoral sagittal bowing. This greater flexion of the femoral component resulted in less AP oversizing. However, the use of a flexible rod had no impact on short-term clinical outcomes.

auto-dynamic intramedullary osteosynthesis for femur fractures and consequences of injuries

The assessment of clinical testing results of the new intramedullary rod which design features neutralize the disadvantages of conventional blocking devices.

Flexible versus standard intramedullary rod in posterior stabilized primary total knee arthroplasty: protocol for a randomized controlled trial

Background In total knee arthroplasty (TKA) a flexible intramedullary rod can be used to account for sagittal bowing of the distal femur. Although patients report better post-operative functional outcome when the flexible rod was used, it is unknown how the use of the flexible rod affects the placement of the femoral TKA component, and how this relates to activities of daily living. It is expected that the use of the flexible rod will result in a more flexed femoral component, a larger patellar tendon moment arm, and consequently in better functional outcome. The goal of this study is to compare the flexible rod to the standard intramedullary rod in primary TKA in terms of fit of the TKA, functional outcome, and sizing of the femoral component. Methods A single-blind randomized controlled trial with two groups (flexible vs standard rod), with patients blinded for group allocation, and 2 years post-operative follow-up. The fit of the TKA is quantified by two parameters: (1) the flexion angle of the TKA in the sagittal plane and (2) the sagittal profile of the distal femur compared between the pre-operative bone and the TKA. Both parameters are calculated in 3D volume images obtained using fluoroscopy. Functional outcome will be measured using (1) the timed Get-up and Go test (2), the stair climbing test (3), knee power output, and (4) patient and clinician reported outcomes. Different parameters will be measured during the TKA procedure to account for the invisibility of cartilage in the 3D volumes and to study if the amount of bone removed during the procedure is affected by group allocation. Discussion The sagittal fit of TKA is not a standardized outcome measure. We discuss our choice of parameters to define the sagittal fit (i.e., flexion angle and sagittal profile), our choice for the parameters we measure during the TKA procedure to account for the lack of cartilage thickness in fluoroscopy, and our choice for the parameters to study if the amount of bone removed during the procedure is affected by group allocation. Lastly, we discuss the merits of this planned trial. Trial registration Netherlands Trial Register, 4888, registered 30 March 2015. https://www.trialregister.nl/trial/4888