Lower limbs lengthening over the intramedullary nail versus lengthening by Ilizarov technique

Introduction. Lengthening over the nail (LON) combines the advantages of external and internal fixations.The objective was to compare the effectiveness of the application, to assess the structure and frequency of complications in patients treated with lengthening by Ilizarov technique and lengthening over the nail.Methods and materials. We analyzed 55 LON cases and 64 cases lengthening by Ilizarov technique. The duration of the external fixation period, complications and quality of the patient life were compared.Results. The external fixation period in LON group was 4 times less than in the Ilizarov technique group. There were 25 complications (45.5 %) in LON group and 54 complications (84.4 %) in the Ilizarov technique group. Femur lengthening was associated with a greater number of complications in both groups. Pin infections were 2.5 times less frequently in the femur LON group. Knee contractures were only in Ilizarov technique group (11.4 %). Ankle joint contracture was noted with the same frequency during tibial lengthening in both groups. Disorders of the consolidation were 2 times more often in the femur LON group and 5 times more often in the tibial lengthening with Ilizarov technique. Premature fusion was observed only in the LON group. There were 2 times less fractures of the half-pins and wires in the LON group.Conclusions. A reduction of external fixation period in LON group correlates with the 2-fold decrease of complications and an increase of the treatment comfort. LON is promising for wider clinical applications.

Range of Motion Exercise Suppresses Myofibroblast Proliferation in the Joint Capsule in a Rat Joint Contracture Model

This study aimed to perform range of motion exercises on a rat knee joint contracture model and clarify changes in the joint range of motion and number of myofibroblasts in the joint capsule. Eighteen male Wistar rats were used and randomly divided into the following three groups: control, immobilized, and exercise. The right hindlimb knee joints of rats in the immobilized and exercise groups were immobilized, and the animals in the exercise group started the range of motion exercises the day after the joint immobilization. After the two weeks experimental period, the range of knee joint extension angle was measured, and the knee joint was collected. To observe the posterior joint capsule of the rat knee joint, hematoxylin and eosin staining and immunostaining were performed. Differences in knee extension restriction angles were significant between all groups, and differences in the number of alpha smooth muscle actin-positive cells were significant between the control and immobilization groups. These results indicate that joint immobilization leads to myofibroblast proliferation, whereas gentle exercise that does not maintain sufficient range of motion in the joint may inhibit myofibroblast proliferation.