Статьи журнала - Гений ортопедии
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Статья научная
Introduction Management of pediatric long bones fractures is a complex and rapidly evolving field. Traditionally, casting and conservative techniques played a key-role in the management of fractures in skeletally immature patients. However, the surgical approach has evolved steadily over the past four decades or so and increasing evidence has been published supporting the advantages of fixation techniques over conservative methods. The purpose of this narrative review is to outline how innovations in orthopedic surgery have changed the rationale of treating long bones fractures in children and adolescents with focus on surgical techniques, particularly elastic stable intramedullary nailing (ESIN). Material and methods We aimed to describe the main trends in pediatric long bones fractures management and to identify its specificities and difficulties as well as the best standard of care. Results The introduction of ESIN has profoundly influenced the management of pediatric upper and lower extremity fractures. Overall, in comparison to conservative techniques, advantages of ESIN include minimally invasiveness, short hospital stay, primary bone union, early mobilization and progressive weight bearing, and good outcome with low complication rate. Moreover, the flexible nail can be used as a closed reduction tool itself. Conclusions Irrespective of the technique performed, the key-concepts remain 1) the proper understanding of the injury to treat; 2) the identification the main characteristics of the patient; 3) the pros and cons of each technique; and 4) the potential complications.
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The analysis report of surgical treatment of limb deformity and disability: 35,075 cases
Статья научная
Objective To investigate the incidence characteristics and corrective strategies of various limb deformities treated by Qinsihe orthopaedic team in the past 40 years, so as to provide a large sample for understanding the causes, types and treatment methods of limb deformity and disability in China. Method A total of 35,075 cases were treated by Qinsihe orthopaedic team from May 1978 to December 2018. The age, gender, deformity characteristics, etiological and pathological composition, regional distribution and surgical methods of the patients were statistically analyzed. Results There were 20,458 males and 14,617 females. The age was 1 year to 82 years old, average 20.5 years. The majority of subjects were from 11 to 25 years old or 19,363 cases (63 %). There were 33,259 cases (94.82 %) of interventions on lower extremity. The geographical distribution of patients covers all the provinces, municipalities directly under the central government, autonomous regions in China and 12 foreign countries. There were 202 etiologies involving neurological, heredity, metabolism, traumatic sequelae, congenital, vascular, lymphoid, skin, endocrine, iatrogenic and so on. The top six deformities were due to poliomyelitis sequelae, cerebral palsy, traumatic sequelae, spondylolysis sequelae, genu varus&valgus, congenital talipes equinovarus. There were 280 kinds of surgical methods, the majority of which were Achilles tendon lengthening, supracondylar osteotomy, subtalar joint arthrodesis, tibiofibular osteotomy, metatarsal aponeurosis and Achilles tendon replacement of peroneal longus muscle, etc. 8,702 cases were treated by orthopedic surgery combined with external fixation, including the Ilizarov fixator in 3,696 cases and hybrid fixator in 5,006 cases. Conclusion Qinsihe orthopaedic database with a history of 40 years is the largest one of limb deformity and disability in China. It reflects the etiology, type, population characteristics, surgical methods and strategy of limb disability and deformity, which can be treated by orthopaedic surgery. The data is a great treasure for orthopaedics and disability medicine in China and worldwide, and its important academic value and historical significance need to be further excavated and deep studied in future.
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Статья научная
The understanding of Ilizarov’s biological principles is guiding clinical treatment. Ilizarov’s First Principle of Biology, Distraction Histogenesis, is a fundamental guidance for bone lengthening. The “Harbin Phenomenon” is an extension of “Transformation Histogenesis”, which was discovered by bone transport for bone defects treatment. It describes the transformation and regeneration capacities of scar tissues under slow and rhythmic distraction, and this transformation satisfies the morphological and functional requirements. This principle is a supplement to the first principle, and could be Ilizarov’s Second Principle of Biology. Together they form the basis to guide clinical bone transport treatment.
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Статья научная
Ilizarov’s tibial transverse transport (TTT) technique can promote vascular regeneration. It has been used in the treatment of a variety of lower limb ischemic diseases, such as thromboangiitis obliterans, diabetic foot ulcers, etc. Recently, several novel therapeutic effects have been discovered based on TTT treatment. For instance, in the treatment of thromboangiitis obliterans, an “Open Skylight Effect” was well defined in which the symptom of resting pain disappeared following tibial cortex osteotomy (Long Qu, 2001). During the treatment of bilateral diabetic foot gangrene, patients that received TTT treatment on the one side of the lower limb were observed to have a simultaneous healing of ulcers on both sides, which was termed as the “Summon Effect” (Qikai Hua, 2017). In 2019, we characterized the above discoveries as the “Twin Open Skylight and Summon Effects”. These findings will inspire more potential clinical applications of TTT technique.
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Статья научная
Introduction Nonunion or delayed union is a known postoperative complication in long bone fractures. Substance abuse may impair bone healing. In this paper, we investigated the effect of narcotics on healing time in femoral shaft transverse fractures and the effect of substance abuse and smoking on postoperative healing time. Material and methods This cohort study was conducted at the Orthopedic Clinic of Poursina Hospital, Rasht from 2017-2019. Patients with transverse fractures of the femoral shaft who underwent intramedullary rod insertion were followed for 6 months. Bone healing time based on substance abuse and smoking status was evaluated. Results There was a significant association between various groups (categorized based on cigarette smoking and using drugs) in terms of bone healing status (P = ы0.006). There was a statistically significant difference in healing status among the control group, smoker group, and addict and smoker group (P = 0.034 and P = 0.004, respectively). However, there was no statistically significant difference in healing status between control and addicts group (P = 0.517). Conclusions Treatment efficiency and performance in addicted and smoker patients are more unfavorable and hence which, in turn, requires more follow-up periods; therapies such as bone grafting and other methods are more frequently considered in addicted and smoker patients in case of lack of healing reaction. Therefore, prevention plans in high-risk groups can play a significant role in primary identification, treatment, and reducing the complications of fractures.
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Статья научная
Purpose To explore the value of ultrasound in the treatment of bone union at the docking site by accordion technique. Methods Sixteen patients were recruited. The accordion operation was performed at the docking site after bone transport. The specific operation process was compression, suspension of adjustment, distraction, retraction. Ultrasound was used to monitor the hematoma, blood flow and callus in and around the docking site at each stage. Results (1) At the compression, there were 14 cases with hematoma and 2 cases without hematoma. (2) The size of hematoma was negatively correlated with the bone healing time of the docking site and the blood flow resistance index. (3) The Adler grading of blood flow gradually increased before the retraction, and then gradually decreased. But the degree of callus mineralization continued to rise. Conclusion (1) Ultrasound can dynamically monitor the change trend of hematoma, blood flow and new callus at the docking site during accordion operation, so as to predict the tendency of bone healing at the docking site. (2) This study can preliminarily demonstrate that the compression stress applied in accordion technique can promote the bone healing at the docking site.
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Статья научная
Background Infected nonunion of the distal femur is a very difficult entity to treat; it grossly affects daily living and adds economic burden to the society. There is no consensus on which surgical technique of its management leads to the best outcome. Materials and methods We reviewed 10 patients with infected nonunion of the distal femur and bone loss who were treated by radical surgical debridement and application of the Ilizarov external fixator from January 2010 to December 2015. Results The mean follow-up after removal of the frame was 18.6 months (range, 14 to 30 months). No patient was lost to follow-up. The mean external fixator time was 313.9 days (range, 275 to 362 days) which correlated with the final lengthening achieved. According to Paley’s grading system, eight patients had excellent clinical and radiological results and five excellent and good functional results. Bony union, ability to bear weight fully, and resolution of the infection were achieved in all the patients. Conclusion Distal femoral nonunion is a complicated orthopedic entity as it may be associated with nonunion, infection, bone loss, shortening, soft tissue scar, contracture, restriction of movement, disuse osteopenia. Ilizarov external fixation is a definitive treatment modality in these cases as it gives stability, allows early weight-bearing, compression/distraction at fracture site, helps to arrest infection and achieve union while corticotomy helps to regain length.
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Tibial fibrous dysplasia in children treated by Ilizarov technique - a review of treatment options
Статья научная
Fibrous dysplasia is a pathological condition, where normal medullary bone is replaced by fibrous tissue and small woven specules of bone. Fibrous dysplasia can occur in epiphysis, metaphysis or diaphysis. Occasionally, biopsy is necessary to establish the diagnosis. We present a review of operative treatment using the Ilizarov technique.
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Tibial lengthening over a bioactive degradable intramedullary implant: a case report
Статья научная
Introduction Long duration of distraction osteosynthesis remains an unsolved problem. One of the promising ways to stimulate reparative regeneration of bone tissue is the technology of combined osteosynthesis with intramedullary elastic reinforcement with titanium wires coated with hydroxyapatite. A significant drawback of this combined distraction osteosynthesis is the planned removal of intramedullary wires several months after disassembling the Ilizarov apparatus.The purpose of this work is to demonstrate the possibility of stimulating reparative regeneration and reducing the duration of distraction osteosynthesis using an intramedullary degradable implant with bioactive filling.Methods We present the first in clinical practice case of surgical leg lengthening in a female 10-year-old patient using the Ilizarov apparatus an intramedullary degradable implant made of polycaprolactone (PCL) saturated with hydroxyapatite to stimulate reparative regeneration in the tibia. Monthly radiographic monitoring of the process of reparative regeneration of bone tissue was supplemented by computed tomography after disassembling the Ilizarov apparatus.Results The process of lengthening the tibia was accompanied by pronounced formation of a bone “sleeve” around the implant, which was directly connected to the endosteum of the tibia. The density of bone substance in the medullary canal reached 496.6 HU. The cortical layer of the tibia in the elongation zone increased to 4 mm, and its density was equal to 1288.8 HU.Discussion Leg lengthening of 4 cm was achieved along with simultaneous correction of valgus recurvatum bone deformity at IO = 15 days/cm, that is two times shorter than the generally accepted excellent IO in distraction osteosynthesis according to Ilizarov.Conclusions Biodegradable polycaprolactone implants saturated with hydroxyapatite might be not inferior to titanium wires coated with hydroxyapatite in regard to the degree of osteoinduction and do not require repeated surgical intervention to remove them.
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Статья научная
Introduction One of the most prevalent ailments for which people seek treatment at a foot and ankle surgery facility is heel discomfort. Plantar fasciitis (PF) is one of the most common causes of adult heel pain and accounts for 11 to 15 % of all foot illnesses requiring medical care. The major symptom is pain and soreness at the heel where the plantar fascia is attached while starting weight- bearing after lengthy periods of rest. Rest, non-steroidal anti-inflammatory drugs (NSAIDs), stretching of the plantar fascia, physical therapy, foot cushioning, and orthotic devices, which may be utilized to meet the patient's demands, are some of the current conservative therapies for PF(planter fasciitis). In intractable instances of plantar fasciitis, where conservative therapy have failed to provide relief, steroid injections into the plantar fascia are often employed. Other treatment options for PF, including extracorporeal shockwave therapy (ESWT) are advised if patients do not react to conservative therapies. Patients and methods This study included 50 patients with chronic PF who had failed to react to conservative treatments such as physical therapy, NSAIDs, stretching exercises, and heel cushions for at least 6 months, and who did not have flatfeet or gastrocnemius contracture met the inclusion criteria. Patients were randomly divided into 2 groups: 25 patients received radial extracorporeal shockwave therapy (ESWT) once a week for six weeks (Group I); 25 patients got a single local corticosteroid injection at the plantar fascia's origin (40 mg / 2 ml of methylprednisolone together with 1 ml of local anesthesia, once) (Group II). Assessment of heel pain was done at the start of the trial and before each session using VAS score which was the primary outcome measure at 1, 3 and 6 months. Results A total of 50 individuals with persistent planter fasciitis (PF) were included in this investigation. Their age varied from 25 to 45 years old. Females made up 70 % of the sample, while males made up 30 %. Group I: 25 patients with PF who got extracorporeal shockwave treatment for 6 weeks at a time (once a week). There were 17 females (68 %) and 8 males (32 %), in the age ranging from 28 to 44 (mean SD 18.2).Group II: consisted of 25 individuals with PF who were given a local corticosteroid injection. There were 18 females (86.7 percent) and 7 males (13.3 percent) with ages ranging from 25 to 45 years (mean SD 21.9). Group I included 20 patients (80 %) and group II had 22 patients (88 %) who had pain in one foot, whereas 5 (20 %) patients and 3 (12 %) patients had pain in both feet, with no statistically significant difference. There was no significant difference between the groups in terms of the VAS score at the start of the trial (p = 0.26), the mean VAS scores were 6.4 and 6.2 in groups I and II, respectively. At one month, the mean VAS scores were 1.6 and 1.2 in group I and II, respectively. At 3 months, the mean VAS score were 2.2 and 1.7, at 6 months 5.1 and 2.3 for groups I and II, respectively. Conclusion ESWT and local corticosteroid injection therapies are safe and effective but local corticosteroid injection is more effective than ESWT in the treatment of chronic plantar fasciitis.
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Treatment of clavicle fractures by Ilizarov technique
Статья научная
Recently, the traditional treatment of patellar fractures is often complicated by infection and insecure fixation. Occurring complications can be treated promptly, which is cost-effective, but limits the function of the joint. The CEF apparatus proposed by us can effectively treat patella fractures with fewer complications. Transverse fractures of the patella with displacement were treated according to the method of compression external fixation, based on the principles of the Ilizarov apparatus with stretched spokes. All patients after the operation were allowed to move in the joints and load. In total, twenty-five fractures were treated with our CEF apparatus. Treatment in 12 patients was by percutaneous procedure. In the treatment of all fractures, a lasting fusion was achieved. The CEF apparatus was removed after 6-8 weeks. In 12 patients the total volume of movements was restored, the average assessment of knee joint function by Insall was 96 points, the average observation period was four years. Mild complications in the form of inflammation in the area of the spokes were observed in five patients, they were treated with local remedies and antibiotics. The CEF technique is a safe and effective method of treating patella fractures, it has advantages over conventional methods in the case of soft tissue deficiency. CEF provides rapid recovery without any additional surgical interventions.
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Treatment of humerus nonunion using G.A. Ilizarov technique
Статья научная
Treatment of humerus nonsense is one of the most difficult problems that a surgeon faces in his practical activity. Usually, the following methods are used to correct this pathology: intramedullary osteosynthesis with a nail, blocking (interlocking), fixing with plates, allotransplantation. In our series according to the GA method. Ilizarov treated 46 patients. The age of the patients ranged from 21 to 62 years, the average age was 32 years. Primary treatment was carried out using DCP (dynamic compression plate), Rush nails and plates fixed with screws. The duration of treatment was 5-11 months (on average 8 months). When using Ilizarov's apparatus, a good volume of movements in the elbow and shoulder joints was achieved. The average control period was 15 years from 1 year to 22 years. The striking was obtained in all 46 cases.
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Treatment of idiopathic increased femoral anteversion in children and adolescents - a perspective
Статья научная
Rotational problems of the lower extremities affect a vast number of infants and children, whereas increased femoral anteversion (inward rotation) is the most frequent cause of intoeing in school-aged children. Femoral anteversion is defined by the angle of the femoral neck in relation to the femoral shaft in the coronal plane, whereas the degree of anteversion is greatest in infancy and gradually decreases towards skeletal maturity in most children. In about 15 % of all children increased femoral anteversion persists into adulthood. In cases of excessive anteversion gait problems, hip and/or knee pain are common. Derotational osteotomy of the femur is an established treatment for the condition. However, there is a lack of knowledge and clear evidence when to perform surgery and how this affects function and pain in these patients. The current paper is not based on a complete literature review and, therefore, does not fulfill the criteria of a review article. However, the article is based on the authors’ in-depth knowledge and a rapid review of the literature, and it can be defined as a scholarly article providing a perspective on the condition.
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Treatment of patella fractures by compressive external fixation (CEF)
Статья научная
Recently, the traditional treatment of patellar fractures is often complicated by infection and insecure fixation. Occurring complications can be treated promptly, which is cost-effective, but limits the function of the joint. The CEF apparatus proposed by us can effectively treat patella fractures with fewer complications. Transverse fractures of the patella with displacement were treated according to the method of compression external fixation, based on the principles of the Ilizarov apparatus with stretched spokes. All patients after the operation were allowed to move in the joints and load. In total, twenty-five fractures were treated with our CEF apparatus. Treatment in 12 patients was by percutaneous procedure. In the treatment of all fractures, a lasting fusion was achieved. The CEF apparatus was removed after 6-8 weeks. In 12 patients the total volume of movements was restored, the average assessment of knee joint function by Insall was 96 points, the average observation period was four years. Mild complications in the form of inflammation in the area of the spokes were observed in five patients, they were treated with local remedies and antibiotics. The CEF technique is a safe and effective method of treating patella fractures, it has advantages over conventional methods in the case of soft tissue deficiency. CEF provides rapid recovery without any additional surgical interventions.
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Статья научная
Introduction The majority of paediatric both bone forearm fractures are treated with manipulative reductions and casting; loss of reduction is one of the most commonly reported complications. We aimed to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures.Materials and methods This prospective observational study was conducted at the Department of Orthopedics, Kalpana Chawala Government Medical College in Karnal to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures. In the present study, 55 patients 16 years old were included irrespective of sex with distal both bones forearm fractures, managed by closed reduction and casting were included.Results Fracture reduction failure was observed in 32.7 % of the patients. Both three-point index and cast index were found to be significantly higher in patients with reduction failure. It was observed that at 2 weeks Area under curve (ROC Curve) for Cast index and Three point index was 0.72 and 0.85 respectively. At 4 weeks, Area under curve for Cast index and Three point index was 0.77 and 0.84 respectively and at 6 weeks 0.74 and 0.86 respectively. Thus, in the present study, CI and 3PI had similar predictability for fracture reduction failure.Discussion There are a few limitations of our study: We could not observe the patients for a longer period of time to know re-modelling in the long term. We did not take in to consideration the severity of fracture, type of anesthesia used (conscious sedation versus General Anesthesia) and the fracture configuration while assessing the outcomes. We also did not collect information about anthropometric parameters like child weight and diameter of the forearm.Conclusion The three-point index and cast index are clinically useful tools to assess the quality of cast molding following closed reduction of pediatric forearm fractures and to predict re-displacement in distal forearm fractures.
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Use of flexible nails in children diaphyseal fractures. Five questions and answers
Статья научная
Introduction More than 40 years after the launch of elastic stable intramedullary nailing (ESIN) as a golden standard of the treatment of some fractures in children and adolescents. Material and methods This review is based on answers to five essential questions: The position of ESIN compared with other methods of treatment; The choice of the implants; The indications for ESIN today; How to avoid complications as much as possible? Do we remove the implants or not? Results The aspects of biomechanics, design, indications for ESIN in comparison to other treatment, surgical techniques depending on fractured bones, complications are presented in the article. Conclusion ESIN is an excellent method to fix long bone fractures in children and adolescents. Top one is definitively the fractures of both bones of the forearm, then the diaphyseal fractures of the femur and the tibia before the age to be eligible for a locking nail. However, some unstable fractures cannot be treated conservatively or with a locking nail, and an ESIN remains unstable. In these cases, we are allowed to propose to add an external fixator for 4 to 6 weeks, waiting for a good stabilisation of the fracture.
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«Золотое сечение» берцовых костей у юношей с варусной установкой оси нижних конечностей
Статья научная
По рентгенограммам у юношей 18,9±1,3 лет, имеющих варусную установку оси нижних конечностей, с позиций «золотого сечения» проведено изучение ширины наружного и внутреннего кортикальных слоев и костномозговых полостей большеберцовой и малоберцовой костей.
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«Шум керамики» как нежелательное явление в эндопротезировании тазобедренного сустава
Статья обзорная
Введение. Керамическая пара трения в эндопротезировании тазобедренного сустава в общемировой ортопедической практике зарекомендовала себя как износостойкий и биоинертный материал. Последние два поколения керамики «Biolox Forte» и «Biolox Delta» значительно повысили свою прочность. Однако появление шума в паре трения стало непредвиденным последствием ее эксплуатации в XXI веке при эндопротезировании тазобедренного сустава.Цель. Оценить современное состояние проблемы шума в керамической паре трения эндопротеза тазобедренного сустава на основании анализа зарубежной и отечественной литературы.Материалы и методы. В представленном обзоре проведен анализ зарубежной и отечественной литературы согласно рекомендациям PRISMA в открытых электронных источниках научной литературы PubMed, Scopus, Google Scholar, eLibrary. Оценивалось методологическое качество статей путем рекомендации MINOR. Поисковые слова: керамическая пара трения, скрип, эндопротезирование тазобедренного сустава, ceramic bearing, ceramic on ceramic, ceramic squeaking, hip.Результаты и обсуждение. Шум в керамической паре трения, по данным опросов, составляет до 37,7 %. Есть множество теорий возникновения и механизма шума: импиджмент и нагрузка на край вкладыша, нарушение пленки, третье тело, микросепарация и резонанс. Однако по сей день нет единого мнения, чем является шум в керамической паре трения и как решить данную проблему.Заключение. Проведя анализ литературы, посвященной керамической паре трения, было обнаружено достаточное количество нерешенных вопросов. Шум может сыграть роль предиктора нарушений в эксплуатации эндопротеза, что при накоплении базы данных приведет к более глубокому пониманию шума, методов его коррекции и, возможно, к своевременному предотвращению риска раскола керамики.
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