Оригинальные статьи. Рубрика в журнале - Гений ортопедии
Management of congenital radial club hand by gradual correction
Статья научная
Introduction Severe congenital radial club hand is aesthetically unacceptable. This paper represents our experience in treating early and late diagnosed cases using gradual distraction by Ilizarov external fixator. Methods We treated 34 cases of congenital radial club hand with an age ranged from 1 to 15 years. There were 20 girls and eight bilateral cases. Three had been treated on both sides. So, we have treated 37 limbs. Nine cases had been operated before. Centralization alone was done in 12 cases and followed by lengthening in eight cases. Ulnar lengthening and gradual correction of wrist deformities were done for the rest of cases. The patients were followed clinically and radiographically with the following parameters: hand forearm angle, range of motion, daily functional activities, extent of lengthening achieved, and cosmetic improvement. Results The follow up ranged from 1 to 10 years. The magnitude of lengthening achieved ranged from 5 to 11 cm. The average healing index was 52.02 days/cm with cosmetic appearance satisfaction in all cases. Complications included; pin tract infection in 24 cases, flexion contractures of the elbow and fingers in 26 cases [which mostly disappeared during follow up], and spontaneous ulnocarpal fusion in 2 cases. Two cases suffered fracture in the regenerate zone. Conclusions The use of the Ilizarov method with gradual distraction of bone and soft tissues in treatment of radial club hand was effective in forearm lengthening with functional and cosmetic improvement.
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Management of forearm bone gap non-unions by Ilizarov technique
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Purpose Proper treatment of forearm bone gap non-union should achieve both biological stimulation of the bone and elastic mechanical stability. The use of Ilizarov technique enhances the healing of a non-union providing osteogenic, osteoconductive and an optimal stability with the Ilizarov fixation. We retrospectively reviewed 26 patients affected by forearm bone non-union and treated with the Ilizarov fixation. Materials and Methods Twenty six patients were treated for gap non-unions of forearm bones with the Ilizarov compression distraction device from 2000 to 2015 in BARI-ILIZAROV ORTHOPAEDIC CENTRE. Results All the difficult non-unions healed in a mean of 7 months, ranging from 5 to 12 months. At the latest follow- up, forearm functions were satisfactory. Conclusion The Ilizarov compression distraction device is a fantastic tool in promoting the healing of forearm non-unions, even if the bones are very atrophic.
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Musculoskeletal anomalies in children with mucopolysaccaridoses
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Introduction The accumulation of glycosaminoglycan (GAGs) in the tissues in Mucopolysaccharidoses (MPS) can lead to skeletal anomalies (DYSOSTOSIS MULTIPLEX) and to soft tissue impairments (neural or medullar compression, joint stiffness, tenosynovitis). Here is a review of orthopedic issues frequently encountered in patients with MPS. Material and methods Surgery may be justified at different age and according to the type of MPS. Different surgical approaches and their indications are exposed in the article. Results The article exposes indications and techniques for orthopedic issues in MPS children: cervical stenosis, cervical instability, kyphosis, hip dysplasia and hip dislocation, genu valgum. Conclusion Various musculoskeletal anomalies can be found in patients with mucopolysaccharidoses. Neurological impairments are frequently seen due to cervical stenosis or instability and should be early detected with regular MRI of the cervical spine. Well-codified management should lead to favorable functional results and maintain functional and walking abilities.
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Neglected сlubfoot treated by Ilizarov and Ponseti methods
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The Ponseti method has revolutionized clubfoot treatment. Though completely neglected clubfeet are now rare, partially or incompletely and improperly treated feet are not uncommon. Relapses after successful correction may occur due to non-compliance with bracing. In scarred soft tissues due to previous surgery, soft tissue distraction using external fixation helps achieve correction. The Ilizarov fixator permits us to follow the Ponseti protocol, using correction methods that may either be constrained or unconstrained by hinges. Applying force vectors perpendicular to the moment arm allows us to correct the equinus without damaging the ankle joint. All of the above is possible when the talus is round. Full correction of the deformity is possible. However, long-term follow-up of these patients has revealed stiffness of the ankle setting and frequently with tibio-talar osteophytes anteriorly. They are probably a reaction to excessive pressure developed in the joint due to the tight soft tissues. Hence the author has now added a mild shortening of the tibia and fibula to reduce soft tissue tension, rather than resorting to further soft tissue releases through scarred tissues. This allows faster correction with the Ponseti-Ilizarov protocol and allows good ankle range of motion to persist.
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Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children
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Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini-fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.
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Pyomyositis: case series of 14 patients to study the significance of early diagnosis and management
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Introduction Pyomyositis denotes primary pyogenic infection of skeletal muscle. It is predominantly a disease of tropical countries. It usually involves the largest muscle groups around the pelvic girdle and lower extremities. Primary reasons for delay in diagnosis are its low incidence and vague presentation [7]. This delay can result in complications such as extension into and destruction of an adjacent joint, sepsis and, even death. Our study is aimed to highlight the extent and sequence of treatment protocol required for good management of these patients. Methods We retrospectively analyzed our experience with a series of 14 pediatric patients with primary pyomyositis who were treated and followed up. There were five girls and nine boys. All 14 patients underwent plain radiographs, USG and MRI of the affected area followed by surgical drainage and a course of antibiotics. Patients were followed up with weekly CRP. Results Six out of 14 (42.9 %) patients had a history of mild trauma. Ileopsoas muscle was involved in 4 patients, 3 cases in which the gluteals or quadriceps were involved, 2 cases with obturator muscle involvement and 2 cases in which adductors were the infection site. All 14 patients were treated surgically. Conclusion Our study shows that early diagnosis, complete drainage of the purulent material and the use of appropriate antibiotic therapy are the key determinants of successful treatment that lead to complete resolution in the majority of cases.
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Статья научная
Optimizing the conditions for cranial bone fracture healing remains to be a relevant field of the current traumatology and orthopaedics. Purpose. To study the impact of compression on reparative osteogenesis when engrafting the resected flaps of calvarial bones. Materials and methods. Two groups of experiments performed in 20 adult mongrel dogs complying with all the requirements of the European Convention for the Protection of Vertebrate Animals used for Experimental and other Scientific Purposes. Dogs from Group 1 (n=10) underwent resection of the two sites of calvarial bones (the caudal flap preserved connections with surrounding soft tissues, the cranial flap - not preserved) of rectangular shape and 1.9×1.5 cm by size, they were laid into their former place and fixation performed with compression using thin wires with stoppers to the medial defect margin by transosseous osteosynthesis method. Compression produced by tightening fixing wires with the force of 40 kg. In Group 2 (n=10) bone flaps were laid into the defect without fixation. The investigations (clinical, radiological and histological) performed 7, 14, 21, 28 and 60 days after surgery. Results. Compression produced at the junction of the margins of free bone fragments and calvarial flat bone defect revealed to contribute to bone tissue formation in earlier periods of time. Conclusion. The results obtained in the present study formed the basis for using the technique of transosseous compression osteosynthesis in treatment of patients with cranial bone fractures in clinical departments of the Center.
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Reconstruction of bone loss of diaphyseal tibial bones using G.A. Ilizarov technique
Статья научная
The treatment of segmental defects in the diaphysis of long bones is one of the most difficult problems that a surgeon faces in his practice. Methods that are used to cover bone defects include bone autotransplantation [1], posterolateral bone transplantation [2], allotransplantation [3], and tibialization [4]. With the application of all the above traditional methods of treating bone defects, numerous surgical interventions are sometimes required. The period of treatment is long, the load on the limb may not be possible, and the functional results are often unsatisfactory. Recent studies have demonstrated that the method used GA. Ilizarov is more popular than the use of vascularized bone grafts, especially with large bone defects [5, 14].
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Reconstructive surgery in recurrent deformity (clubfoot relapse)
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Introduction Recurrent clubfoot deformity may be due to either an imperfect initial correction, or a natural history of a severe disease. In the later, idiopathic clubfoot is uncommon. In the review we describe reconstructive surgery in recurrent deformity of idiopathic clubfoot. Material and methods Surgery may be justified at different age and according to the type of deformity. Different surgical approaches and their indications are exposed in the article. Results After Ponseti’s method application additional surgeries may be considered in recurrent clubfoot deformity which may represent 10 to 20 % of cases: second Achilles tenotomy, postero-lateral relapse, complete antero-medial and postero-lateral relapse, transfer of the anterior tibial tendon, correction of sequelae: metatarsus varus, residual equinus, residual rotation of the calcaneopedal unit. Conclusion Idiopathic equine varus clubfoot is a frequent condition. Well-codified management should lead to extremely favorable functional results. Unfortunately, some cases lead to a recurrence of the deformity. Surgical procedures are sometimes required. The goal is to avoid as much as possible arthrodesis and secondary degenerative arthritis.
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Resorbable implants in paediatric orthopaedics and traumatology
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Background Development of resorbable implants for paediatric orthopaedics is promising as there is no need for implant removal.The aim of this paper is to present our experience in resorbable implants in paediatric traumatology, and to make an overview of the recent literature.Material and methods In our department of paediatric traumatology and orthopaedics, we have operated 7 children with fractures of long bones with resorbable screws (ActivaScrew™). The inclusion criteria were intra-articular and juxta-articular fractures in children with an indication for screw fixation. To prepare the review, we searched for information sources at the scientific platforms such as PubMed, Scopus, ResearchGate, RSCI, as well as other published products (Elsevier, Springer).Results The cohort is represented by 7 patients, 4 girls and 3 boys, aged from 5 to 14 years old. The 7 fractures were 3 at the elbow and 4 at the ankle joint. In the immediate postoperative period, no patient presented with abnormal swelling, redness, or tissue reaction. Pain disappeared at day 7 in all cases. Weight-bearing and return to sport activities were allowed in normal delay. Radiological bone union was obtained between 3 and 6 weeks. Range of motion in adjacent joints was comparable to the opposite non-fractured side at 3 months. There were no cases of complications, no infection, and no need for a reoperation.Discussion The use of resorbable implants, either co-polymers or magnesium, solves the problem: removal of implants is not anymore necessary. Resorbable implants are becoming safer as they have good solidity allowing bone union of fractures and osteotomies before their eliminating.Conclusion Main indications of resorbable implants in pediatrics remain fractures and osteotomies fixed with screws. The development of plates and intramedullary nails will enlarge the indications. Level of evidence: IV.
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Статья научная
Background Percutaneous minimally invasive surgery (MIS) has been increasingly implemented to treat thoracolumbar (TL) fracture against a conventional open pedicle screw fixation (OPSF) with desirable radiological and clinical outcomes. Studies in the Indian context are required to determine the efficiency of MIS over OPSF. Objective To compare restoration and maintenance of vertebral body height (VBH) following MIS versus OPSF. Methods A prospective comparative study was conducted in a tertiary care hospital. Patients (n = 36) aged 18-65 years (males = 23, females = 13) with traumatic TL fractures were identified. Eighteen of them underwent OPSF and other eighteen underwent MIS. The radiological outcomes like anterior and posterior vertebral body height percentage (AVBH % and PVBH %) restoration and maintenance were evaluated. Quantitative variables were analyzed and described using mean ± standard deviation and qualitative variables were presented using frequency and percentage. Student t-test was used to analyse continuous data and Chi-square/Fisher Exact test was used to analyse categorical data. Results The mean age of the patients was 38.8 years. The majority of fractures were seen in the T12-LI segment (52.7 %). The AVBH % restoration and maintenance in OPSF was significantly higher compared to that of MIS at immediate post-operative (IPO) period (p = 0.01), 6 weeks (p = 0.02) and 12 weeks (p = 0.006) post-surgery. Long segment stabilization provided statistically significant AVBH and PVBH values for OPSF compared to MIS (p 0.05). Superficial surgical site infection (SSSI) was seen in both the groups without any statistical significance between them (p > 0.05). Conclusion OPSF is superior over MIS in the restoration of AVBH. Restoration of PVBH was also better with OPSF although not statistically significant. OPSF with longer segment fixation had better restoration of both AVBH and PVBH. The presence or absence of pedicle screw at fractured vertebral level did not seem to have any significance in both the groups. However, the MIS approach can be a reasonable alternative to open surgery with potential advantages like better clinical and functional outcome. A selected population of patients treated with MIS will show better surgical outcomes.
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Статья научная
Introduction Supracondylar and intercondylar fractures of the distal femur are often attributed to high energy trauma. Treatment of such severely comminuted fractures is challenging. Poor overlying soft tissue, bone loss in the presence of severe comminution and intercondylar extension makes implant selection difficult. Unilateral knee spanning external fixators and hybrid fixators can lead to knee joint stiffness and the issue of bone loss is difficult to deal with them. Ilizarov ring fixator is reserved for severely comminuted fractures and injuries with poor overlying soft tissues. It can effectively manage the bone loss and facilitates limb length restoration, promotes early weight bearing and mobilization. Aim To study the role of the Ilizarov ring fixator in management of severely comminuted supracondylar and intercondylar fractures of the distal femur. Material and Method A total of 13 (all male patients) consecutive patients with severely comminuted supracondylar and intercondylar fractures of the distal femur were treated from December 2013 to March 2016. There was one case with A3 type, one with C1, five cases with C2 and six cases with C3 type as per AO/ASIF Classification. Gustilo-Anderson classification was used for compound fractures. Four cases of C3 type required limited open reduction. Results All patients completed one-year follow-up. Average fracture union time was 20 weeks. Pin tract infection (n = 7) was a frequent complication. Patients with C3 Type of fracture had more restriction in knee flexion (n = 5). No case had limb length discrepancy more than 2.5 cm. No case of nonunion or premature fixator removal due to infection was noted in the series. Conclusion Ilizarov ring fixator can be considered as one of the reliable treatment options for severely comminuted distal femoral fractures with intra-articular extension.
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Seri-остеотомия как один из методов оперативного лечения вальгусной деформации первого пальца стопы
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Проблема хирургического лечения деформации первого пальца стопы на сегодняшний день не утратила свою актуальность. Цель. Изучение результатов применения малоинвазивной операции SERI-остеотомии при лечении вальгусного отклонения первого пальца стопы. Материалы и методы. В отделении травматологии РКБ № 1за период с декабря 2011 по март 2014 года было прооперировано 34 больных (58 стоп) по поводу Hallux valgus в возрасте от 30 до 55 лет (29 женщин и 5 мужчин). Всем больным была произведена SERI-остеотомия первой плюсневой кости. Из них у 27 больных (42 стопы) с HVA до 40 градусов и IMA менее 20 градусов и у 4 больных (8 стоп) - с HVA более 40 градусов и IMA более 20 градусов. Четырем больным (6 стоп) была произведена косая остеотомия с удлинением первой плюсневой кости и 1 больному (2 стопы) - поперечная остеотомия без удлинения. Результаты. Через 2 мес. клинические признаки сращения костных отломков наблюдались у 24 больных. По результатам рентгенологических исследований сращение было признано удовлетворительным у 13 больных, слабым - у 15 больных. Признаков сращения не наблюдалось у 3 больных. Трое больных выпали из наблюдения. Коррекция была признана удовлетворительной у всех больных. Все больные довольны результатами операции. Отдаленные результаты лечения оценивались по шкале AOFAS. На четвертом месяце наблюдений результаты лечения были признаны отличными у 22 больных (95-97 баллов), хорошими - у 23 больных (80-92 балла), удовлетворительными - у 10 больных (72 балла). Заключение. SERI-остеотомия при коррекции вальгусной деформации первого пальца стопы может быть предложена как одна из малоинвазивных и эффективных методик оперативного лечения и требует более внимательного дальнейшего изучения.
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We studied 34 severely injured open fractures of long bones, managed by Ilizarov external fixator in National Institute of Traumatology & Orthopaedic Rehabilitation, Pink unit-II (Ilizarov, Deformity Correction and Reconstruction Unit) Dhaka, Bangladesh. All the patients were selected according to inclusion criteria and through counseling the patients and his/her relative. Duration of study was 2 years. Average post-operative hospital stay was 10 days. Pin sites inflammation, pin loosening and pain at rest, swelling of leg and thigh were the commonest complications in our study. Average union time was 20 weeks and union rate was 100 %. Close adherences to Ilizarov principles make it now possible to successfully treat orthopedic conditions that previously were fraught with high morbidity rates and poor results.
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Introduction Over the last decades numerous new materials and techniques for bone tissue engineering have been developed. The use of bioresorbable polymeric scaffolds is one of the most promising techniques for surgical management of bone defects. However, the lack of bioactive properties of biodegradable polymers restricts the area of their application for bone tissue engineering.The aim of study was to apply solvent/non-solvent treatment to coat the surface of 3D-printed bioresorbable poly(ε-caprolactone) scaffolds with bioactive hydroxyapatite particles and report on the physicochemical properties of the resulting materials.Material and Methods In the present study, biomimetic poly(ε-caprolactone) scaffolds were 3D-printed via fused deposition modeling technology and their surface was treated with the solvent/non-solvent method for coating with bioactive particles of hydroxyapatite.Results It has been found that treatment in the mixture of toluene and ethanol is suitable for the coating of poly(ε-caprolactone) scaffolds with hydroxyapatite. The scaffolds maintain porous structure after treatment while hydroxyapatite particles form homogeneous coating. The amount of hydroxyapatite on the treated scaffolds was 5.7 ± 0.8 wt. %.Discussion The proposed method ensures a homogeneous coating of outer and inner surfaces of the poly(ε-caprolactone) scaffolds with hydroxyapatite without a significant impact on the structure of a scaffold. Fourier-transform infrared spectroscopy confirmed that the solvent/non-solvent treatment has no effect on the chemical structure of PCL scaffolds.Conclusion Coating of biomimetic 3D-printed PCL scaffolds with bioactive hydroxyapatite by the solvent/non-solvent treatment has been successfully carried out. Upon coating, scaffolds retained their shape and interconnected porous structure and adsorbed hydroxyapatite particles that were uniformly distributed on the surface of the scaffold.
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Surgical roadmap for congenital cervical spine abnormalities
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Study Design A descriptive study based on medical records of patients with congenital cervical spine abnormalities. Objective The hypothesis of the study was that patients with congenital cervical spine abnormalities could be divided according to the main pathological syndrome. Summary of Background Data Abnormalities of the cervical spine belong to embryopathies and are a very heterogeneous group. The variety of this pathology made it hard to create a general classification based on a morphological approach. Materials Medical records of 68 patients with congenital cervical spine abnormalities were analyzed and were a clinical material for working out the algorithm of their management. Computer tomography, magnetic resonance imaging (MRI) and selective angiography were used to specify the abnormality structure and preoperative planning. Use of functional positioning was an important feature in all these investigations. Various techniques of surgical treatment such as halo, anterior and posterior fusion, decompression of the cerebral, spinal cord and cervical vertebral arteries, revision of the spinal canal, neurolysis, and meningolysis were used in 28 patients aged from 2 to 47 years old. Results All patients were divided according to leading pathological syndromes. Those were instability, stenosis and brain ischemia. Each group had its own important subgroup. The main surgical steps in management of complex congenital anomalies of the cervical spine were bone fusion or (and) decompression of the brain and spinal cord. Conclusions Selection of the main pathological syndrome or combination of syndromes is a simple and effective way for making the right decision when treating patients with congenital cervical spine abnormalities. Syndromic approach can be used for prognosis as well.
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Technical points of Ilizarov external mini-fixator for the treatment of phalanx fractures
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The Ilizarov external mini-fixator (IEMF) has become an effective tool for the treatment of acute and chronic hand and foot injuries and deformity correction due to its advantages of easy fixation, good holding power, and artful appearance. However, there are relatively few clinical reports on this technique. Materials and methods From June 2019 to March 2021, we preformed IEMF on 113 patients with open phalanx fractures as emergency surgery, and all patients had 3-6 months follow-up. Results All fractures achieved clinical healing. Among them, pin site infection occurred in 8 fractures (7.07 %), arthrolysis occurred after 6 fractures (5.3 %), and 4° rotation malunion occurred in 3 cases (2.65 %).
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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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