Role of Perforating Artery Pedicled Neurotrophic Flap in the Treatment of Compound Tissue Defect of Tibia Using the Ilizarov Technique

Chirality Regulates Bone Regeneration through Mechanoresponse and Immunoregulation

As an omnipresent occurrence in the natural world, chirality plays a crucial role in numerous biological and physiological processes. Therefore, incorporation of chirality into biointerface materials has been emerging as a research hotspot in the development of regenerative biomaterials. Nevertheless, how chiral biointerface materials interact with biological organisms remains poorly understood. In the current study, a bioinspired chiral self-assembled nanohydroxyapatite material is developed for bone regeneration using a distraction osteogenesis model. We found that the left-handed chirality, rather than the right-handed chirality, possessed the greatest heightened ability for bone regeneration. Molecular mechanism research reveals that the left-handed chirality can activate mechanosensitive pathways to promote Ca2+ influx, subsequently enhancing macrophage type-2 polarization through phosphorylation of signal transducer and activator of transcription (STAT6), which eventually stimulates bone regeneration by harnessing the synergistic effects of angiogenesis and osteogenesis. These findings provide additional insights into the underlying mechanism of chiral recognition between biological systems and biointerface materials, offering alternative pathways for the development of biomaterials.

Orthoplastic Reconstruction of Distal Tibia High-Energy Fractures Using a Circular External Fixator-A Systematic Review

Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications.

The Principle of Limb Reconstruction-"One Walking, Two Lines, and Three Balances": A Retrospective Analysis of Post-Traumatic Lower Limb Deformity Correction

OBJECTIVE

The principles of limb reconstruction are crucial for treatment success, but there is no unified standard for complex limb deformities. The aim of this study was to analyze the characteristics of the cases of post-traumatic lower limb deformity and explore the new principle of limb reconstruction.

METHOD

A retrospective analysis was conducted of 148 patients with post-traumatic lower limb deformity who underwent surgery from May 1978 to December 2023; 85 were males (57.4%) and 63 were females (42.6%); 65 cases of left side (43.9%), 79 cases of right side(53.4%), and 4 cases were on both sides (2.7%), the average age was 24.64 years (5-69). There were 4 cases suffering hip deformities, 40 cases of femoral deformities, 18 cases from knee, 40 cases from tibiofibular, 93 cases of foot and ankle deformities, and some patients also had two or more types. All patients underwent surgical intervention in an average of 40.5 months (12-96) after injury. According to the evaluation of limb deformities, deformity correction and functional reconstruction with external fixation were implemented, following the principle of "one walking, two lines, and three balances." The clinical evaluation adopts the criteria of Qinsihe lower limb deformity correction and functional reconstruction.

RESULT

148 patients with post-traumatic lower limb deformities were followed up for 40.9 (12-356) months. The main surgical procedures implemented were tendon lengthening and soft tissue release (84 cases), osteotomy (93 cases), joint fusion (30 cases), and tendon transposition (16 cases); there were multiple surgical procedures in some patients. Among them, 124 cases used external fixators for stress control and 27 cases used internal fixation, while 3 cases used plaster or brace. There were 5 wire reactions postoperatively, which improved after dressing change and oral antibiotics. There were 2 pin infections, which improved by pin removing. No surgical related deep infections occurred, and no surgical related neurovascular damage occurred. At the last follow-up, all limb deformities were corrected, limb function improved, and the results of treatment was very satisfactory. According to Qinsihe evaluation criteria for lower limb deformities, 74 cases were excellent, 56 cases good, and 18 cases fair, with an excellent and good rate of 87.84%.

CONCLUSION

Stress control with external fixation is effective, safe, and controllable in correcting and reconstructing post-traumatic lower limb deformities. The principle of "one walking, two lines, and three balances" plays an important role in the entire process of stress control limb reconstruction.

Role of microsurgical techniques combined with Ilizarov techniques in limb salvage and functional reconstruction of thermal‑crush injuries of the hand: A case report

The Ilizarov technology was proposed by Former Soviet orthopedic physician Ilizarov. It is a medical method to reconstruct missing tissues. Ilizarov technology combined with soft tissue stretching technology is of great significance in the treatment of common orthopedic problems like bone defects, finger absence, joint contracture and joint stiffness following thermal-crush injuries of the hand. In the present study a 25-year-old male patient sought for limb salvage treatment 1 month after sustaining thermal-crush injuries of the right hand and forearm. The patient had been treated by another hospital with multiple procedures of debridement, and recommended for forearm amputation. The patient was diagnosed with: i) Postoperative infection of thermal-crush injuries of the right hand and right forearm; ii) comminuted open fractures of the proximal and distal phalanges of the right thumb; iii) osteomyelitis; iv) palm skin defects with exposed tendons; and v) skin defects of the opisthenar and the forearm. After a series of treatments including debridement, removal of necrotic tissue, tissue transplantation, skin pedicle, bone lengthening, external shaping, tissue release, joint fusion, traction and rehabilitation exercises, the patient recovered some hand function. Overall, thermal-crush injuries of the hand are severe, complicated combined injuries composed of both heat burn and compression injury and their treatment is challenging. Overall, microsurgery combined with Ilizarov technology can effectively reconstruct the function of complex thermal-crush injuries of the hand.

Masquelet technique with radical debridement and alternative fixation in treatment of infected bone nonunion

Background

Infected bone nonunion is the toughest problem in fracture-related infection, leading to high disability and recurrence. The aim of this study was to evaluate the effectiveness of the Masquelet technique with radical debridement and alternative fixation in the management of infected bone nonunion.

Patients and Methods

A retrospective study of prospectively collected data in two trauma centers was performed from 2016 to 2020. Patients diagnosed as infected bone nonunion were included in this study. The initial implant was removed and all patients received a two-stage Masquelet procedure with radical debridement and alternative fixation. The disappearance of inflammatory manifestations and regression of infection indicators (such as interleukin-6 (IL-6), C-reactive protein, white blood cell count) to the normal range were regarded as radical debridement. The alternative fixation depended on local soft tissue conditions. Results were evaluated according to clinical and radiographic assessment and patient satisfaction.

Results

A total of 23 patients were included in our study. Six of them received internal fixation, while the other 17 received external fixation. Of the 23 cases, 21 were successfully reconstructed without infection recurrence, except 2 reinfected cases. Mean full weight bearing time was 6.6 months follow-up post last surgery. Out of the 23, 20 cases had satisfactory functional outcomes without additional bone or soft tissue comorbidities. Discrepancies in leg length and joint stiffness were observed in three cases and marked as unsatisfied results.

Conclusions

Infected bone nonunion can be successfully managed using the Masquelet technique under radical debridement combined with an alternative fixation method.