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Popkov A, Pietrzak S, Antonov A, Parol T, Lazović M, Podeszwa D, Popkov D. Combined lengthening for acquired leg length discrepancy: Are there advantages of hydroxyapatite-coated intramedullary nails? Orthop Traumatol Surg Res 2021; 109:103101. [PMID: 34628087 DOI: 10.1016/j.otsr.2021.103101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this multicenter prospective study was to analyze the outcomes of bone lengthening by external fixator associated with flexible intramedullary nailing (FIN) in acquired limb length discrepancy (LLD). HYPOTHESIS Hydroxyapatite (HA)-coated FIN enables reduced External Fixation Index in limb lengthening for acquired leg length discrepancies in comparison to non-HA-coated FIN. MATERIAL AND METHODS This study included 54 patients (mean age, 17.9 years) operated on for femoral or tibial lengthening by combined technique (External fixator with FIN) for acquired length discrepancy. Titanium non-HA-coated FIN (29 cases) or HA-coated FIN (25 cases) were used. The factors that might influence external fixation index, complication occurrence and outcome were analyzed: age, amount of lengthening, nail diameter, HA-coating vs. non-HA-coated nails. RESULTS The mean External Fixation Indexes (EFI) of groups compared for non-HA-coated nails vs. HA-coated nails were not significantly different: 26.5 d/cm and 27.2 d/cm in femoral lengthening and 34.9 d/cm and 31.7 d/cm in tibial lengthening. Positive correlation between the "nail diameter/inner distance between cortices at osteotomy site" ratio and EFI in tibial lengthening was revealed (p=0.034). The nail types and the "nail diameter/medullary canal diameter" ratio interact and have significant simultaneous effect on EFI in femoral lengthening (p=0.021). DISCUSSION The results of this study revealed no differences with regards to EFI using HA-coated or non-HA-coated titanium FIN in lengthening for acquired leg-length discrepancies. Combined technique allowed reduced EFI and avoided major complications. Both non-HA-nail and HA-coated nail lengthening provided good and excellent outcomes. LEVEL OF EVIDENCE III; (controlled trial without randomization) prospective comparative study.
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Affiliation(s)
- Arnold Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Szymon Pietrzak
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Alexander Antonov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation
| | - Tomasz Parol
- Department of Orthopaedics, Children's Orthopaedics and Traumatology Medical Center of Postgraduate Education, Otwock, Poland
| | - Mikan Lazović
- Orthopaedic Department, Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - David Podeszwa
- Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Dmitry Popkov
- Ilizarov National Medical Center for Traumatology and Orthopaedics, Kurgan, Russian Federation.
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Popkov A, Aranovich A, Antonov A, Journeau P, Lascombes P, Popkov D. Lower limb lengthening and deformity correction in polyostotic fibrous dysplasia using external fixation and flexible intramedullary nailing. J Orthop 2020; 21:192-8. [PMID: 32256003 DOI: 10.1016/j.jor.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
The study describes preliminary experience of the use of external fixators for limb lengthening and deformity correction in combination with flexible intramedullary nailing in management of polyostotic fibrous dysplasia. Patients and methods The retrospective study included 8 patients (mean age 11.6 ± 3.38 years; range 7-17 years) with polyostotic fibrous dysplasia operated on using external circular frame and flexible intramedullary nailing. Mean follow-up was 2.6 years. Surgical technique consisted of percutaneous osteotomy of a segment and application of circular external frame. The intramedullary nailing was done using two bent nails. Hydroxyapatite-coated nails were applied in three patients; five patients had titanium nails. Amount of lengthening (cm and %), amount of deformity correction, duration of external fixator use, index of external fixation, "nail/medullary canal at narrowest site" ratio, "nail-medullary canal at osteotomy site" ratio were analyzed. Results and complications were assessed according to Lascombes's classification. Results The mean amount of lengthening was 4.5 cm (or 13.7 ± 6.0% per segment). This gave a mean external fixation index of 32.5 ± 13.97 days/cm. The mean ratio of IM nail diameter/medullary canal diameter at the narrowest site was 0.22 ± 0.07 (range, 0.125-0.3 mm). No migration of IM nails into medullary canal were noticed. But in one case there was external migration of Ti-nail. In a year after frame removal, the results of treatment were classified as grade I in 7 cases and IIb in one case.At the latest follow-up control, mechanical axis deviation was found within normal limits in six patients. Two patients had excessive MAD of 11 and 28 mm. In the first case a partial varus deformity recurrence occurred at middle shaft site where a large dysplastic zone was presented. In the second case, a specific shepherd's crook deformity developed and caused excessive MAD. Mean lower limb length discrepancy varied from 1 to 15 mm. Conclusion There are advantages of using elastic intramedullary nailing and external fixation in the treatment of limb length discrepancy and deformity of long bones in patients with PFD. This strategy ensures reduced external fixation time and high accuracy of alignment. Intramedullary nails left in situ, especially nails with HA-coating, seem to prevent deformity recurrence and stimulate remodeling in dysplastic fibrous zones.
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Popkov D, Popkov A, Dučić S, Lazović M, Lascombes P. Combined technique with hydroxyapatite coated intramedullary nails in treatment of anterolateral bowing of congenital pseudarthrosis of tibia. J Orthop 2020; 19:189-193. [PMID: 32025131 DOI: 10.1016/j.jor.2019.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose The goal of this study is to evaluate the treatment outcomes of anterolateral bowing and residual deformities of distal tibia in patients with CPT using circular external fixation and hydroxyapatite coated flexible intramedullary nailing without excision of affected part of tibia. Patients and methods Six patients (4 boys and 2 girls, mean age 12.4 ± 4.1 years) were included in the study. Mean follow-up is 2.1 years. In 4 patients with early onset of disease initial surgical treatment (at age of 5-8 years) was dysplastic zone or pseudarthrosis resection with proximal metaphyseal osteotomy for bone transport. Children with unbroken bowed tibia (2 cases of type II according to Crawford classification) had no previous surgery. Neurofibromatosis type I was diagnosed in 4 cases. Surgical technique for residual deformity correction consisted of percutaneous osteotomy, application of circular external frame and composite hydroxyapatite-coated intramedullary nailing. Results Mean external fixation time was 95.3 ± 17.5 days. All patients never get fractured after frame removal. At the present time, they are considered to be healed, in 2.1 years, in average, without fractures or deformity recurrence. Mean lower limb length discrepancy varied from 2 to 10 mm at the latest follow-up control. After realignment procedure, patients didn't require additional surgery but one. Intramedullary nails were removed in two years after deformity correction for individual reason. Conclusion Correction of anterolateral bowing or residual deformity in children with CPT is indicated. Association of external fixation with intramedullary nailing/rodding left in situ after frame removal ensure stability and accuracy of deformity correction. Biological methods of stimulation of bone formation in dysplastic zone are obligatory to ensure bone union. Intramedullary nailing with composite hydroxyapatite-coated surface provides mechanical and biological advantages in patients with CPT.
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Affiliation(s)
- Dmitry Popkov
- Clinic of Neuroorthopaedics and Systemic Diseases of the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Arnold Popkov
- Clinic of Neuroorthopaedics and Systemic Diseases of the Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Siniša Dučić
- Orthopaedic Department, Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Mikan Lazović
- Orthopaedic Department, Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Pierre Lascombes
- Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, CH - 1211, Geneva, 14, Switzerland
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Pogorelić Z, Vodopić T, Jukić M, Furlan D. Elastic Stable Intramedullary Nailing for Treatment of Pediatric Femoral Fractures; A 15-Year Single Centre Experience. Bull Emerg Trauma 2019; 7:169-175. [PMID: 31198807 PMCID: PMC6555214 DOI: 10.29252/beat-070213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To analyze outcomes of treatment and complications in children treated with elastic stable intramedullary nailing (ESIN) due to femoral fracture. Methods: From May 2002 until May 2018 case records of 103 patients (76 male and 27 female), with median age of 9 (range, 3-17) and follow-up of 92 months, who underwent ESIN because of displaced femoral fracture were retrospectively reviewed. The patient’s information including age, sex, side involved, trauma mechanism, type of fracture, associated injuries, neurovascular status, complications, operation time, duration of hospital stay, time to implant removal were analyzed. The surgical procedure implied a reposition of bone fragments and osteosynthesis with titanium elastic nails introduced through an incision over the lateral and medial border of the distal femoral metaphysis. Results: All patients achieved complete radiographic healing at a mean of 8.5 (range, 5-15) weeks. Nine (8.49%) postoperative complications were recorded: three entry site skin irritation, two cases of valgus angulation and one case of nail protrusion, re-fracture, Varus angulation and delayed union. All complications, except case of re-fracture and one valgus angulation, were treated conservatively, with no long term consequences for the patients. Two patients were re-operated. After removal of nails all patients recovered complete function of the extremity, without long term consequences. Conclusion: The ESIN for treatment of femoral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. Because of the excellent objective and subjective results, the operative stabilization of femoral fractures with ESIN should be recommended to all pediatrics patients
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia.,University of Split, School of Medicine, Split, Croatia
| | - Tonći Vodopić
- University of Split, School of Medicine, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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Popkov A, Dučić S, Lazović M, Lascombes P, Popkov D. Limb lengthening and deformity correction in children with abnormal bone. Injury 2019; 50 Suppl 1:S79-S86. [PMID: 30987742 DOI: 10.1016/j.injury.2019.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/28/2019] [Indexed: 02/08/2023]
Abstract
Flexible intramedullary nailing (FIN) provides multiple advantages in limb lengthening and progressive deformity correction in combination with external fixation. The article presents brief literature review and authors' experience in limb lengthening of abnormal bone (Ollier's disease, fibrous dysplasia, osteogenesis imperfecta). Titanium and, especially, hydroxyapatite-coated bent elastic nails in combination with external fixator are appropriate in limb lengthening of abnormal bone in children. FIN left in situ after lengthening procedure and external frame removal should be applied for long-term reinforcement of lengthened bone in patients with abnormal bone (metabolic bone disorders, skeletal dysplasias with compromised bone tissue development). The FIN respects bone biology, which is mandatory for good bone consolidation. Osteoactive properties of intramedullary elastic implants are favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up.
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Affiliation(s)
- Arnold Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Siniša Dučić
- Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Mikan Lazović
- Children's University Hospital, Tiršova 10, Belgrade, Serbia
| | - Pierre Lascombes
- Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, rue Willy Donzé 6, CH - 1211, Geneva 14, Switzerland
| | - Dmitry Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation.
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Popkov D. Use of flexible intramedullary nailing in combination with an external fixator for a postoperative defect and pseudarthrosis of femur in a girl with osteogenesis imperfecta type VIII: a case report. Strategies Trauma Limb Reconstr 2018; 13:191-197. [PMID: 30269195 PMCID: PMC6249152 DOI: 10.1007/s11751-018-0320-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/25/2018] [Indexed: 11/06/2022] Open
Abstract
Telescopic rodding has been developed in order to obtain long-lasting osteosynthesis in the growing long bones of children with osteogenesis imperfecta (OI). The major and still unsolved drawback of any telescopic rod or nail design is a lack of rotational stability and, currently, no telescopic system allows immediate weight-bearing. When these problems are associated with insufficient longitudinal bone stability and diminished healing capacity, the result can be unfavourable causing secondary bone fragment displacement, delayed or non-union. This article presents a case report of operative treatment in a 9-year-old girl affected with OI type VIII complicated with postoperative defect and pseudarthrosis of the femur causing functional impairment with loss of walking ability. A combination of intramedullary flexible nailing and minimal external fixation was applied for treatment of femoral defect-pseudarthrosis in a girl of 9 years with OI type VIII. Intramedullary and extramedullary nails with wrapping of titanium nickel mesh subperiosteally provided osteosynthesis and deformity correction of the tibia of a small intramedullary canal diameter. Upright standing and walking with progressive weight-bearing was started 4 days after surgery. There were no septic or vascular complications nor complications related to Ilizarov fixator. Radiographs demonstrated bone union in the femur 46 days after surgery. At the follow-up visit 9 months after fixator removal, clinical alignment remained excellent without any relapse of deformity. Bone remodelling with restitution of medullary canal was noted on lower limb radiographs. The patient was able to stand and walk without pain with an aide or walker. At the follow-up visit 17 months after fixator removal, there was no decrease in achieved functional abilities and the treatment outcome remained satisfactory. Use of an external fixator with intramedullary nailing for treatment of postoperative pseudarthrosis in patient with severe OI (recessive form of OI, type VIII) provides longitudinal, rotational and angular stability. Furthermore, this approach ensured early functional activity and walking with full weight-bearing, both favourable conditions for bone tissue regeneration. The external fixator was applied for a short period and only for additional stability and not for progressive deformity correction or other manipulation. In addition, the combination of intramedullary and extramedullary nailing and subperiosteal titanium nickel mesh seems to be promising for osteosynthesis in the deformity correction of bones with small diameter in children with OI.
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Affiliation(s)
- Dmitry Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M.Ulyanova Street, Kurgan, Russian Federation, 640014.
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Pogorelić Z, Kadić S, Milunović KP, Pintarić I, Jukić M, Furlan D. Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children: A retrospective series of 118 cases. Orthop Traumatol Surg Res 2017; 103:765-770. [PMID: 28330797 DOI: 10.1016/j.otsr.2017.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/02/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to analyze outcomes of treatment and complications in children treated with flexible intramedullary nailing (FIN) due to humeral fracture. HYPOTHESIS The FIN for treatment of humeral fractures in children would allow an early functional and cast-free follow-up with a quick pain reduction and low complication rate. PATIENTS AND METHODS From May 2002 until May 2016 case records of all children who underwent fixation with titanium intramedullary nails because of humeral fracture were retrospectively reviewed. The study included 118 patients treated with FIN for proximal humeral or humeral shaft fracture. The average age at the time of trauma was 12 years. Mean follow-up was 77 months. Left hand was affected in 51% of patients. The most common mechanism of injury was fall (n=58), followed by sports injuries, road traffic accidents, pathological fractures, motorbike accidents and bicycle riding. RESULTS There were no residual valgus/varum deformities. All patients achieved complete radiographic healing at a mean of 7.5 weeks. Nine complications were recorded: 1 humeral shaft fracture in patient with osteogenesis imperfecta, 4 entry site skin irritations, 2 skin infections and 2 radial nerve injuries. There were no cases of delayed union, nonunion or mal-union. After removal of the nails, all patients regained full function and all complications resolved. DISCUSSION The FIN for humeral fractures is a minimally invasive, simple and well reproducible technique with very low complication rate. CONCLUSION The FIN for treatment of humeral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. LEVEL OF EVIDENCE Level IV - retrospective study.
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Affiliation(s)
- Z Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia; University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia.
| | - S Kadić
- University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - K P Milunović
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - I Pintarić
- University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia; Department of Anatomy, University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - M Jukić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
| | - D Furlan
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
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Sultan A, Bhat MR, Khursheed O, Maqbool Wani M, Ahmad Kawoosa A, Kotwal HA, Manzoor QW. Evaluation of Complications from Stainless-Steel Flexible Intramedullary Nailing in Children's Femoral Shaft Fractures and Recommendations for Continued Use. Ortop Traumatol Rehabil 2017; 19:263-271. [PMID: 29086751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
[b]Background.[/b] Flexible intramedullary nailing is currently considered the treatment of choice for femoral diaphyseal fractures in school-aged children. The purpose of our study was to critically evaluate and analyze the complications of stainless steel flexible intramedullary nailing in children's femoral shaft fractures. (mean age, 8.2 years) with a femoral shaft fracture treated with stainless steel flexible intramedullary nailing from January 1, 2009 to July 31, 2015 and evaluated for complications.[b]Results.[/b] All fractures united in a mean time of 9.2 weeks. Minor complications were noted in 19 patients, and major complications were noted in two patients. The Flynn score was excellent in 74 patients, satisfactory in 23 patients, and poor in three patients.[b]Conclusions.[/b] 1. Stainless steel flexible intramedullary nailing in children's femoral shaft fractures is associated with minimal complications. 2. These complications are not related to the alloy of the implant and are mostly due to the long nail end; these complications can be prevented easily. 3. Stainless steel flexible intramedullary nailing is also cost effective, and we recommend its use be enhanced for the treatment of femoral shaft fractures in children.
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Affiliation(s)
- Asif Sultan
- Government Hospital for Bone and Joint Surgery, Barzulla, Srinagar, Kashmir
| | - M Rafiq Bhat
- Government Hospital for Bone and Joint Surgery, Barzulla, Srinagar, Kashmir
| | - Omar Khursheed
- Government Hospital for Bone and Joint Surgery, Barzulla, Srinagar, Kashmir
| | | | | | - Hilal Ahmad Kotwal
- Government Hospital for Bone and Joint Surgery, Barzulla, Srinagar, Kashmir
| | - Qazi Waris Manzoor
- Government Hospital for Bone and Joint Surgery, Barzulla, Srinagar, Kashmir
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Kim BS, Lee YS, Park SY, Nho JH, Lee SG, Kim YH. Flexible Intramedullary Nailing of Forearm Fractures at the Distal Metadiaphyseal Junction in Adolescents. Clin Orthop Surg 2017; 9:101-108. [PMID: 28261435 PMCID: PMC5334019 DOI: 10.4055/cios.2017.9.1.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 09/07/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the radiographic and functional outcomes of flexible intramedullary (IM) nailing in adolescent patients with forearm fractures at the diaphysis or at the metadiaphyseal junction (MDJ). METHODS We retrospectively reviewed the results of 40 patients who underwent IM nailing for pediatric forearm fractures. Thirty males and 10 females were followed for an average of 16 months (range, 12 to 20 months). Their average age was 11 years (range, 10 to 16 years). The average duration from the onset of trauma to surgery was 3.8 days (range, 1 to 36 days). Fracture sites were located at the MDJ of the radius in 8 patients (MDJ group) while 32 patients had middle-third fractures (D group). We assessed the magnitude and location of the maximum radial bow and range of movements. Functional outcomes were evaluated using Daruwalla criteria. RESULTS Open reduction was carried out in 8 cases. Union was achieved at an average of 8.3 weeks postoperatively. The results were classified as good in 38 and excellent in 2 according to Daruwalla criteria with restoration of forearm rotation. The mean angulation at the last follow-up was 1.8° on the anteroposterior radiograph and 3.3° on the lateral radiograph (MDJ group: 1.8° and 2.1°, respectively; D group: 1.9° and 2.8°, respectively). There was no significant difference in the mean angulation between the groups. The mean magnitude of maximal radial bow was 5.7% ± 1.8% (MDJ group, 5.2% ± 0.8%; D group, 5.9% ± 1.9%). The mean location of maximal radial bow was 58.0% ± 8.8% (MDJ group, 56.4% ± 8.9%; D group, 58.6% ± 8.9%). The differences in the mean magnitude and location of maximal radial bow with the normal contralateral arms (7.0% ± 1.2% and 50.9% ± 6.0%, respectively) were not significantly different between the groups. Complications included superficial infection (2), delayed union (1), and refracture (1). CONCLUSIONS IM nail fixation provided satisfactory results and maintained adequate stability for both forearm bone fractures in adolescents, even though the fracture was located at the MDJ of the radius.
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Affiliation(s)
- Byung Sung Kim
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yong Sung Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Yong Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Hwi Nho
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sun Geun Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Hwan Kim
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Popkov D, Lascombes P, Journeau P, Popkov A. Current approaches to flexible intramedullary nailing for bone lengthening in children. J Child Orthop 2016; 10:499-509. [PMID: 27826905 PMCID: PMC5145831 DOI: 10.1007/s11832-016-0781-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 02/03/2023] Open
Abstract
Limb-length discrepancies and extremity deformities are among the most common non-traumatic orthopaedic conditions for which children are hospitalised. There is a need to develop new treatment options for lower-limb length discrepancy in order to ameliorate treatment outcomes, avoid or reduce rates of complication and provide early rehabilitation. The authors report on the basic principles, experimental and clinical data, advantages, problems and complications of a combined technique associating the Ilizarov method and flexible intramedullary nailing (FIN) in limb lengthening and deformity correction in children. They describe features of the use of hydroxyapatite-coated intramedullary nails in patients with certain metabolic bone disorders and in cases where bone consolidation has been compromised. The advantages of bone lengthening using a combined technique (circular fixator plus FIN) are a lower healing index, quicker distraction-consolidation, a reduced rate of septic and bone complications, the ability to correct deformities gradually and the increased stability of bone fragments during the external fixation period and after frame removal.
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Affiliation(s)
- Dmitry Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6 M. Ulyanova Street, Kurgan, 640014, Russian Federation.
| | - Pierre Lascombes
- Division of Paediatric Orthopaedics, Hôpitaux Universitaires de Genève, rue Willy Donzé 6, 1211, Geneva 14, Switzerland
| | - Pierre Journeau
- CHU Brabois, Hôpital d'Enfants, Chirurgie Infantile Orthopédique, Rue du Morvan, 54500, Vandoeuvre, France
| | - Arnold Popkov
- Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, 6 M. Ulyanova Street, Kurgan, 640014, Russian Federation
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Tu KK, Zhou XT, Tao ZS, Chen WK, Huang ZL, Sun T, Zhou Q, Yang L. Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures. Injury 2015; 46:2428-32. [PMID: 26472198 DOI: 10.1016/j.injury.2015.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/27/2015] [Accepted: 09/29/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems. METHODS Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. RESULTS All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee. CONCLUSION This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures.
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Affiliation(s)
- Kai-Kai Tu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Xian-Ting Zhou
- Department of Orthopaedic Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
| | - Zhou-Shan Tao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Wei-Kai Chen
- Department of Orthopaedic Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou, Wenzhou, Zhejiang, China.
| | - Zheng-Liang Huang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Tao Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Qiang Zhou
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Lei Yang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
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Popkov A, Aranovich A, Popkov D. Results of deformity correction in children with X-linked hereditary hypophosphatemic rickets by external fixation or combined technique. Int Orthop 2015; 39:2423-31. [PMID: 26150332 DOI: 10.1007/s00264-015-2814-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The operative procedures to correct multiplanar bone deformities may be indicated for prevention of secondary orthopaedic complications in children with X-linked hereditary hypophosphatemic rickets (XHPR). Different problems related to surgical correction were reported: increased rate of non-union, delayed union, recurrent deformity, deep intramedullary infection, refracture, nerve palsy, and pin tract infection. The aim of this retrospective study was comparison of results of correction in children with XHPR who underwent the treatment with either the Ilizarov device alone or a combined technique: the Ilizarov fixator with flexible intramedullary nailing (FIN) with hydroxyapatite bioactive coating and FIN. MATERIAL AND METHODS We retrospectively analysed 47 cases (children of age under 14 years) affected by XHPR. Simultaneous deformity correction in femur and tibia was performed with the Ilizarov device (group I) or the combined method (group II). This article is based on the results of a historical comparative retrospective study from the same institution. RESULTS The duration of external fixation is noted to be shorter applying the combined technique: 124.7 days (group I) vs 87.4 days (group II). In both groups deformity correction was achieved with a proper alignment. Nevertheless, while a child continues to grow during long-term follow-up, deviations of the mechanic axis from the centre of the knee joint have been developing again and values of mLDFA, mMPTA have become pathologic in the most of the cases. In group I location of a newly developed deformity resembled a pre-operative one, whereby both diaphyseal and metaphyseal parts were deformed. In group II in all the cases an apex of deformity was located in distal metadiaphyseal zone of the femur and proximal metadiaphyseal zone of the tibia. It is important to note that all of those in group II were out of the zone of the intramedullary nail. CONCLUSION Simultaneous correction of femoral and tibial deformities by means of circular external fixators is preferable. Application of a combined osteosynthesis allows to considerably reduce the duration of external fixation and decrease the number of complications. There were no recurrent deformities in parts of bone reinforced by intramedullary nails.
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Affiliation(s)
- Arnold Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Anna Aranovich
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation
| | - Dmitry Popkov
- Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulyanova Street, 640014, Kurgan, Russian Federation.
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Ge YH, Wang ZG, Cai HQ, Yang J, Xu YL, Li YC. Flexible intramedullary nailing had better outcomes than kirschner wire fixation in children with distal humeral metaphyseal-diaphyseal junction fracture: a retrospective observational analysis. Int J Clin Exp Med 2014; 7:3568-3572. [PMID: 25419399 PMCID: PMC4238475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/16/2014] [Indexed: 06/04/2023]
Abstract
The effectiveness evaluation of flexible intramedullary nailing (FIN) and kirschner wire fixation (K-wire) used for MDJ fractures fixation have been described in multiple reports. But there have been few reports about comparison between FIN and K-wire in children with distal humeral MDJ fracture. In our retrospective study, Nineteen children received K-wire and twenty children received FIN, during the follow-up, six children in the K-wire group and one children in the FIN group was found to have postoperative cubitus varus; fixation method was an independent risk factor for postoperative cubitus varus (P = 0.001), fixation methods contributed significantly to operation time (t = 6.519, P < 0.001), surgical blood loss (t = 5.349, P < 0.001) and postoperative fracture healing time (t = 4.940, P < 0.001). We can conclude that FIN was related with lower incidence of postoperative cubitus varus, shorter operation time, less surgical blood loss and shorter fracture healing time compared to K-wire in children with MDJ fractures of the distal humerus.
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Affiliation(s)
- Yi-Hua Ge
- Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University Shanghai 200127, China
| | - Zhi-Gang Wang
- Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University Shanghai 200127, China
| | - Hai-Qing Cai
- Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University Shanghai 200127, China
| | - Jie Yang
- Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University Shanghai 200127, China
| | - Yun-Lan Xu
- Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University Shanghai 200127, China
| | - Yu-Chan Li
- Shanghai Children's Medical Center, Medical School of Shanghai Jiaotong University Shanghai 200127, China
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de Billy B, Gindraux F, Langlais J. Osteotomy and fracture fixation in children and teenagers. Orthop Traumatol Surg Res 2014; 100:S139-48. [PMID: 24394918 DOI: 10.1016/j.otsr.2013.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 02/02/2023]
Abstract
Significant changes have occurred recently in fixation methods following fracture or osteotomy in children and teenagers. Children have benefited the most from these advances. A child's growth is anatomically and physiologically ensured by the growth plate and periosteum. The need to keep the periosteum intact during trauma cases has led to the introduction of flexible intramedullary nailing. We will review the basic principles of this safe, universally adopted technique, and also describe available material, length and diameter options. The problems and the limitations of this method will be discussed extensively. In orthopedics, the desire to preserve the periosteum has led to the use of locking compression plates. Because of their low profile and high stability, they allow the micromovements essential for bone union. These new methods reduce the immobilization period and allow autonomy to be regained more quickly, which is especially important in children with neurological impairment. The need to preserve the growth plate, which is well known in pediatric surgery, is reviewed with the goal of summarizing current experimental data on standard fracture and osteotomy fixation methods. Adjustable block stop wires provide better control over compression. These provide an alternate means of fixation between K-wires and screws (now cannulated) and have contributed to the development of minimally invasive surgical techniques. The aim of this lecture is to provide a rationale for the distinct technical features of pediatric surgery, while emphasizing the close relationship between the physiology of growth, bone healing and technical advances.
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Huber H, André G, Rumeau F, Journeau P, Haumont T, Lascombes P. Flexible intramedullary nailing for distal femoral fractures in patients with myopathies. J Child Orthop 2012; 6:119-23. [PMID: 23730342 PMCID: PMC3364347 DOI: 10.1007/s11832-012-0399-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 03/19/2012] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Distal femoral fractures are quite common in nonambulating patients with myopathies, as they present marked osteoporosis. The deterioration of preexisting knee flexion contracture is a known problem, as these fractures are usually angulated posteriorly. The goals of treatment are to reduce immobilization and bed rest to a minimum, prevent function loss, and prevent refracture. The aim of our work was to investigate if these goals can be achieved by an operative treatment with closed reduction and flexible intramedullary nailing (FIN). METHODS Six distal femoral fractures in four nonambulating patients with myopathies (three Duchenne muscular dystrophy and one nemaline myopathy) were treated with FIN between 2005 and 2011. Patient charts and radiographs were reviewed to determine if intra- or postoperative complications occurred and to detect the interval to wheelchair mobilization and hospital discharge. Pre- and postoperative knee flexion contracture was noted from the patient charts of our reeducation unit, where patients were already known preoperatively. RESULTS Wheelchair mobilization without further immobilization after an interval of 2-3 days was possible. No aggravation of knee flexion contracture was detected in our patient series. No complications associated to the operative treatment itself and no refractures in the follow up occurred. CONCLUSION Our experience showed that FIN is a low invasive and sufficiently stable osteosynthesis in such fractures. Left in place, nails will reinforce mechanical stability.
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Affiliation(s)
- Hanspeter Huber
- />Department of Pediatric Orthopaedic Surgery, CHU Brabois Hôpital d’Enfants, Chirurgie Infantile A, Rue du Morvan, 54500 Vandoeuvre les Nancy, France , />Department of Surgery, University Children’s Hospital of Zürich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Guillaume André
- />Department of Pediatric Orthopaedic Surgery, CHU Brabois Hôpital d’Enfants, Chirurgie Infantile A, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - Francine Rumeau
- />Service MPR, Institut Régional de Réadaptation, Centre de Référence Maladies Neuro-musculaires, Hôpital d’Enfants, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - Pierre Journeau
- />Department of Pediatric Orthopaedic Surgery, CHU Brabois Hôpital d’Enfants, Chirurgie Infantile A, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - Thierry Haumont
- />Department of Pediatric Orthopaedic Surgery, CHU Brabois Hôpital d’Enfants, Chirurgie Infantile A, Rue du Morvan, 54500 Vandoeuvre les Nancy, France
| | - Pierre Lascombes
- />Department of Pediatric Orthopaedic Surgery, CHU Brabois Hôpital d’Enfants, Chirurgie Infantile A, Rue du Morvan, 54500 Vandoeuvre les Nancy, France , />Department of Pediatric Orthopaedic, University Hospitals of Geneva (HUG), Rue Willy Donzé 6, 1211 Geneva 14, Switzerland
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Jauquier N, Doerfler M, Haecker FM, Hasler C, Zambelli PY, Lutz N. Immediate hip spica is as effective as, but more efficient than, flexible intramedullary nailing for femoral shaft fractures in pre-school children. J Child Orthop 2010; 4:461-5. [PMID: 21966311 PMCID: PMC2946524 DOI: 10.1007/s11832-010-0279-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 07/13/2010] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Flexible intramedullary nailing (FIN) is the gold standard treatment for femur fracture in school-aged children. It has been performed successfully in younger children, although Spica cast immobilisation (SCI) has been the most widely used strategy to date. METHOD A retrospective analysis was performed between two comparable groups of children aged 1-4 years with a femoral shaft fracture. Two University hospitals, each using specific treatment guidelines, participated in the study: SCI in Group I (Basel, Switzerland) and FIN in Group II (Lausanne, Switzerland). RESULTS Group I included 19 children with a median age of 26 months (range 12-46 months). Median hospital stay was 1 day (range 0-5 days) and casts were retained for a median duration of 21 days (range 12-29 days). General anaesthesia was used in six children and sedation in four. Skin breakdown secondary to cast irritation occurred in two children (10.5%). The median follow-up was 114 months (range 37-171 months). No significant malunion was noted. Group II included 27 children with a median age of 38.4 months (range 18.7-46.7 months). Median hospital stay was 4 days (range 1-13 days). All children required general anaesthesia for insertion and removal of the nails. Free mobilisation and full weight bearing were allowed at a median of 2 days (range 1-10 days) and 7 days (range 1-30 days), respectively, postoperatively. Nail exteriorisation was noted in three children (11%). The median follow-up was 16.5 months (range 8-172 months). No significant malunion was reported. CONCLUSIONS Young children with a femoral shaft fracture treated by SCI or FIN had similarly favourable outcomes and complication rates. FIN allowed earlier mobilisation and full weight bearing. Compared to SCI, a greater number of children required general anaesthesia. In a pre-school child with a femoral shaft fracture, immediate SCI applied by a paediatric orthopaedic team following specific guidelines allowed early discharge from hospital with few complications.
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Affiliation(s)
- Nicolas Jauquier
- />Paediatric Orthopaedic and Traumatology Unit, Children’s Hospital, Lausanne, Switzerland
| | - Martina Doerfler
- />Department of Paediatric Surgery, University Children’s Hospital, Basel, Switzerland
| | - Frank-Martin Haecker
- />Department of Paediatric Surgery, University Children’s Hospital, Basel, Switzerland
| | - Carol Hasler
- />Orthopaedic Department, University Children’s Hospital, Basel, Switzerland
| | - Pierre-Yves Zambelli
- />Paediatric Orthopaedic and Traumatology Unit, Children’s Hospital, Lausanne, Switzerland
| | - Nicolas Lutz
- />Paediatric Orthopaedic and Traumatology Unit, Children’s Hospital, Lausanne, Switzerland
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