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Reddy VN, Reddy R, Safiullah M. A Case of "Nonunion Distal Tibia and Fibula Malleoli Fracture with posterior Malleoli Fracture" Treated with Ilizarov: A Case Report. J Orthop Case Rep 2024; 14:121-124. [PMID: 38420223 PMCID: PMC10898707 DOI: 10.13107/jocr.2024.v14.i02.4240] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/30/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Orthopedic surgeons have long acknowledged the difficulty of treating distal tibia and fibula fractures with posterior malleoli fractures in individuals with medical comorbidities due to a lack of inadequate blood supply. Aged Type 2 diabetic individuals, with distal tibia and fibula fracture with posterior malleoli fracture, are more prone to complications such as non-union, wound infection, and delayed bone healing. It is debatable whether surgical or non-invasive treatment is preferable for diabetic complex fractures. Case Report A 62-year-old male suffered a right distal tibia and fibula fracture with posterior malleoli fracture following an incidental fall followed by a hit over the iron rod. The patient was treated conservatively with POP for 6 weeks due to the patient's refusal of surgical management. Radiography after 6 weeks revealed features of non-union. Conclusion The Ilizarov external fixation with bone graft was planned later to treat the non-union distal tibia and fibula fracture with posterior malleoli fracture. About 18 months after the Ilizarov fixation radiography reviewed the features of the union and clinically also patient improved.
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Affiliation(s)
| | - Rajlaxmi Reddy
- Department of Orthopaedics, Sree Balaji Medical College, Chennai, Tamil Nadu, India
| | - Mohamed Safiullah
- Department of Orthopaedics, Sree Balaji Medical College, Chennai, Tamil Nadu, India
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Widanage KND, De Silva MJ, Dulantha Lalitharatne T, Bull AMJ, Gopura RARC. Developments in circular external fixators: A review. Injury 2023; 54:111157. [PMID: 37951162 DOI: 10.1016/j.injury.2023.111157] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
Circular external fixators (CEFs) are successfully used in orthopedics owing to their highly favorable stiffness characteristics which promote distraction osteogenesis. Although there are different designs of external fixators, how these features produce optimal biomechanics through structural and component designs is not well known. Therefore, the aim of this study was to conduct a review on CEFs following the PRISMA statement. A search for relevant research articles was performed on Scopus and PubMed databases providing the related keywords. Furthermore, a patent search was conducted on the Google Patent database. 126 records were found to be eligible for the review. Different designs of CEFs were summarized and tabulated based on their specific features. A bibliometric analysis was also performed on the eligible research papers. Based on the findings, the developments of CEFs in terms of materials, automation, adjustment methods, component designs, wire-clamping, and performance evaluation have been extensively discussed. The trends of the CEF design and future directions are also discussed in this review. Significant research gaps include a lack of consideration towards ease of assembly, effective wire-clamping methods, and CEFs embedded with online patient-monitoring systems, among others. An apparent lack of research interest from low-middle and low-income countries was also identified.
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Affiliation(s)
- Kithmi N D Widanage
- Department of Engineering and Design, University of Sussex, Falmer, Brighton, BN1 9RH, United Kingdom; Department of Mechanical Engineering, University of Moratuwa, Moratuwa, 10400, Sri Lanka.
| | | | | | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, SW7 2BX, United Kingdom
| | - R A R C Gopura
- Department of Mechanical Engineering, University of Moratuwa, Moratuwa, 10400, Sri Lanka
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Zheng H, Wang L, Jiang W, Qin R, Zhang Z, Jia Z, Zhang J, Liu Y, Gao X. Application of 3D printed patient-specific instruments in the treatment of large tibial bone defects by the Ilizarov technique of distraction osteogenesis. Front Surg 2023; 9:985110. [PMID: 36684263 PMCID: PMC9852528 DOI: 10.3389/fsurg.2022.985110] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
Background The Ilizarov technique of distraction osteogenesis is an effective treatment for tibia defect. However, repeated attempts to reduce due to the complexity of the bone defect during the operation will increase the operation time and iatrogenic injury, and excessive radiation exposure. Three-dimensional (3D)-printed patient-specific instrument (PSI) for preoperative 3D planning and intraoperative navigation have the advantages of accuracy and visualization. The purpose of this study is to investigate whether 3D-printed PSI is helpful to correct tibial bone defects accurately and effectively. Method From May 2019 to September 2022, 19 patients with tibial bone defects were treated, including 9 males and 10 females, aged 37 to 64 years. There were 4 cases in proximal tibia, 9 in midshaft tibia and 6 in distal tibia. All were treated with Ilizarov technique of distraction osteogenesis. 3D-printed PSI was used in 9 cases, while traditional surgery was used in 10 cases. All patients underwent computed tomography before surgery. Computer software was used to analyze the measurement results, design and print PSI. During the operation, PSI was used to assist in reduction of tibia. Operation times were recorded in all cases, the number of fluoroscopy during the operation, and the varus/valgus, anteversion/reversion angle after the operation were measured. All measurement data were expressed by means ± SD, and Student's t test was used to examine differences between groups. The chi square test or Fisher's precise test was used to compare the counting data of the two groups. Result All PSI matched well with the corresponding tibia bone defect, and were consistent with the preoperative plan and intraoperative operation. The affected limb had a good reduction effect. The operation time from the beginning of PSI installation to the completion of Ilizarov ring fixator installation was 31.33 ± 3.20 min, while that in the traditional operation group was 64.10 ± 6.14 min (p < 0.001). The times of fluoroscopy in the PSI group during operation was 10.11 ± 1.83, and that in the traditional operation group was 27.60 ± 5.82. The reduction effect of tibia in PSI group was better than that in traditional operation group, with the average angle of PSI group is 1.21 ± 0.24°, and that of traditional operation group is 2.36 ± 0.33° (p < 0.001). Conclusion The PSI simplifies procedures, reduces the difficulty of the operation, improves the accuracy of the operation, and provides a good initial position when used in distraction osteogenesis to treat the tibial defects.
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Affiliation(s)
- Hao Zheng
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Lili Wang
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Wenbo Jiang
- Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People’ s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiqing Qin
- Clinical and Translational Research Center for 3D Printing Technology, Shanghai Ninth People’ s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyu Zhang
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Zhuqing Jia
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Jian Zhang
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yong Liu
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China,Correspondence: Xuejian Gao Yong Liu
| | - Xuejian Gao
- Department of Trauma Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China,School of Clinical Medicine, Weifang Medical University, Weifang, China,Correspondence: Xuejian Gao Yong Liu
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Reitenbach E, Rödl R, Gosheger G, Vogt B, Schiedel F. Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures. Springerplus 2016; 5:2003. [PMID: 27933259 PMCID: PMC5121109 DOI: 10.1186/s40064-016-3666-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 11/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Distraction osteogenesis is a method of stimulating the growth of new bone tissue in order to lengthen the extremities or bridge resected bone defects. In addition to the now-established intramedullary procedures, two different fixator systems are in use. The present study investigated the classical Ilizarov ring fixator (IRF) and a hexapod to assess the precision of lower-leg lengthening and complications classified using the Paley criteria for problems, obstacles, and complications. The study also examined the follow-up results in functional tests to assess outcomes in terms of range of motion in adjacent joints, daily activities, and quality of life. PATIENTS AND METHODS A total of 43 patients (53 segments) who were treated over a period of 16 years were re-assessed. In 33 segments, treatment was carried out with the hexapod Taylor Spatial Frame (TSF); the conventional IRF was used in 20 segments. The patients' mean age was 13.5 years (range 2-54 years). The follow-up examinations were carried out 2-15 years postoperatively and comprised measurement of a current leg axis view with the patient standing, calculation of a knee score, activity scores, ankle joint scores, and assessment of motor function and sensory function using appropriate scores in the lower leg and foot. The post-treatment health-related quality of life was assessed using the Short-Form Health Survey-36 questionnaire. RESULTS Using the Paley criteria, far fewer problems occurred in the TSF group in comparison with the IRF (TSF 12.1%, IRF 50%). In the problems category, significant differences were observed with regard to axial deviation (TSF 0%, IRF 36.8%) and pin infections (TSF 9.1%, IRF 40%). Comparison of the obstacles and complications did not identify any significant differences between the two groups. Analysis of the scores for the knee, activity, and motor function/sensory function also did not show any marked discrepancies, apart from a major difference in mobility in the upper and lower ankle joints with poorer findings in the TSF group. CONCLUSIONS During treatment, the TSF ring fixator leads to fewer problems, fewer secondary axial translations, and fewer pin infections. However, with temporary transfixation of the ankle joints, the TSF system is also associated with postoperative deterioration in mobility in the upper and lower ankle joint.
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Affiliation(s)
- Eugen Reitenbach
- Department of Orthopaedics, Klinikum Dortmund GmbH, Klinikzentrum Mitte, Dortmund, Germany
| | - Robert Rödl
- Department of General Orthopaedics and Tumor Orthopaedics, Münster University Hospital, Münster, Germany
| | - Georg Gosheger
- Department of Pediatric Orthopaedics, Deformity Correction and Foot Surgery, Münster University Hospital, Münster, Germany
| | - Björn Vogt
- Department of General Orthopaedics and Tumor Orthopaedics, Münster University Hospital, Münster, Germany
| | - Frank Schiedel
- Clemenshospital Muenster, Dept. of Pediatric Orthopedics and Deformity Correction, Muenster, Germany
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Abstract
BACKGROUND This study was conducted to determine the pin-site care protocols currently in use and to analyse their effectiveness and outcomes. METHODS PubMed, the Cochrane Library and Embase databases were screened for manuscripts that described comparative studies of different methods of pin-site care and referred to complications related to any kind of external fixator application. RESULTS A total of 369 manuscripts were screened and only 13 of these met the inclusion criteria evaluating different protocols of pin-site care. This review is based on a total of 574 patients. Infection rates were very variable depending on the type of implant used and the protocol of pin-site care applied. CONCLUSIONS None of the different protocols of pin-site care that were evaluated in this study were associated with a 0% infection rate. There is currently no consensus in the international literature about which protocol should be applied universally. Meticulous surgical technique during pin insertion and implementation of one of the existing protocols of pin-site care are the mainstay of prevention and/or reduction of the incidence of pin-site infections.
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Affiliation(s)
- Ioannis Ktistakis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Enrique Guerado
- Academic Department of Trauma & Orthopaedic Surgery, University of Malaga, Malaga, Spain
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, LS7 4SA, UK.
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Abstract
BACKGROUND Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20-50 years were treated with the Ilizarov method. MATERIALS AND METHODS Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases. RESULTS Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5-2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4-6 weeks. CONCLUSION The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.
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Affiliation(s)
- Sunil Kulkarni
- Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, India
| | - GS Kulkarni
- Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, India
| | - Ashok K Shyam
- Department of Academic Research, Indian Orthopedic Research Group, Mumbai, Maharashtra, India,Address for correspondence: Dr. Ashok K Shyam, Academic Research Division, Sancheti Institute of Orthopedics and Rehabilitation, 16 Shivaji Nagar, Pune-411 005, Maharashtra, India. E-mail:
| | - Milind Kulkarni
- Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, India
| | - Ruta Kulkarni
- Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, India
| | - Vidisha Kulkarni
- Department of Orthopaedics, Postgraduate Institute of Swasthiyog Pratishthan, Miraj, India
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