Ilizarov technique combined with limited adjunctive surgical procedures for correction of relapsed talipes equinovarus in children

Objective To evaluate the efficacy and safety of using the Ilizarov invasive distraction technique combined with limited surgical operations in the treatment of relapsed talipes equinovarus in children. Methods This retrospective study analysed the outcomes of paediatric patients with relapsed talipes equinovarus who were treated with the Ilizarov technique with moderate open limited soft tissue or bony operations. The International Clubfoot Study Group (ICFSG) classification system score was used to evaluate the deformities before and after surgery. Results The study evaluated 16 feet in 14 patients (nine boys). The correction time ranged from 6 to 12 weeks. The mean duration of frame application was 5.9 months. The gait was improved significantly in all patients. At final follow-up, the mean ankle dorsiflexion and plantarflexion ranges were 8.3° and 34.6°, respectively. The talocalcaneal angle improved from 10.0° preoperatively to 28.3° postoperatively in the anteroposterior plane; and from 4.1° preoperatively to 42.1° postoperatively in the lateral plane. The differences in the angle of plantarflexion, dorsiflexion, range of motion of the ankle joint and talocalcaneal angles pre- and postoperation were significant. Conclusions These current findings suggest that the Ilizarov technique combined with limited surgery effectively corrects relapsed talipes equinovarus in children.

The effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method

PURPOSE

Exerting axial pressure on the affected lower limb remains one of the most crucial elements of Ilizarov method. The objective was to determine the effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov method.

METHODS

The study included 15 patients who underwent lower limb lengthening. The patients were tested on the third day after surgery using the pedobarographic platform. The tests were performed four times in the standing position: twice with the support of forearm crutches and twice without crutches. Patients were asked to either remain in the relaxed standing position (two tests) or use the lower limb equipped with Ilizarov apparatus to support the body weight (two tests).

RESULTS

In relaxed stance average pressure with forearm crutches was 24.1% for affected limb, as compared to 75.9% for the healthy limb. In test without forearm crutches average pressure for affected limb was 26.1%, as compared to 73.9% for the healthy limb. Patients shifted body weight to the affected limb with forearm crutches on average, at the rate of 53.6%. In test without forearm crutches the affected limb was supporting the body weight at the rate of 48.26%. None of the patients was able to fully support the body weight on the affected leg.

CONCLUSIONS

In spite of strict physiotherapy regimen, patients are neither able to equally distribute their body weight between the two lower limbs nor to shift their body weight to the limb equipped with Ilizarov apparatus.

TREATMENT OF CONGENITAL PSEUDARTHROSIS OF THE TIBIA

The work is based on an analysis of treatment results of 47 patients with congenital pseudarthrosis of the tibia. The Ilizarov technique of unfree osteoplasty was applied on these patients. The authors considered an application of combined variants of exterior and external osteosynthesis as very perspective in rehabilitation of the patients with congenital pseudarthrosis.

The analysis of self-esteem based on patients` self-perception after Ilizarov limb lengthening treatment

In the article there is shown the analysis of patients self-perception after the Ilizarov limb lenghening treatment due to inequality. 150 patients both sexes (78 girls and 72 boys) were tested between 1992 and 2003 in our center. The average age for girls at the time of follow-up was 19.5 years and 18.5 years for boys. In the survey there was used four point-scale SES by Irena Dzwokowska, Kinga Lachowicz-Tabaczek and Mariola Łagun which was based on Rosenberg work. The results were divided into two groups: low or high score. It was evaluated according to the table of standards which included people age and sex. Then the score was transformed into standard ten. For statistical calculations was used MicroSoft Excel spreadsheet. In the case of statistical studies was used Spss v.17.0. It was found that among survey respondents regardless of gender and age after the satisfactory completion of Ilizarov treatment patients gain a high level of self-assessment at 7 standard ten. The high self-esteem can predict the level of patients` comfort in many aspects of their lives. People with such a hight self-perception will experience more positive emotions and will be healthier and more active.

The principles of caring for patients with Ilizarov external fixation

External fixation is an important aspect of complex fracture management. Ilizarov fixation is a specialised type of external fixator consisting of numerous wires that penetrate the limb and are attached to a circular metal frame. Ilizarov fixation is used for fracture fixation and stabilisation, limb reconstruction, deformity correction and limb lengthening. The external fixator can be in place for many months and patients will need to adapt to the device and demonstrate an understanding of the principles of pin site care. Psychosocial issues also need to be considered.

[Complications of distraction-compression osteogenesis and their prophylaxis--a clinical report]

The authors present a historical overview of various classifications of distraction osteogenesis complications. Paley's classification as well as the authors' own classification also presented. Basing on the authors' own 10 year experiences with the Ilizarov method, selected complications at different stages of diagnostics, treatment and rehabilitation are presented. The most effective forms of prophylaxis are presented, with special attention given to the surgeon's own experience with the Ilizarov method.

The Ilizarov method in infected nonunion of fractures

Thirty patients with infected non-union of long bones were treated with radical resection of the necrotic bone and bone transport or compression/distraction osteosynthesis. Non-union, infection, deformity, bone gap and shortening were all addressed simultaneously using the Ilizarov principles. There were 15 cases with bone loss ranging from 4 to 12 cm (median bone gap of 7 cm), 10 cases of stiff non-union (six of which had an associated deformity) and five cases of mobile non-union. The median time in the Ilizarov frame was 150 days. Median follow up time after frame removal was 23.5 months. Bone grafting at the docking site was only required in three cases (10%). There were three cases of refracture (10%) and three cases of recurrence of infection (10%). The bone result was excellent in 21 patients (70%), good in three (10%), fair in none (0%) and poor in six (20%). The functional results were excellent in eight patients (26.7%), good in 12 (40.0%), fair in three (10%) and poor in seven (23.3%). It is difficult to precisely define the indications for preservation and reconstruction of severe injuries. The surgical team has to take into account the length, disability, complications and cost of treatment. Patients must be aware of the limitations of functional results and the possible difficulty of return to work despite the reconstructive attempt.

Reconstruction of bone defect using the bone transport technique for a case of osteosarcoma of the femur

There are few reports on skeletal reconstruction using the bone transport technique to repair bone defects caused by resections of tumors associated with osteosarcoma. We attempted to reconstruct a 23 cm bone defect after resection of an osteosarcoma of the left femur, and succeeded in gaining 17 cm by bone transport. Five years after surgery, this patient remains alive without metastasis or local recurrence.

[Self-care in treatment following the Ilizarov method--a case study]

The authors performed a case study using Dorothea Orem's self-care model as a framework in the treatment by llizarov's method, administering care and specific orientations for recovery and prevention of further disorders. The operational system of the study consisted of procedures related to demands of universal and therapeutic care during hospitalization. Demands were detected in the pre-operative and care developed in the postoperative phase, providing the patient with the knowledge and achievement of the necessary procedures to be followed at home.