Strategies in Trauma and Limb Reconstruction

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2016 | November | Volume 11 | Issue 3

Review

Alexander V. Gubin, Dmitry Y. Borzunov, Larisa O. Marchenkova, Tatiana A. Malkova, Irina L. Smirnova

Contribution of G.A. Ilizarov to bone reconstruction: historical achievements and state of the art

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:8] [Pages No:145 - 152]

Keywords: Ilizarov method, Bone regeneration, Distraction, Compression, External fixation

PDF  |  DOI: 10.1007/s11751-016-0261-7  |  Open Access |  How to cite  | 

Abstract

Methodological solutions of Prof. G.A. Ilizarov are the core stone of the contemporary bone lengthening and reconstruction surgery. They have been acknowledged in the orthopaedic world as one of the greatest contributions to treating bone pathologies. The Ilizarov method of transosseous compression–distraction osteosynthesis has been widely used for managing bone non-union and defects, bone infection, congenital and posttraumatic limb length discrepancies, hand and foot disorders. The optimal conditions for implementing distraction and compression osteogenesis were proven by numerous experimental studies that Prof. G.A. Ilizarov organized and supervised at a large orthopaedic research institute in Kurgan. The tension stress effect on regeneration and growth of tissues was thoroughly investigated with radiographic, histological and biochemical methods. The impact of the Ilizarov method on the progress of bone lengthening and reconstruction surgery could be called revolutionary.

Original Article

Ibrahim Elsayed Abdellatif Abuomira, Francesco Sala, Yasser Elbatrawy, Giovanni Lovisetti, Salvatore Alati, Dario Capitani

Distraction osteogenesis for tibial nonunion with bone loss using combined Ilizarov and Taylor spatial frames versus a conventional circular frame

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:7] [Pages No:153 - 159]

Keywords: Bone transport, Tibial nonunion, Bone defect, Docking site, Taylor spatial frame, Ilizarov

PDF  |  DOI: 10.1007/s11751-016-0264-4  |  Open Access |  How to cite  | 

Abstract

This retrospective review assesses 55 tibial nonunions with bone loss to compare union achieved with combined Ilizarov and Taylor spatial frames (I–TSF) versus a conventional circular frame with the standard Ilizarov procedure. Seventeen (31 %) of the 55 nonunions were infected. Thirty patients treated with I–TSF were compared with 25 patients treated with a conventional circular frame. In the I–TSF group, an average of 7.6 cm of bone was resected and the lengthening index (treatment time in months divided by lengthening amount in centimeters) was 1.97. In the conventional circular frame group, a mean of 6.5 cm was resected and the lengthening index was 2.1. Consolidation at the docking site and at the regenerate bone occurred in 49 (89 %) of 55 cases after the first procedure. No statistically significant difference was shown between the two groups. Superiority of one modality of treatment over the other cannot be concluded from our data. Application of combined Ilizarov and Taylor spatial frames for bone transport is useful for treatment of tibial nonunion with bone loss. Level of evidence Case series, Level III.

Original Article

Kamilcan Oflazoglu, Nienke Koenrades, Matthijs P. Somford, Michel P. J. van den Bekerom

Recognizing the elbow prosthesis on conventional radiographs

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:8] [Pages No:161 - 168]

Keywords: Elbow, Arthroplasty, Prosthesis, Radiograph

PDF  |  DOI: 10.1007/s11751-016-0263-5  |  Open Access |  How to cite  | 

Abstract

The objective of this study was to make an overview that can be useful in determining which type and brand of prosthesis a patient has when visiting the emergency department or outpatient clinic with a periprosthetic fracture, dislocation, or implant failure. The commonly used prostheses in Europe are opted for this list. The radiographs used for this list are obtained either from the company or from our own patients. This list contains the Coonrad/Morrey total elbow prosthesis, the Nexel total elbow prosthesis, the GSB III Elbow Prosthesis, the iBP Total Elbow System, the Discovery Elbow System, the NESimplavit Elbow System, the Latitude Elbow prosthesis, the Solar Elbow, and the Souter–Strathclyde total elbow. The characteristics of each prosthesis are described.

Original Article

John Ham, Mark Flipsen, Marianne Koolen, Arnard van der Zwan, Konrad Mader

Multiple osteochondromas (MO) in the forearm: a 12-year single-centre experience

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:7] [Pages No:169 - 175]

Keywords: Multiple hereditary exostoses (MHE), Multiple osteochondromas (MO), Masada classification, Forearm reconstruction, Corrective osteotomy, External fixation, Review

PDF  |  DOI: 10.1007/s11751-016-0267-1  |  Open Access |  How to cite  | 

Abstract

Multiple osteochondromas (MO) are a rare autosomal dominant disorder characterized by the presence of osteochondromas located on the long bones and axial skeleton. Patients present with growth disturbances and angular deformities of the long bones as well as limited motion of affected joints. Forearm involvement is found in a considerable number of patients and may vary from the presence of a simple osteochondroma to severe forearm deformities and radial head dislocation. Patients encounter a variety of problems and symptoms e.g., pain, functional impairment, loss of strength and cosmetic concerns. Several surgical procedures are offered from excision of symptomatic osteochondromas to challenging reconstructions of forearm deformities. We describe visualizing, planning and treating these forearm deformities in MO and, in particular, a detailed account of the surgical correction of Masada type I and Masada type II MO forearm deformities.

Original Article

J. A. D. van der Woude, S. Spruijt, B. T. J. van Ginneken, R. J. van Heerwaarden

Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:10] [Pages No:177 - 186]

Keywords: Distal femoral osteotomy, Valgus producing, Closed-wedge, Limb alignment, Biplanar, Uniplanar

PDF  |  DOI: 10.1007/s11751-016-0266-2  |  Open Access |  How to cite  | 

Abstract

Varus deformity can be localized in the tibia, in the femur or in both. If varus deformity is localized within the femur, it is mandatory to correct it in the femur. This report presents the technique and results of a consecutive case series of lateral uniplanar and biplanar closed-wedge valgus osteotomy of the distal femur for the treatment of varus deformity of the knee. Retrospectively, fifteen patients (sixteen knees) were identified. Indications for surgery varied from unloading an osteoarthritic medial compartment to reduction to symmetrical varus leg alignment. Pre- and post-operative X-rays, including a full leg radiograph, were assessed as well as bone healing time at follow-up intervals. Clinical outcome was assessed using different questionnaires. There were nine male and six female patients with a median age at surgery of 45 (±14) years. The mLDFA changed from 95.9° (±2.7°) preoperatively to 89.3° (±2.9°) post-operatively. Preoperative planning and the use of angle stable implants resulted in accurate corrections according to preoperative aims in all but one patient. At follow-up (mean, 40 months), the mean VAS score was 2.5 (±2.4) and the WOMAC score averaged 80 (±20). The mean bone healing time of biplanar osteotomies (4 ± 3 months) was shorter than in the uniplanar osteotomies (6 ± 3 months). Distal lateral closed-wedge valgus osteotomy of the femur for the treatment of femoral varus deformities resulted in clinical improvement and accurate corrections in patients with different aims for correction. A biplanar osteotomy technique shortens bone healing time.

Original Article

Nikolai Briffa, Raju Karthickeyan, Joshua Jacob, Arshad Khaleel

Comminuted supracondylar femoral fractures: a biomechanical analysis comparing the stability of medial versus lateral plating in axial loading

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:5] [Pages No:187 - 191]

Keywords: Supracondylar femur fracture, Medial versus lateral plating, Axial loading testing, Construct stability

PDF  |  DOI: 10.1007/s11751-016-0268-0  |  Open Access |  How to cite  | 

Abstract

The aim of this study was to compare the biomechanical properties of medial and lateral plating of a medially comminuted supracondylar femoral fracture. A supracondylar femoral fracture model comparing two fixation methods was tested cyclically in axial loading. One-centimetre supracondylar gap osteotomies were created in six synthetic femurs approximately 6 cm proximal to the knee joint. There were two constructs investigated: group 1 and group 2 were stabilized with an 8-hole LC-DCP, medially and laterally, respectively. Both construct groups were axially loaded. Global displacement (total length), wedge displacement, bending moment and strain were measured. Medial plating showed a significantly decreased displacement, bending moment and strain at the fracture site in axial loading. Medial plating of a comminuted supracondylar femur fracture is more stable than lateral plating.

Original Article

Alexios Dimitrios Iliadis, Parag Kumar Jaiswal, Jay Meswania, Gordon Blunn, David Goodier, Peter Calder

Stability at the half pin–frame interface on external fixation constructs

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:6] [Pages No:193 - 198]

Keywords: Half pin–frame interface, External fixation constructs, Grub screws, Bolt screws, Stability

PDF  |  DOI: 10.1007/s11751-016-0269-z  |  Open Access |  How to cite  | 

Abstract

A mechanical study investigating the use of two different methods (grub and bolt screws) to secure external fixation half pins to circular frames. A four part experiment: (1) Grub and bolt screws were used to secure half pins in Taylor Spatial frames. Loosening torques were measured using a calibrated torque wrench. (2) Using universal testing machine (UTM), axial loading was applied to establish thresholds for loosening in grub and bolt screw constructs. (3) We established the application torque to produce failure at the head–driver interface using these two methods. (4) Grub and bolt screw constructs were created controlling torque. Using UTM, axial loading was applied to establish thresholds for loosening. Statistical analysis was conducted using SPSS v20.0.0. (1) Higher torque is employed when bolt rather than grub screws is used to secure half pins on Rancho cubes (p < 0.05). (2) Loading threshold for loosening is higher in bolt screw constructs when the torque applied to secure the constructs is not controlled (p < 0.05). (3) Torque required for failure at the head–driver interface was 5.3 Nm for grub screws and 9.9 Nm for bolts. (4) Loading threshold for loosening is higher in grub screw constructs when the same torque was applied to secure them (p < 0.05). Bolt screws can be employed to secure the half pin–frame interface. They offer good stability and reduce failure at the head–driver interface. Further research is needed to determine the mechanical properties of such constructs in vivo.

TECHNICAL REPORT

Saravanaraja Muthusamy, S. Robert Rozbruch, Austin T. Fragomen

The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery

[Year:2016] [Month:November] [Volume:11] [Number:3] [Pages:7] [Pages No:199 - 205]

Keywords: Limb lengthening, Deformity correction, Intramedullary lengthening nail, Reverse rule of thumb, Blocking screws

PDF  |  DOI: 10.1007/s11751-016-0265-3  |  Open Access |  How to cite  | 

Abstract

Internal lengthening nail (ILN) is a recent development in limb lengthening and deformity correction specialty. The ILN has the distinct advantage of combining acute deformity correction with gradual lengthening of bone. While using ILN, the short metaphyseal bone fragment may develop a deformity at the time of osteotomy and nail insertion or during bone lengthening because of the wide medullary canal. These deformities are typically predictable, and blocking screws (Poller screws) are helpful in these situations. This manuscript describes the common deformities that occur in femur and tibia with osteotomies at different locations while using ILN in antegrade and retrograde nailing technique. Also, a systematic approach to the appropriate use of blocking screws in these deformities is described. In addition, the “reverse rule of thumb” is introduced as a quick reference to determine the ideal location(s) and number of blocking screws. These principles are applicable to limb lengthening and deformity correction as well as fracture fixation using intramedullary nails.

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