Статьи журнала - Гений ортопедии

Все статьи: 2024

In vitro исследование динамики элюции антибактериальных препаратов, импрегнированных в матрицы на основе полимерного гидрогеля

In vitro исследование динамики элюции антибактериальных препаратов, импрегнированных в матрицы на основе полимерного гидрогеля

Меликова Регина Энверпашаевна, Цискарашвили Арчил Важаевич, Артюхов Александр Анатольевич, Сокорова Наталья Вячеславовна

Статья научная

Цель. Изучить динамику и длительность элюции антибактериальных препаратов из образцов на основе полимерного гидрогеля и ПММА. Материалы и методы. Сравниваемые образцы, импрегнированные ванкомицином, рифампицином и цефазолином в различных концентрациях, помещали в фосфатно-солевой буфер, инкубировали при 37 °C. На 1, 3, 7, 14, 21 и 28 сутки проводили полную замену среды. Концентрацию препаратов в растворе и их профили высвобождения определяли спектрофотометрическим методом. Для статистического описания данных 5 параллельных исследований использовали медиану и 95 % ДИ. Результаты. На протяжении всего периода исследования концентрации всех протестированных антибиотиков, элюированных из полимерного гидрогеля, превышали концентрации, высвобожденные из ПММА, в среднем в 7 раз на 1-е сутки, в 15 раз - на 2-е и 3-и сутки, в 6,6 раза - на 7-е сутки, в 3 раза и более - в последующие дни наблюдения. Заметно отличалась и скорость релиза антибиотиков из объема гидрогелей. Обсуждение. Для всех гидрогелевых образцов релиз препаратов составил более 70 % от его общего количества, в отличие от ПММА, элюция которого не превышала 10 %. Несмотря на то, что, как и в случае костного цемента, наблюдался бёрст-релиз, и до 80 % антибиотика высвободилось в первые 5 суток наблюдений, концентрация элюированного препарата из гидрогелей была кратно выше и превышала МПК в течение всего периода наблюдения. Высвобождение противомикробного агента из гидрогелей обусловлено диффузией частиц из вcего объема матрицы, что является важным преимуществом по сравнению с ПММА, потенциал которого ограничен поверхностным истощением. Заключение. На данном этапе нами показана возможность создания потенциальных депо-систем на основе ненасыщенных производных ПВС с контролируемым релизом антибиотиков, которые превосходят по своим характеристикам ПММА.

Бесплатно

In vitro оценка антимикробной активности модифицированных костных ксеноматериалов

In vitro оценка антимикробной активности модифицированных костных ксеноматериалов

Стогов Максим Валерьевич, Смоленцев Дмитрий Владимирович, Науменко Зинаида Степановна, Годовых Наталья Викторовна, Гурин Максим Вячеславович, Киреева Елена Анатольевна, Лукьянов Александр Евгеньевич, Дюрягина Ольга Владимировна, Тушина Наталья Владимировна

Статья научная

Цель. Оценка антимикробных свойств оригинальных костных имплантационных ксеноматериалов, импрегнированных по разным технологиям ванкомицином. Материалы и методы. Костный ксеноматрикс модифицировали по двум технологиям: адсорбция ванкомицина на поверхности материала и абсорбция ванкомицина в объеме материала с использованием промежуточного носителя. При импрегнации антибиотика использовали метод сверхкритической флюидной экстракции диоксидом углерода. Изучена кинетика высвобождения антибиотика из модифицированного ксеноматериала. В исследовании in vitro изучена его антимикробная активность по отношению S. aureus. Результаты. Обнаружено, что выход ванкомицина из материала, выполненного по технологии адсорбции, после 24 часов инкубации составил более 98 % от исходного содержания в матриксе. Остаточное содержание антибиотика в среднем составляло 1,75 %. Использование промежуточного носителя (L/D изомер полилактида) позволяет получить материал с дозированным пролонгированным выходом ванкомицина...

Бесплатно

In vivo эффективность полимерных гидрогелей, импрегнированных антибактериальным препаратом, при хроническом остеомиелите

In vivo эффективность полимерных гидрогелей, импрегнированных антибактериальным препаратом, при хроническом остеомиелите

Цискарашвили А.В., Меликова Р.Э., Волков А.В., Зайцева О.С., Пхакадзе Т.Я., Артюхов А.А., Сокорова Н.В.

Статья научная

Введение. Полиметилметакрилат (ПММА) является распространенной депо-системой при лечении хронического остеомиелита. Однако множество существующих недостатков не позволяет считать его идеальной.Цель. В условиях in vivo изучить эффективность купирования хронического остеомиелита большеберцовой кости на модели кроликов полимерным гидрогелем, содержащим антибиотик, и сравнить с ПММА.Материалы и методы. Исследование выполнено на голени 25 половозрелых кроликов породы Шиншилла. Была создана модель хронического остеомиелита большеберцовой кости. Инфекционным агентом выбран метициллинчувствительный штамм Staphylococcus aureus (MSSA), высокоактивный в отношении цефазолина. Через 21 день после клинико-лабораторного, рентгенологического имикробиологического подтверждения диагноза приступали к хирургической санации, методика для всех животных была одинаковой. Опытной группе (n = 11) имплантировали полимерный гидрогель, сравнительной (n = 11) - ПММА, контрольной (n = 3) - имплантация не производилась. В послеоперационном периоде проводили мониторинг локального статуса, веса и температуры тела животных, микробиологическое и рентгенологическое исследование. Животных выводили поэтапно. Биоптаты направляли на бактериологическое и гистоморфометрическое исследование. Статистическое сравнение групп выполнено при помощи критериев Манна - Уитни, Краскелла - Уоллиса и Тьюки, для контрольной группы использовали описательную статистику.Результаты. В опытной группе во всех случаях послеоперационные раны зажили своевременно, уровни WBC и СРБ значимо (p = 0,040) снизились с 14 и 21 суток соответственно. Микробиологически роста микрофлоры из отделяемого раны и биоптатов не выявлено, рентгенологически прогрессирование хронического остеомиелита не наблюдалось, гистоморфометрически отмечено достоверное (p = 0,002) эффективное купирование воспалительного процесса. В случае сравнительной группы с 7-х послеоперационных суток потребовалась системная антибиотикотерапия. Уровни маркеров воспаления снижались менее эффективно, чем в опытной группе. MSSA верифицировался из отделяемого раны и биоптатов почти на каждом контрольном сроке. Рентгенологически и гистоморфометрически (p = 0,001) в среднем наблюдалась картина обострения остеомиелита. В контрольной группе системная терапия не дала положительной динамики.Обсуждение. Сравнительный анализ показал, что гидрогель в отличие от ПММА достоверно купирует хронический остеомиелит без дополнительной вспомогательной системной антибиотикотерапии и не вызывает материал-ассоциированную резорбцию костной ткани. При этом клинико-лабораторная картина полностью соответствует данным микробиологии, рентгенологии и гистоморфометрии.Заключение. Гидрогель, импрегнированный антибиотиком, достоверно и эффективно купирует хронический остеомиелит по сравнению с ПММА.

Бесплатно

Insignificant correlation between post-operative swelling and early functional outcome after ankle fusion

Insignificant correlation between post-operative swelling and early functional outcome after ankle fusion

Primadhi Raden Andri, Prasetia Renaldi, Alpharian Gibran, Rasyid Hermawan Nagar

Статья научная

Introduction Swelling is a common complication following a foot and ankle surgery, and is one of the most prevalent complaints that patients present at the clinics. While it affects patients’ satisfaction, the relevance between the swelling and clinical outcome remains unclear. Material and Methods This study assessed volume of foot and ankle swelling in 112 patients with history of ankle fusion, the patients’ Foot Function Index (FFI) score, and patients’ satisfaction. The relationships between swelling volume and early outcomes were analysed with Pearson’s correlation coefficient and a scatter plot. Results The mean of swelling volume increase was 120.0 ± 96.2 ml (range 5 ~ 400 ml); pre-operative FFI score mean was 73.7 ± 4.8 % (range 68 % ~ 81 %), 3 months post-operative FFI score mean was 32.8 ± 5.0 % (range 22 % ~ 56 %) and satisfaction scale’s median was 1 (satisfied). In the correlation analysis, while the meaningful Pearson’s correlation coefficient was found with satisfaction scale, swelling volume showed a weak correlation of Pearson’s correlation test with FFI scores (R value = 0.190; p value = 0.045). Conclusions This study revealed that the swelling of the foot and ankle following ankle fusion surgery are not associated with functional clinical outcome. However, because it affects the patients’ satisfaction, we emphasize the need to identify the problem and management of the swelling, while assuring them that the swelling does not correlate with the early functional outcome.

Бесплатно

Is arthroplasty inevitable after Ilizarov hip reconstruction of unstable hip joints in adolescents and young adults? Long-term evaluation of 136 cases

Is arthroplasty inevitable after Ilizarov hip reconstruction of unstable hip joints in adolescents and young adults? Long-term evaluation of 136 cases

Hosny Gamal Ahmed, Ahmed Abdel-Salam Abdel-Aleem

Статья научная

Introduction Whereas hip joint destroying trauma and diseases are difficult situations, the problem is more complex when it is complicated by hip instability. This could be a sequel of several hip affections such as trauma, septic or tuberculous arthritis, neglected developmental dysplasia of the hip, postoperative conditions, and neurologic pathologies (cerebral palsy, myelomeningocele, poliomyelitis). Purpose The purpose of this study is to evaluate long-term radiographic and clinical outcomes of the Ilizarov hip reconstruction for the treatment of painful and unstable hips in adolescents and young adults. Materials and methods The study included 136 patients with an average age of 18.3 years (range, 6 to 34 years); 75 patients were males (55.1%) and 61 females (44.9%). The primary causes of the hip instability were untreated or unsuccessfully treated cases of septic arthritis (40 cases; 29.4 %), congenital hip dislocation (28 cases; 20.6 %), paralytic hip dislocation (36 cases; 26.5 %), proximal femoral focal deficiency (14 cases; 10.3 %), neglected fracture of the femoral neck (10 cases; 7.4 %), osteoarthritis (6 cases; 4.4 %), and tuberculous hip arthritis (2 cases; 1.5 %). The intervention consisted in the performance of two osteotomies (proximal and distal) of the femur with pelviс support and placement of the Ilizarov apparatus of a specific assembly. Results The external fixation period ranged from 4 to 12 months (6.5 months on average). Patients were followed up for an average of 17.4 years (range, 5 to 27 years). Multiple clinical parameters at final follow-ups showed significant improvement, including pain relief, pain-free walking distance, lameness, hip flexion and abduction, hip contracture, and lumbar lordosis. Functionally, the mean Harris Hip Score improved with a statistically significant difference from 48 points (range, 35-65) before surgery to 83 points (range 70-90) after surgery. The pain disappeared in all patients, with the exception of six cases of pain in the early postoperative period. In all cases, supportive walking aids were no longer necessary, with the exception of two cases of persistent pain by physical activities. Walking ability and painless walking distance improved in all patients from an average of 35 m (range, 10 to 50 m) before surgery to 1,150 m (range, 1,000 to 1,500 m) after surgery, showing significant difference. Conclusion Ilizarov pelvic support osteotomy provided a multi-purpose solution to the complex challenging problem of hip instability in adolescents and young adults with variable primary etiologies. The improvements in the hip motion, mechanical axis, and correction of limb-length discrepancy lead to good functional outcomes over a long-term follow-up. This treatment modality might avoid or postpone the need for total hip arthroplasty for several years.

Бесплатно

Management of bone defect of humerus by Ilizarov method

Management of bone defect of humerus by Ilizarov method

Omer Ali Rafiq Barawi

Статья

Бесплатно

Management of congenital radial club hand by gradual correction

Management of congenital radial club hand by gradual correction

Gamal A. hosny, Abdel-salam A. ahmed

Статья научная

Introduction Severe congenital radial club hand is aesthetically unacceptable. This paper represents our experience in treating early and late diagnosed cases using gradual distraction by Ilizarov external fixator. Methods We treated 34 cases of congenital radial club hand with an age ranged from 1 to 15 years. There were 20 girls and eight bilateral cases. Three had been treated on both sides. So, we have treated 37 limbs. Nine cases had been operated before. Centralization alone was done in 12 cases and followed by lengthening in eight cases. Ulnar lengthening and gradual correction of wrist deformities were done for the rest of cases. The patients were followed clinically and radiographically with the following parameters: hand forearm angle, range of motion, daily functional activities, extent of lengthening achieved, and cosmetic improvement. Results The follow up ranged from 1 to 10 years. The magnitude of lengthening achieved ranged from 5 to 11 cm. The average healing index was 52.02 days/cm with cosmetic appearance satisfaction in all cases. Complications included; pin tract infection in 24 cases, flexion contractures of the elbow and fingers in 26 cases [which mostly disappeared during follow up], and spontaneous ulnocarpal fusion in 2 cases. Two cases suffered fracture in the regenerate zone. Conclusions The use of the Ilizarov method with gradual distraction of bone and soft tissues in treatment of radial club hand was effective in forearm lengthening with functional and cosmetic improvement.

Бесплатно

Management of forearm bone gap non-unions by Ilizarov technique

Management of forearm bone gap non-unions by Ilizarov technique

Bari M.M., Islam Shahidul, Shetu Nazmul Huda, Mahfuzer Rahman

Статья научная

Purpose Proper treatment of forearm bone gap non-union should achieve both biological stimulation of the bone and elastic mechanical stability. The use of Ilizarov technique enhances the healing of a non-union providing osteogenic, osteoconductive and an optimal stability with the Ilizarov fixation. We retrospectively reviewed 26 patients affected by forearm bone non-union and treated with the Ilizarov fixation. Materials and Methods Twenty six patients were treated for gap non-unions of forearm bones with the Ilizarov compression distraction device from 2000 to 2015 in BARI-ILIZAROV ORTHOPAEDIC CENTRE. Results All the difficult non-unions healed in a mean of 7 months, ranging from 5 to 12 months. At the latest follow- up, forearm functions were satisfactory. Conclusion The Ilizarov compression distraction device is a fantastic tool in promoting the healing of forearm non-unions, even if the bones are very atrophic.

Бесплатно

Microsurgical limb reconstruction utilizing Truelok TL external fixator:a case report

Microsurgical limb reconstruction utilizing Truelok TL external fixator:a case report

Rodriguez-Collazo Edgardo, Huey Jonathan

Статья научная

Coverage of lower extremity wounds, especially those in the distal leg, present challenges to the reconstructive surgeon. The present case illustrates a surgical technique utilizing a distally based reverse soleus muscle flap for coverage of an anterior leg wound deficit with exposed bone. The wound failed conservative wound care and was at risk of a below the knee amputation. The wound was first debrided to healthy bleeding tissue. The Truelok TL External Fixator was then applied for stabilization of the muscle flap. The medial portion of the soleus muscle was dissected with care to preserve its vascular supply and transposed to cover the wound defect. This was followed by utilization of the Integra Bi-Layer Matrix to control the vapor loss of the wound, act as a bacterial barrier, and provide a scaffold for cellular invasion and capillary growth. A wound VAC was applied to promote granular tissue formation. Following post-operative wound care, a split-thickness skin graft was later applied. The limb was salvaged and wound closure was achieved within three months. The patient began ambulating in a patella tendon bearing orthosis within four months. The reverse soleus muscle flap provides a viable option for ankle wound and anterior leg coverage, especially in medically frail patients. Due to a high degree of versatility, reliability, minimal donor site morbidity, less operating time, low cost and good functional gain; this procedure is highly suitable for the treatment of complex middle and lower leg defects. It should be considered in the reconstruction of soft tissue defects about the ankle, especially when the surgeon has exhausted all other conservative and surgical options.

Бесплатно

Musculoskeletal anomalies in children with mucopolysaccaridoses

Musculoskeletal anomalies in children with mucopolysaccaridoses

Mller Florence, Alomar Khaled, Journeau Pierre

Статья научная

Introduction The accumulation of glycosaminoglycan (GAGs) in the tissues in Mucopolysaccharidoses (MPS) can lead to skeletal anomalies (DYSOSTOSIS MULTIPLEX) and to soft tissue impairments (neural or medullar compression, joint stiffness, tenosynovitis). Here is a review of orthopedic issues frequently encountered in patients with MPS. Material and methods Surgery may be justified at different age and according to the type of MPS. Different surgical approaches and their indications are exposed in the article. Results The article exposes indications and techniques for orthopedic issues in MPS children: cervical stenosis, cervical instability, kyphosis, hip dysplasia and hip dislocation, genu valgum. Conclusion Various musculoskeletal anomalies can be found in patients with mucopolysaccharidoses. Neurological impairments are frequently seen due to cervical stenosis or instability and should be early detected with regular MRI of the cervical spine. Well-codified management should lead to favorable functional results and maintain functional and walking abilities.

Бесплатно

Mycobacterium abscessus как возбудитель перипротезной инфекции

Mycobacterium abscessus как возбудитель перипротезной инфекции

Касимова А.Р., Кочиш А.А., Гордина Е.М., Артюх В.А., Рукина А.Н., Божкова С.А.

Статья научная

Введение. Вид Mycobacterium abscessus относится к группе нетуберкулезных микобактерий, ответственных за хронические инфекции у лиц с ослабленным иммунитетом. M. abscessus способны колонизировать искусственные поверхности, в том числе медицинские и хирургические инструменты/устройства. В связи с низкой частотой встречаемости M. abscessus как возбудителя ортопедической инфекции он представляет несомненный интерес для практикующих врачей. Данный инфекционный агент является редким возбудителем, в отношении которого отсутствует отработанный лечебный алгоритм.Цель. Представить способ достижения успешного результата лечения пациента с перипротезной инфекцией, вызванной M. abscessus.Материалы и методы. Из историй болезни и выписных документов известно, что пациентке Х. по месту жительства выполнено тотальное эндопротезирование тазобедренного сустава. В раннем послеоперационном периоде манифестировали признаки острой инфекции послеоперационной раны.Результаты. Спустя три месяца пациентка госпитализирована в профильное учреждение с диагнозом хроническая глубокая перипротезная инфекция. При дообследовании установлена этиология процесса. Пациентке в две госпитализации последовательно выполнены 4 санирующие операции (в том числе мышечная пластика и установка антимикробного спейсера) и проводилась массивная парентеральная антибактериальная терапия в течение 8 месяцев, в том числе на амбулаторном этапе, с применением минимум 3-х антибактериальных средств. Спустя 4 года пациентка не предъявляет жалоб со стороны очага инфекционного процесса. Послеоперационный рубец 45 см без особенностей. Оставшееся укорочение правой нижней конечности 3 см компенсируется ортопедической обувью.Обсуждение. Лечение инфекции, вызванной M. abscessus, является сложной задачей вследствие природной устойчивости возбудителя к широкому спектру антибактериальных лекарственных средств. В литературе описаны единичные случаи ортопедической инфекции, вызванной данным патогеном. Все авторы сходятся в том, что залогом успешного лечения является комбинация радикальной хирургической санации и антибактериальной терапии с применением минимум трех антимикробных препаратов.Заключение. Длительная агрессивная антибиотикотерапия в комбинации с этапным хирургическим лечением позволила добиться успеха при лечении пациента с перипротезной инфекцией, вызванной Mycobacterium abscessus, после первичного эндопротезирования тазобедренного сустава.

Бесплатно

Neglected сlubfoot treated by Ilizarov and Ponseti methods

Neglected сlubfoot treated by Ilizarov and Ponseti methods

Chaudhary Milind M., Chaudhary Ishani M.

Статья научная

The Ponseti method has revolutionized clubfoot treatment. Though completely neglected clubfeet are now rare, partially or incompletely and improperly treated feet are not uncommon. Relapses after successful correction may occur due to non-compliance with bracing. In scarred soft tissues due to previous surgery, soft tissue distraction using external fixation helps achieve correction. The Ilizarov fixator permits us to follow the Ponseti protocol, using correction methods that may either be constrained or unconstrained by hinges. Applying force vectors perpendicular to the moment arm allows us to correct the equinus without damaging the ankle joint. All of the above is possible when the talus is round. Full correction of the deformity is possible. However, long-term follow-up of these patients has revealed stiffness of the ankle setting and frequently with tibio-talar osteophytes anteriorly. They are probably a reaction to excessive pressure developed in the joint due to the tight soft tissues. Hence the author has now added a mild shortening of the tibia and fibula to reduce soft tissue tension, rather than resorting to further soft tissue releases through scarred tissues. This allows faster correction with the Ponseti-Ilizarov protocol and allows good ankle range of motion to persist.

Бесплатно

Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children

Outcomes using the Ilizarov external mini-fixator for Monteggia fractures in children

Li Kewei, Rong Shuai, Zheng Chong, Teng Yong, Li Hao, Liu Liantao, Zhen Kepei, Shen Xiaoyu, Feng Jianshu, Li Feng

Статья научная

Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini-fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.

Бесплатно

Pyomyositis: case series of 14 patients to study the significance of early diagnosis and management

Pyomyositis: case series of 14 patients to study the significance of early diagnosis and management

Gupta Pranav, Garg Shipra, Garg Keerty, Jindal Mohit, Gupta Varsha, Garg Aseem

Статья научная

Introduction Pyomyositis denotes primary pyogenic infection of skeletal muscle. It is predominantly a disease of tropical countries. It usually involves the largest muscle groups around the pelvic girdle and lower extremities. Primary reasons for delay in diagnosis are its low incidence and vague presentation [7]. This delay can result in complications such as extension into and destruction of an adjacent joint, sepsis and, even death. Our study is aimed to highlight the extent and sequence of treatment protocol required for good management of these patients. Methods We retrospectively analyzed our experience with a series of 14 pediatric patients with primary pyomyositis who were treated and followed up. There were five girls and nine boys. All 14 patients underwent plain radiographs, USG and MRI of the affected area followed by surgical drainage and a course of antibiotics. Patients were followed up with weekly CRP. Results Six out of 14 (42.9 %) patients had a history of mild trauma. Ileopsoas muscle was involved in 4 patients, 3 cases in which the gluteals or quadriceps were involved, 2 cases with obturator muscle involvement and 2 cases in which adductors were the infection site. All 14 patients were treated surgically. Conclusion Our study shows that early diagnosis, complete drainage of the purulent material and the use of appropriate antibiotic therapy are the key determinants of successful treatment that lead to complete resolution in the majority of cases.

Бесплатно

Radiological and morphological substantiation of using compression osteosynthesis for treating cranial bone fractures. Experimental canine data

Radiological and morphological substantiation of using compression osteosynthesis for treating cranial bone fractures. Experimental canine data

Diachkov Aleksandr Nikolaevich, Gorbach Elena Nikolaevna, Mukhtiaev Sergei Vasilevich, Chirkova Aleftina Mikhailovna

Статья научная

Optimizing the conditions for cranial bone fracture healing remains to be a relevant field of the current traumatology and orthopaedics. Purpose. To study the impact of compression on reparative osteogenesis when engrafting the resected flaps of calvarial bones. Materials and methods. Two groups of experiments performed in 20 adult mongrel dogs complying with all the requirements of the European Convention for the Protection of Vertebrate Animals used for Experimental and other Scientific Purposes. Dogs from Group 1 (n=10) underwent resection of the two sites of calvarial bones (the caudal flap preserved connections with surrounding soft tissues, the cranial flap - not preserved) of rectangular shape and 1.9×1.5 cm by size, they were laid into their former place and fixation performed with compression using thin wires with stoppers to the medial defect margin by transosseous osteosynthesis method. Compression produced by tightening fixing wires with the force of 40 kg. In Group 2 (n=10) bone flaps were laid into the defect without fixation. The investigations (clinical, radiological and histological) performed 7, 14, 21, 28 and 60 days after surgery. Results. Compression produced at the junction of the margins of free bone fragments and calvarial flat bone defect revealed to contribute to bone tissue formation in earlier periods of time. Conclusion. The results obtained in the present study formed the basis for using the technique of transosseous compression osteosynthesis in treatment of patients with cranial bone fractures in clinical departments of the Center.

Бесплатно

Reconstruction of bone loss of diaphyseal tibial bones using G.A. Ilizarov technique

Reconstruction of bone loss of diaphyseal tibial bones using G.A. Ilizarov technique

Bari Mofakhkharul, Shahidul Islam, Shetu Nazmul Huda, Mahfuzer Rahman D.

Статья научная

The treatment of segmental defects in the diaphysis of long bones is one of the most difficult problems that a surgeon faces in his practice. Methods that are used to cover bone defects include bone autotransplantation [1], posterolateral bone transplantation [2], allotransplantation [3], and tibialization [4]. With the application of all the above traditional methods of treating bone defects, numerous surgical interventions are sometimes required. The period of treatment is long, the load on the limb may not be possible, and the functional results are often unsatisfactory. Recent studies have demonstrated that the method used GA. Ilizarov is more popular than the use of vascularized bone grafts, especially with large bone defects [5, 14].

Бесплатно

Reconstructive surgery in recurrent deformity (clubfoot relapse)

Reconstructive surgery in recurrent deformity (clubfoot relapse)

Lascombes Pierre, Popkov Dmitry A., Leonchuk Sergei S.

Статья научная

Introduction Recurrent clubfoot deformity may be due to either an imperfect initial correction, or a natural history of a severe disease. In the later, idiopathic clubfoot is uncommon. In the review we describe reconstructive surgery in recurrent deformity of idiopathic clubfoot. Material and methods Surgery may be justified at different age and according to the type of deformity. Different surgical approaches and their indications are exposed in the article. Results After Ponseti’s method application additional surgeries may be considered in recurrent clubfoot deformity which may represent 10 to 20 % of cases: second Achilles tenotomy, postero-lateral relapse, complete antero-medial and postero-lateral relapse, transfer of the anterior tibial tendon, correction of sequelae: metatarsus varus, residual equinus, residual rotation of the calcaneopedal unit. Conclusion Idiopathic equine varus clubfoot is a frequent condition. Well-codified management should lead to extremely favorable functional results. Unfortunately, some cases lead to a recurrence of the deformity. Surgical procedures are sometimes required. The goal is to avoid as much as possible arthrodesis and secondary degenerative arthritis.

Бесплатно

Restoration of vertebral body height in traumatic thoracolumbar fractures: open versus minimal invasive surgery - which is better?

Restoration of vertebral body height in traumatic thoracolumbar fractures: open versus minimal invasive surgery - which is better?

Mahesh M., Ravikumar T.V., Harshith N., Nirdesh Hiremaglur, Dinakar Reddy C.R., Ronak Kotian N., Sneha B., Safia M., Arun Eapen

Статья научная

Background Percutaneous minimally invasive surgery (MIS) has been increasingly implemented to treat thoracolumbar (TL) fracture against a conventional open pedicle screw fixation (OPSF) with desirable radiological and clinical outcomes. Studies in the Indian context are required to determine the efficiency of MIS over OPSF. Objective To compare restoration and maintenance of vertebral body height (VBH) following MIS versus OPSF. Methods A prospective comparative study was conducted in a tertiary care hospital. Patients (n = 36) aged 18-65 years (males = 23, females = 13) with traumatic TL fractures were identified. Eighteen of them underwent OPSF and other eighteen underwent MIS. The radiological outcomes like anterior and posterior vertebral body height percentage (AVBH % and PVBH %) restoration and maintenance were evaluated. Quantitative variables were analyzed and described using mean ± standard deviation and qualitative variables were presented using frequency and percentage. Student t-test was used to analyse continuous data and Chi-square/Fisher Exact test was used to analyse categorical data. Results The mean age of the patients was 38.8 years. The majority of fractures were seen in the T12-LI segment (52.7 %). The AVBH % restoration and maintenance in OPSF was significantly higher compared to that of MIS at immediate post-operative (IPO) period (p = 0.01), 6 weeks (p = 0.02) and 12 weeks (p = 0.006) post-surgery. Long segment stabilization provided statistically significant AVBH and PVBH values for OPSF compared to MIS (p 0.05). Superficial surgical site infection (SSSI) was seen in both the groups without any statistical significance between them (p > 0.05). Conclusion OPSF is superior over MIS in the restoration of AVBH. Restoration of PVBH was also better with OPSF although not statistically significant. OPSF with longer segment fixation had better restoration of both AVBH and PVBH. The presence or absence of pedicle screw at fractured vertebral level did not seem to have any significance in both the groups. However, the MIS approach can be a reasonable alternative to open surgery with potential advantages like better clinical and functional outcome. A selected population of patients treated with MIS will show better surgical outcomes.

Бесплатно

Role of the Ilizarov ring fixator in management of severely comminuted supracondylar & intercondylar fractures of the distal femur

Role of the Ilizarov ring fixator in management of severely comminuted supracondylar & intercondylar fractures of the distal femur

Yadkikar S.V., Yadkikar V.S., Somnath Das

Статья научная

Introduction Supracondylar and intercondylar fractures of the distal femur are often attributed to high energy trauma. Treatment of such severely comminuted fractures is challenging. Poor overlying soft tissue, bone loss in the presence of severe comminution and intercondylar extension makes implant selection difficult. Unilateral knee spanning external fixators and hybrid fixators can lead to knee joint stiffness and the issue of bone loss is difficult to deal with them. Ilizarov ring fixator is reserved for severely comminuted fractures and injuries with poor overlying soft tissues. It can effectively manage the bone loss and facilitates limb length restoration, promotes early weight bearing and mobilization. Aim To study the role of the Ilizarov ring fixator in management of severely comminuted supracondylar and intercondylar fractures of the distal femur. Material and Method A total of 13 (all male patients) consecutive patients with severely comminuted supracondylar and intercondylar fractures of the distal femur were treated from December 2013 to March 2016. There was one case with A3 type, one with C1, five cases with C2 and six cases with C3 type as per AO/ASIF Classification. Gustilo-Anderson classification was used for compound fractures. Four cases of C3 type required limited open reduction. Results All patients completed one-year follow-up. Average fracture union time was 20 weeks. Pin tract infection (n = 7) was a frequent complication. Patients with C3 Type of fracture had more restriction in knee flexion (n = 5). No case had limb length discrepancy more than 2.5 cm. No case of nonunion or premature fixator removal due to infection was noted in the series. Conclusion Ilizarov ring fixator can be considered as one of the reliable treatment options for severely comminuted distal femoral fractures with intra-articular extension.

Бесплатно

Seri-остеотомия как один из методов оперативного лечения вальгусной деформации первого пальца стопы

Seri-остеотомия как один из методов оперативного лечения вальгусной деформации первого пальца стопы

Асилова Саодат Убайевна, Югай Альберт Валентинович, Нуримов Гайрат Кадамбаевич, Умарова Гулрух Шавкатовна, Валиева Камола Нуруллаевна, Мурадов Уткиржон Бахромович, Убайдуллаев Бекзод Шавкатович, Мирзаидов Миржахон Раимузакович, Усанов Миржахон Раимузакович

Статья научная

Проблема хирургического лечения деформации первого пальца стопы на сегодняшний день не утратила свою актуальность. Цель. Изучение результатов применения малоинвазивной операции SERI-остеотомии при лечении вальгусного отклонения первого пальца стопы. Материалы и методы. В отделении травматологии РКБ № 1за период с декабря 2011 по март 2014 года было прооперировано 34 больных (58 стоп) по поводу Hallux valgus в возрасте от 30 до 55 лет (29 женщин и 5 мужчин). Всем больным была произведена SERI-остеотомия первой плюсневой кости. Из них у 27 больных (42 стопы) с HVA до 40 градусов и IMA менее 20 градусов и у 4 больных (8 стоп) - с HVA более 40 градусов и IMA более 20 градусов. Четырем больным (6 стоп) была произведена косая остеотомия с удлинением первой плюсневой кости и 1 больному (2 стопы) - поперечная остеотомия без удлинения. Результаты. Через 2 мес. клинические признаки сращения костных отломков наблюдались у 24 больных. По результатам рентгенологических исследований сращение было признано удовлетворительным у 13 больных, слабым - у 15 больных. Признаков сращения не наблюдалось у 3 больных. Трое больных выпали из наблюдения. Коррекция была признана удовлетворительной у всех больных. Все больные довольны результатами операции. Отдаленные результаты лечения оценивались по шкале AOFAS. На четвертом месяце наблюдений результаты лечения были признаны отличными у 22 больных (95-97 баллов), хорошими - у 23 больных (80-92 балла), удовлетворительными - у 10 больных (72 балла). Заключение. SERI-остеотомия при коррекции вальгусной деформации первого пальца стопы может быть предложена как одна из малоинвазивных и эффективных методик оперативного лечения и требует более внимательного дальнейшего изучения.

Бесплатно

Журнал