Journal of Limb Lengthening & Reconstruction最新文献_第7页

Relationship between distal tibial transosseous wires and ankle joint synovium: A cadaveric analysis 胫骨远端经骨金属丝与踝关节滑膜的关系:尸体分析

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_7_19

R. Baruah, J. Baruah, S. Sunder

{"title":"Relationship between distal tibial transosseous wires and ankle joint synovium: A cadaveric analysis","authors":"R. Baruah, J. Baruah, S. Sunder","doi":"10.4103/jllr.jllr_7_19","DOIUrl":"https://doi.org/10.4103/jllr.jllr_7_19","url":null,"abstract":"Background: Distal tibial fractures are managed with external fixation techniques such as Ilizarov to prevent soft-tissue-related complications. In spite of adequate care in wire placement techniques, some cases experience synovitis of ankle joint, stiffness of joint due to pin-tract infections, and deep-seated infection. The accurate description of the ankle joint capsular and synovial recess anatomy is still not clear. The purpose of our study was to study the accuracy of the available guidelines for wire insertion by identifying the relationship between the ankle capsular attachments and the wires in an Indian population. Materials and Methods: 1.8-mm Ilizarov transosseous wires were inserted percutaneously through the distal fibula to tibia from posterolateral to anteromedial direction 2 cm above the joint line in 20 embalmed cadaveric limbs. Dissection of the ankle joint was performed after a dye was introduced into the joint capsule to look for the extent of synovium from the joint line, medial malleolus, and lateral malleolus by the visible bulging and color change of the membrane. Distance from the wire to the synovial extensions distally was measured with a vernier caliper. Results: The mean distance of synovial extension from the joint line, medial malleolus, and lateral malleolus were 20.2 mm, 30.8 mm, and 41.4 mm, respectively. Distal wire-to-synovial extension distance anteriorly was ± 0.2 mm. Wire-to-joint line distance after dissection was 20 mm. The proximal synovial extension was found to be in the 101% from the joint line to the wire. Conclusion: The synovial extensions were found to be close to the distal tibial transosseous wires. A minimum distance of 2.5–3 cm from the joint line proximally should be the safe extent for passing the wires to prevent the risk of synovitis.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122517542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Regenerative techniques in the management of post-traumatic segmental bone defects at a level one trauma center 再生技术在一级创伤中心创伤后节段性骨缺损治疗中的应用

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_10_19

S. Lau, P. Taylor, D. de Villiers, J. Lahy, S. Chambers, A. Oppy

{"title":"Regenerative techniques in the management of post-traumatic segmental bone defects at a level one trauma center","authors":"S. Lau, P. Taylor, D. de Villiers, J. Lahy, S. Chambers, A. Oppy","doi":"10.4103/jllr.jllr_10_19","DOIUrl":"https://doi.org/10.4103/jllr.jllr_10_19","url":null,"abstract":"Introduction: Segmental loss of bone after traumatic injury can be managed with primary amputation or attempted limb salvage with bony regeneration. We aimed to describe our experience of treating traumatic bone loss at a tertiary level one trauma center and propose an approach to help in the treatment of these patients. Methods: Ten patients were identified via a search of the hospital's medical records covering a 5-year period. Each patient was then retrospectively reviewed with injury factors, treatment options, and final outcomes. Each patient was treated based on an anatomic approach developed by the unit to manage segmental bone loss. Results: Of the patients who underwent bony regeneration, we had four distal tibial fractures: three in the upper limb and one distal femoral fracture. Both primary amputation patients had tibial fractures. The mean bone loss was 88.5 mm. We employed bone transport in four cases, Masquelet in two, a free vascularized fibular graft and soft-tissue flap in one instance, and a combination of free vascularized fibula graft and Masquelet in another case. All patients achieved union, although the mean time to union in smokers was 1403 days, compared to 499 days in nonsmokers. Complications included three returns to theater for bone grafting and three recurrent soft-tissue infections. Post regeneration, the patients had a mean Short Form-36 score of 54.2, and most of the patients were “very satisfied” with the outcome of their surgeries. Conclusion: The regeneration of bone after traumatic loss is onerous on patients, is demanding for clinicians, and requires significant health resources. It should only be considered with appropriate patient buy-in and in the absence of contraindications.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114316907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ilizarov techniques for upper tibial nonunions: How difficult is it to achieve excellent results? Ilizarov技术治疗胫骨上骨不连:达到良好效果有多困难?

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_23_19

M. Chaudhary, M. Malhotra, Umamahesh Neeli, Kelvin Vaishnani, Suman Banik, Naeem Jagani

{"title":"Ilizarov techniques for upper tibial nonunions: How difficult is it to achieve excellent results?","authors":"M. Chaudhary, M. Malhotra, Umamahesh Neeli, Kelvin Vaishnani, Suman Banik, Naeem Jagani","doi":"10.4103/jllr.jllr_23_19","DOIUrl":"https://doi.org/10.4103/jllr.jllr_23_19","url":null,"abstract":"Introduction: Upper tibial nonunions (UTNUs) pose challenging difficulties such as soft-tissue scarring, infection, deformity, shortening, and small fragments with intra-articular extension. We present a retrospective analysis of probably the largest series of UTNUs using the Ilizarov techniques. Factors determining the outcome based on difficulty scores and NU scores were also assessed. Patients and Methods: Forty-one patients with UTNU (within 10 cm of joint line) were evaluated retrospectively. Fourteen were aseptic and 27 were septic. The mean NU distance was 5.6 cm from the knee joint. The Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores were evaluated and compared with NU severity score (NUSS), NU level of difficulty score (NULODS), and infection severity score (ISS). External fixation duration (EFD) was compared to NUSS and NULODS to determine which is better in predicting the outcome. We also compared our results with the literature. Results: We achieved union in all except one. The mean EFD was 333 days. The mean regenerate lengthening was 8.6 cm. The ASAMI bone score was: excellent – 16, good – 22, fair – 2, poor – 1. The ASAMI functional score was: excellent – 16, good – 14, fair – 9, poor – 2, and failure – 0. We found a positive correlation between NUSS, NULODS, and ISS. EFD correlated better with overall NULODS and subset of NULODS gap score compared to NUSS and NUSS gap score, respectively. Conclusions: Ilizarov is an effective method to treat UTNU. It corrects the deformity, provides stable fixation, achieves union, and corrects limb length discrepancy.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"132 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128663856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Diamonds are expensive, rings are not: Mastering The Paradoxical Evolution Of Nonunion Treatment 钻石很贵，戒指不贵:掌握骨不连治疗的矛盾演变

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_24_19

M. Chaudhary

引用次数: 0

Monofocal distraction of stiff hypertrophic nonunions. How and why does it work? A systematic review and mechanobiological explanation 僵硬肥厚性骨不连的单焦点分散治疗。它是如何以及为什么起作用的?系统综述及机械生物学解释

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_19_19

Y. Tanwar, N. Ferreira

引用次数: 0

Blocking screws for intramedullary nail guidance 髓内钉导向用阻断螺钉

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_16_19

K. Ross, Michael E. Steinhaus, S. Rozbruch, A. Fragomen

{"title":"Blocking screws for intramedullary nail guidance","authors":"K. Ross, Michael E. Steinhaus, S. Rozbruch, A. Fragomen","doi":"10.4103/jllr.jllr_16_19","DOIUrl":"https://doi.org/10.4103/jllr.jllr_16_19","url":null,"abstract":"Intramedullary nails (IMNs) are commonly used for fracture fixation of the femur and tibia, and internal lengthening nails (ILNs) can be used for deformity correction and limb lengthening. While this form of fixation has demonstrated substantial success, one major limitation is imperfect reduction and malalignment, particularly when used for fractures or osteotomies in the metaphysis. One means of overcoming this challenge is through the use of blocking screws, given their ability to guide the path of the nail, decrease the width of the medullary canal, and maintain reduction. In this literature review, indications, techniques, outcomes, and complications are reported. Searches of PubMed and The Cochrane Collaboration were performed. Technique articles and single case reports were not reviewed. All other English studies reporting outcomes of IMN or ILN fixation of the femur or tibia with concomitant use of blocking screws were reviewed. Blocking screws have been used successfully in the lower extremity for both trauma and in deformity surgery. Key techniques are placing the screws in the concavity and perpendicular to the plane of deformity, with adequate distance from the planned path of the nail and from the fracture or osteotomy site. Current data suggest high rates of union with adequate alignment and a low complication rate, although most studies are small, retrospective case series. Blocking screws appear to be a reasonable strategy for achieving fixation in difficulty, metaphyseal segments. Further, well-designed prospective studies should be carried out to make more definitive conclusions.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114279264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Use of cable bone transport as a method of soft tissue preservation 使用骨电缆运输作为软组织保存的方法

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_15_19

Fadia B. Aboud, P. Nudelman, H. Shtarker

{"title":"Use of cable bone transport as a method of soft tissue preservation","authors":"Fadia B. Aboud, P. Nudelman, H. Shtarker","doi":"10.4103/jllr.jllr_15_19","DOIUrl":"https://doi.org/10.4103/jllr.jllr_15_19","url":null,"abstract":"Context: Ilizarov method of bone transport is a well-recognized method in treating bone loss; however, soft tissue complications and potential flap compromise associated with the transport process are a major drawback. Aim: We propose the use of a central transport system of cables and pulleys, as introduced by Weber in 1998 to help preserve soft tissue cover, retain flap integrity, and decrease patient discomfort. Design: This was a retrospective study. Patients and Methods: Consecutive series of patients treated for severe bone loss and fragile soft tissue cover, between 2013 and 2018, according to the Weber method of bone transport, were included in the study. In total, six cases were identified. Inclusion criteria were any patient who underwent bone transport using the Weber method due to bone loss caused by trauma or infection. Exclusion criteria were any patient who did not complete the bone distraction process or had a follow-up of < 1 month after bone transport apparatus installation. Results: Five out of six patients completed the bone transport process; one case was excluded from the results since the patient was lost to follow-up before bone distraction was begun. The average follow-up was 13.2 months; no patient had soft tissue complications, the transport process was painless, and the flap integrity was maintained. Bone regenerate was good in all except one case since the patient was lost to follow-up a month after transport was initiated. Conclusion: The Weber method is a reliable technique generating good-quality bone, while maintaining the integrity of the soft tissue envelope, minimizing soft tissue complications associated with the classical method of bone transport. The Weber technique is especially valuable when bone transport is performed in a flap covered area, where the excursion of half pins and K-wires can compromise flap survival.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114453609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ilizarov strategies in the management of nonunions and difficult fractures of the femur Ilizarov策略在处理股骨骨不连和难治性骨折中的应用

Journal of Limb Lengthening & Reconstruction Pub Date : 2019-07-01 DOI: 10.4103/jllr.jllr_12_19

R. Baruah, Siddhartha Kumar

{"title":"Ilizarov strategies in the management of nonunions and difficult fractures of the femur","authors":"R. Baruah, Siddhartha Kumar","doi":"10.4103/jllr.jllr_12_19","DOIUrl":"https://doi.org/10.4103/jllr.jllr_12_19","url":null,"abstract":"Introduction: Infected nonunion, neglected open fractures, aseptic nonunion, and neglected displaced comminuted fractures are difficult fractures of femur requiring tailored management. We used Ilizarov principles and strategies in such difficult presentations and the aim to evaluate results. Materials and Methods: Thirty-eight patients (37 males and 1 female), 3–48 years old, with infected nonunion (11 cases), neglected open fractures (12 cases), aseptic nonunions (9 cases), and neglected displaced comminuted fractures (6 cases) treated during 2000–2015 were evaluated. Cases of infected nonunion were subclassified using Rosens's classification to guide debridement and underwent single-stage monofocal or bifocal treatment. Neglected open fractures were Type 3 open fractures (Gustillo Anderson) after ≥12 h of injury-underwent debridement and single-stage monofocal or bifocal treatments. Aseptic nonunion cases underwent implant removal and monofocal or bifocal treatment. Neglected displaced comminuted fractures were fixed in situ, monofocal treatment, length, and rotation correction was done. Accordion maneuver was used extensively. No bone grafting was done. Results: Thirty-six cases (95%) achieved successful union and 97% cases had infection eradication. Excellent-to-good bony and functional results were seen in 86% and 68% cases, respectively (ASAMI criteria). Complications such as soft-tissue interposition (5%), Grade III pin-tract infection (13%), and hyporegenerate (11%) were seen. Discussion and Conclusion: With Ilizarov strategies tailored for specific situation, satisfactory and predictable results can be obtained offering one-stage solution to the global problems associated with such difficult fractures. The technique obviates need for bone graft or major soft tissue reconstruction.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132676658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Concomitant bone regeneration to restore bone stock during revision distal femur replacement after large tumor resection 大肿瘤切除后股骨远端置换术翻修期间伴随骨再生以恢复骨储备

Journal of Limb Lengthening & Reconstruction Pub Date : 2018-07-01 DOI: 10.4103/JLLR.JLLR_17_18

E. Schwarzkopf, Ridhi Sachdev, V. Boddapati, Daniel E. Prince

{"title":"Concomitant bone regeneration to restore bone stock during revision distal femur replacement after large tumor resection","authors":"E. Schwarzkopf, Ridhi Sachdev, V. Boddapati, Daniel E. Prince","doi":"10.4103/JLLR.JLLR_17_18","DOIUrl":"https://doi.org/10.4103/JLLR.JLLR_17_18","url":null,"abstract":"Loss of bone stock is a common problem in revision arthroplasty, specifically in large distal femur replacements (DFRs) after tumor resection. It can lead to worse functional outcomes and increased risk of revision procedures. Restoration of bone using distraction osteogenesis (DO) with an intramedullary nail may be an appropriate solution for this problem, especially in younger adults who may require future surgical interventions. In this series of three patients, we describe the successful use of DO through an internal device to address bone loss after a large osseous resection and revision endoprosthetic reconstruction. Bone stock was restored with a combination of lengthening and bone transport using a multistage revision strategy: removal of existing hardware, treatment of infection if present, lengthening of proximal femur with a temporary antibiotic spacer in the distal femur, and reimplantation of a definitive DFR after bone stock restoration. A magnetically actuated internal lengthening intramedullary rod was utilized to perform the proximal femur osteoplasty. Conversion to a definitive weight-bearing DFR was achieved in two patients; one patient required an above-the-knee amputation for chronic osteomyelitis which could not be controlled after numerous debridements and courses of IV antibiotics. In this patient, the infection could be eradicated from the lengthened bone, the regenerate bone served to provide length to the amputation stump and fully remodeled to provide full weight-bearing and prosthetic use. DO was successfully used in three patients for revision DFR and bone stock restoration. In one of the two patients who required revision surgery for infection, amputation was ultimately required. All three patients achieved successful bone regeneration.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121777491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anesthesia for removal of external fixation with hydroxyapatite-coated half pins 羟基磷灰石包覆半针外固定物取出的麻醉

Journal of Limb Lengthening & Reconstruction Pub Date : 2018-07-01 DOI: 10.4103/JLLR.JLLR_29_17

A. Fragomen, Anton M. Kurtz, P. Wagner, J. Nguyen, Spencer S. Liu, S. Rozbruch

{"title":"Anesthesia for removal of external fixation with hydroxyapatite-coated half pins","authors":"A. Fragomen, Anton M. Kurtz, P. Wagner, J. Nguyen, Spencer S. Liu, S. Rozbruch","doi":"10.4103/JLLR.JLLR_29_17","DOIUrl":"https://doi.org/10.4103/JLLR.JLLR_29_17","url":null,"abstract":"Background: External fixation utilizing hydroxyapatite (HA)-coated half pins has produced excellent clinical results revolutionizing the field of limb lengthening and deformity correction surgery. Removal of these pins is a painful patient experience that may be best conducted under anesthesia. Purpose: The current study documents how a deformity practice removes these external fixators (frames) under anesthesia. We asked: (1) How much anesthesia is needed for frame removal? (2) How effective was this protocol in controlling patient pain? (3) How did patients taking narcotic medications at the time of frame removal differ from those not taking narcotics during frame removal surgery? Patients and Methods: We prospectively recorded data during the removal of 53 consecutive external fixators that used HA-coated half pins including the use of pre operative narcotics at the time of frame removal, location and complexity of frames, type and dosages of medications administered, and adequacy of anesthesia. Results: All patients were managed with a combination of midazolam, propofol, fentanyl, and ketamine. Anesthesia was graded as good to excellent in 91% and unsatisfactory to poor in 9% of cases. The preoperatively medicated group was administered significantly less fentanyl (P = 0.020) and had significantly more frames located about the ankle and foot (P = 0.049) than the preoperatively non-medicated cohort. Conclusions: IV sedation administered by an anesthesiologist in the operating room provided adequate pain control to perform fixator removal and pin site debridement in most cases. External fixation used for foot and ankle reconstruction may provide a more painful experience for patients.","PeriodicalId":307806,"journal":{"name":"Journal of Limb Lengthening & Reconstruction","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133997432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1