International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100th birthday of G. A. Ilizarov)

The Ilizarov method is one of the current methods used in bone reconstruction. It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA. Its main merits are viable new bone formation through distraction osteogenesis, high union rates and functional use of the limb throughout the course of treatment. The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery. Since then, the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails. They gave rise to a relatively new orthopedic subspecialty termed “limb lengthening and reconstruction surgery”. Based on a comprehensive literature search, we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community. The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating. The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents. It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery

Ilizarov bone transport combined with the Masquelet technique for bone defects of various etiologies (preliminary results)

BACKGROUND: The Ilizarov bone transport (IBT) and the Masquelet induced membrane technique (IMT) have specific merits and shortcomings, but numerous studies have shown their efficacy in the management of extensive long-bone defects of various etiologies, including congenital deficiencies. Combining their strong benefits seems a promising strategy to enhance bone regeneration and reduce the risk of refractures in the management of post-traumatic and congenital defects and nonunion that failed to respond to other treatments. AIM: To combine IBT and IMT for the management of severe tibial defects and pseudarthrosis, and present preliminary results of this technological solution. METHODS: Seven adults with post-traumatic tibial defects (subgroup A) and nine children (subgroup B) with congenital pseudarthrosis of the tibia (CPT) were treated with the combination of IMT and IBT after the failure of previous treatments. The mean number of previous surgeries was 2.0 ± 0.2 in subgroup A and 3.3 ± 0.7 in subgroup B. Step 1 included Ilizarov frame placement and spacer introduction into the defect to generate the induced membrane which remained in the interfragmental gap after spacer removal. Step 2 was an osteotomy and bone transport of the fragment through the tunnel in the induced membrane, its compression and docking for consolidation without grafting. The outcomes were retrospectively studied after a mean follow-up of 20.8 ± 2.7 mo in subgroup A and 25.3 ± 2.3 mo in subgroup B. RESULTS: The “true defect” after resection was 13.3 ± 1.7% in subgroup A and 31.0 ± 3.0% in subgroup B relative to the contralateral limb. Upon completion of treatment, defects were filled by 75.4 ± 10.6% and 34.6 ± 4.2%, respectively. Total duration of external fixation was 397 ± 9.2 and 270.1 ± 16.3 d, including spacer retention time of 42.4 ± 4.5 and 55.8 ± 6.6 d, in subgroups A and B, respectively. Bone infection was not observed. Postoperative complications were several cases of pin-tract infection and regenerate deformity in both subgroups. Ischemic regeneration was observed in two cases of subgroup B. Complications were corrected during the course of treatment. Bone union was achieved in all patients of subgroup A and in seven patients of subgroup B. One non-united CPT case was further treated with the Ilizarov compression method only and achieved union. After a follow-up period of two to three years, refractures occurred in four cases of united CPT. CONCLUSION: The combination of IMT and IBT provides good outcomes in post-traumatic tibial defects after previous treatment failure but external fixation is longer due to spacer retention. Refractures may occur in severe CPT

Experimental and clinical justification of combined osteosynthesis for long bone defects (preliminary report)

The motivation for researching combined technology of transosseus osteosynthesis and intramedullary nailing was need to reduce time of treatment, and improve the rehabilitation of patients with long bone defects. Defect-pseudoarthrosis with anatomical shortening of the bone was modeled in an experiment in five adult mongrel dogs. Then nailing, Ilizarov transosseous fixation and osteotomy in proximal metadiaphysis were carried out. Bone-transport was produced according to the traditional principles of academic Ilizarov. Radiological findings showed regenerate with zonal structure, bone sections of which were presented homogeneous shadows with a periosteal osteogenesis. After 30 days of distraction regenerate lost its zonal structure, and acquired a mechanical soundness. By this time also was detected consolidation of pseudarthrosis. We have experience of treatment of six patients with posttraumatic defects of the long bones, according to the described method. At the same time carried out transosseous osteosynthesis and nailing with locking in one bone fragment. The osteotomy was performed for following distraction. After necessary length of the bone was received, the opponent locking was carried out. And external fixation was removed. This technology has allowed not using Ilizarov in fixation period of the treatment

Superinvasion opisthorchis felineus was associated with giardiasis

We describe the clinical picture and laboratory findings in 71 patients with invasion opisthorchis felineus. Of these, 13 people diagnosed concomitant giardiasis. The analysis of various forms of opisthorchosis. The influence lamblia intestinalis on the nature and severity of clinical symptoms and laboratory opisthorchosis. It is proved that the inclusion of albendazole in combination therapy opisthorchosis combine with invasion lamblia intestinalis leading to persistent clinical and parasitological remission as giardiasis and opistorhoza.Описана клиническая картина и лабораторные отклонения у 71 пациента с инвазией opisthorchis felineus. Из них у 13 человек выявлен сопутствующий лямблиоз. Проведен анализ различных форм описторхоза. Изучено влияние lamblia intestinalis на характер и выраженность клинических и лабораторных симптомов описторхоза. Доказано, что включение албендазола в комбинированную терапию описторхоза сочетающегося с инвазией lamblia intestinalis приводит к стойкой клинической и паразитологической ремиссии как лямблиоза так и описторхоза

Аллопластические и имплантационные материалы для костной пластики: обзор литературы

Bone reconstruction aft er trauma, infection, tumour or congenital genetic disorder is an important subject of modern medicine usually relying on bone graft ing materials. Autologous bone or autograft is still considered the “gold standard” most eff ective in bone defect reconstruction and osseous regeneration. Having the advantages of autograft ing, a series of issues remain related to a limited donor material, painful graft taking and the risk of putative complications (nonunions, graft rejection, infection, iatrogenic fractures, post-microsurgery arteriovenous shunt thrombosis, etc.). Th erefore, improved biomaterials are demanded to adequately meet the autograft criteria. Choosing optimal graft materials becomes relevant, aside to the rationale of selecting new surgical techniques. Th e osteoconductive and osteoinductive property evaluation in modern osteoplastic materials comprises a research avenue into optimal graft development for osseous correction in maxillofacial surgery, neurosurgery, traumatology and orthopaedics. Such biomaterials can be combined with alloplastic graft s to attain the required properties of osteoconduction, osteoinduction and osteogenesis. Th is analytic literature review focuses on current state-of-the-art in alloplastic graft ing that, in our opinion, grounds the progress of auto- and allograft innovative development.Восстановление костных дефектов, вызванных травмой, инфекциями, опухолями или врожденными генетическими нарушениями, является важной проблемой в  современной медицине, которая обычно требует использования материалов для костной пластики. При этом аутологичная кость, или аутотрансплантат, попрежнему считается «золотым стандартом» и  наиболее эффективным методом для восстановления костных дефектов и регенерации костной ткани. Однако при всех преимуществах костной аутотрансплантации имеется ряд проблем, связанных с ограниченным объемом донорского материала, болями в зоне забора имплантатов и опасностью возникновения возможных осложнений (несращений, отторжений трансплантатов, инфекции, ятрогенных переломов, тромбозов артериовенозных шунтов при применении микрохирургической техники и т. д.). Поэтому имеется необходимость в разработке улучшенных биоматериалов, которые бы максимально соответствовали характеристикам аутотрансплантатов. В связи с этим наряду с рациональным выбором новых хирургических методик актуальным становится выбор оптимальных имплантационных материалов. Оценка остеокондуктивных и остеоиндуктивных свойств современных остеопластических материалов является одним из направлений исследований по поиску оптимальных имплантов для лечения пациентов с костными дефектами в челюстно-лицевой хирургии, нейрохирургии и травматологии и ортопедии. При этом данные биоматериалы можно комбинировать с аллопластическим материалом, в результате чего может быть разработан имплант, который удовлетворяет требованиям по остеокондукции, остеоиндукции и остеогенезу. Аналитический обзор доступной литературы посвящен современному состоянию проблемы применения аллопластических имплантационных материалов, что, по нашему мнению, может послужить основой для разработки инновационных заменителей костных ауто- и аллотрансплантатов

METHODIC PRINCIPLES OF FILLING-IN FOREARM BONE DEFECTS USING TECHNOLOGIES OF TRANSOSSEOUS OSTEOSYNTHESIS

The article is based on treatment experience of 93 patients with defects and pseudoarthroses of forearm bones using transosseous osteosynthesis. The work presents main methodic principles and approaches to rehabilitation of patients using closed transosseous osteosynthesis and surgical lengthening of bone fragments