Errors and complications in management of primary long bone tumors in the lower limbs with the Ilizarov transosseous osteosynthesis

Introduction The Ilizarov method of non-free bone plasty has been widely used for management of lower limb long bones after resection of primary tumors. Analysis of errors and complications by using this method is a demanded and relevant task. Purpose We retrospectively studied the errors and complications by using the method of Ilizarov non-free bone toplasty in patients with primary neoplasms in lower limb long bones. Material and methods Rehabilitation of 133 patients with primary tumors of lower limb long bones was analyzed. All of them were treated with the Ilizarov method of compression-distraction osteosynthesis for bridging post-resection defects. Results Our retrospective study revealed organizational, tactical, technical errors and complications, which we observed during clinical and rehabilitation stages. Conclusion Systematization of errors and associated complications allowed us to develop recommendations for their prevention and treatment

Surgical orthopaedic management of cerebral palsy in adults: literature review and preliminary analysis of our treatment experience

Introduction Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy. However, functional motor limitations aggravate after their physiological growth completion and the risk of pain increases. The aim of this work was to study the literature on the problem of surgical orthopedic treatment in adolescents and adults with cerebral palsy belonging to GMFCS levels I-IV of motor disorders as well as to make a preliminary analysis of the surgical orthopedic treatment performed in this category of patients at our institution. Materials and methods The results of multi-level single-event interventions were studied in 165 patients older than 16 years. The sample for analysis included cases that met the following criteria: age of 16 years and older, spastic types of cerebral palsy, GMFCS levels I–IV. In addition, some patients underwent botulinum therapy during the stages of surgical treatment. Results The maximum functional effect was manifested 12–24 months after the surgery if proper early and subsequent rehabilitation was provided. According to the Gillette Functional Assessment Questionaire, motor abilities improved in 81.3 %. Multilevel interventions included 2.3–3.5 elements on average during one surgical session. Current literature postulates the implementation of multi-level single-event interventions and indications for surgery and follow-up control are studied at a motion analysis laboratory. Conclusion Multi-level orthopedic interventions are indicated for patients who have completed physiological growth. Techniques of such interventions should provide early functional activity. Surgical orthopedic treatment in adult patients with cerebral palsy should be performed by the staff and at an institution that specialize in neuro-orthopedic

Vasodilator effect of vascular endothelial growth factors (VEGF) in the conditions of bone tissue formation by the method of discrete traction in congenital segmental pathology

The development of the limbs in patients with congenital segmental defects is associated with defects in the vascular system of the same segment. In this case, vascular endothelial growth factors that participate in physiological angiogenesis may have effect on bone tissue formation in ontogenesis and participate in endochondral ossification. In this regard, the aim of the study was to compare the quantitative changes in growth factors (VEGF) and the contractile properties of arterioles under conditions of discrete distraction for congenital pathology of the lower leg bones. Materials and methods Subjects of the study were 12 patients with congenital pseudarthrosis of the lower leg (ICD-10 Q 74.0). Their serum was analyzed using an enzyme immunoassay. Microcirculation in the calf skin was examined by laser flowmetry (BLF21, Transonic Systems Inc., USA). We used the findings obtained from the study of blood serum in 103 somatically healthy people for control. Results Significant imbalance in serum concentrations of endothelial factors and their receptors was detected in the subjects with congenital pathology. As a result of surgical treatment, the imbalance of secretion of vascular growth factors and their receptors increased. Vasodilator effect in the precapillary vessels in the zone of the operated segment in patients with congenital pathology was not revealed by surgical intervention

Regional hemodynamics in patients with femoral shaft nonunions treated with combined external fixation and intramedullary nail

Objective The purpose of the study was to explore peripheral hemodynamics in patients with femoral shaft nonunions treated with combined external fixation and intramedullary nail. Material and methods Two groups of patients were identified. Group I included 11 patients with a deformity at the apex of nonunion treated with consecutive combined osteosynthesis. Group II consisted of 15 patients with nonunions and femoral shortening treated with synchronous combined distraction-compression osteosynthesis. Methods of examination comprised duplex ultrasound of veins and paraosseous vessels at the regeneration site (HITACHI HI Vision Avius), USDG (ANGIO-PLUS, Moscow) and tetrapolar rheovasography (RVG) of lower limbs (Rheograph RGPA-6/12, Taganrog). Results and discussion Volumetric blood flow of the femur and tibia measured postoperatively with RVG showed no differences in the intact and operated limb whatever technique was applied. In all patients, major blood flow was recorded at stages of combined fixation and Ilizarov fixation, linear systolic velocity and pulsatility index were not significantly different from normal and intact limb values, hemodynamic criteria of vasoconstriction of major vessels were not identified. The steal syndrome of distal segments due to functional bypass was observed in patients with unstable metal constructs and did not aggravate after surgical treatment in Group I. Duplex ultrasound scan of the femoral shaft cortical bone showed expressed arterial and venous color map in all patients with high peripheral indices reflecting vascular tone and measuring PI = 12 ± 3.5; RI = 0.9 ± 0.1. Conclusion No significant hemodynamic changes were detected in major arteries during treatment of patients with femoral nonunions using combined techniques of external fixation and intramedullary nail. Vasodilatation of veins recorded during treatment of patients with femoral nonunions using combined techniques of external fixation and intramedullary nail was determined as a risk factor for venous thromboembolism. A local increase in the arterial and venous paraosseous blood flow was recorded at the cortical site of nonunion with combined intramedullary osteosynthesis

Activities of a large limb lengthening and reconstruction center in the 21st century

Background: Limb lengthening and reconstruction surgery (LLRS) is a relatively new orthopedic subspecialty. It started to develop in the 1980s when the Ilizarov method became known to the world orthopedic community. Purpose: We evaluated the caseload dynamics and compared the use of the Ilizarov techniques against the total of annual surgical interventions performed at our center. Materials and Methods: We retrospectively examined archival data on the admissions and surgical activities since the center's inception and in several years separately. The total of admissions, surgical activity, and the total of external fixation operations was calculated. We also reviewed all consecutive LLRS cases for a sample period of 2015, assessing admission patterns and surgical categories. Academic activity was reviewed using available databases of medical publications. Results: The total of admissions throughout 45 years was 185,839. The number of admissions reached 12,451 in 2016, almost six times more than in 1986. In 1996, the surgical volume significantly decreased and started to grow significantly from 2011. LLRS reduced relative to the total of operations performed though its absolute number grew by 52.6% in 2016 as compared with 1986. It comprised only 30% in 2016 while other orthopedic and joint pathology techniques were employed in 70% of operations. The number of operations with the Ilizarov method for osteomyelitis increased >4.45-fold in 2016 as compared to 1986. According to the Scopus database, the most productive years were 2015 and 2016 with 50 and 54 articles, respectively, published in the national and international journals. Conclusions: The scope of the center's activities has expanded beyond the Ilizarov method. Many newer technologies for the management of musculoskeletal diseases are employed to meet the needs of the market. Due to growth of musculoskeletal diseases and above mentioned factors, LLRS activity has been constantly growing. Its main concepts are the Ilizarov philosophy, age, and technical continuity

Synthetic biomaterials based on hydroxyapatite and tricalcium phosphate: analysis of current clinical trials

Introduction To date, a wide variety of synthetic materials, including metals, polymers and ceramics, have been proposed and used as a substitute for bone grafts in the field of traumatology/orthopedics, neurosurgery and oral and maxillofacial surgery (OMFS). However, the most studied materials are calcium phosphate ceramics (CPC), in particular hydroxyapatite and tricalcium phosphate, as well as their mixtures, called byphasic calcium phosphates. This interest stems from the fact that the main component of bone is the apatite mineral calcium phosphate. Hydroxyapatite and tricalcium phosphate are among the most commonly used and effective synthetic substitutes for bone grafts. They have not only osteoconductive properties, but also osteoinductive. These properties, combined with cell-mediated resorption, ensure complete regeneration of bone defects. This study will analyze existing clinical trials, registered on the clinicaltirals.gov website, on the use of hydroxyapatite and tricalcium phosphate in the field of traumatology and orthopedics, neurosurgery and OMFS. Aim To identify the potential for clinical use, as well as possible side effects, of CPC as a replacement for bone grafts. Materials and methods The search strategy was to use material from the clinicaltrials.gov website, which focused on key terms such as hydroxyapatite, tricalcium phosphate, hydroxyapatite and tricalcium phosphate, traumatology and orthopedics, maxillofacial surgery, dentistry, neurosurgery, bone, и diseases of the musculoskeletal system. Results and discussion As of November 2022, there were approximately 85 clinical trials with hydroxyapatite application, approximately 49 clinical trials with tricalcium phosphate, and approximately 16 clinical trials with the hydroxyapatite/tricalcium phosphate combination. Most of the studies were Phase 1-2, Phase 2, or Phase 4. Most focused on tibial trauma therapy, osteoporosis/osteopenia, alveolar bone resorption, and spinal surgery. It was found that full results were published only in 3, 7 and 2 clinical trials on the use of hydroxyapatite, tricalcium phosphate and their combination, respectfully. All clinical trials had similar preparation methods and all of those clinical trials produced positive results without serious side effects. Conclusion There is a wide potential for clinical use of CPC as synthetic bone graft substitutes without reports of serious side effects. Many preclinical and clinical studies are currently underway on the use of hydroxyapatite and tricalcium phosphate, and their future results will further explore their clinical potential

Features of organotopic remodeling of bone tissue and implanted osteoplastic material in Charcot neuro/osteoarthropathy

Introduction Despite the recognition of MRI as the gold diagnostic standard for Charcot arthropathy, there is evidence in the literature that MSCT is more informative for objective qualitative and quantitative diagnosis of the condition, primarily of the bone skeleton of the Charcot foot, in comparison with standard radiography. The sensitivity and specificity of these methods are different. Purpose To reveal the features of organotopic remodeling of bone tissue and implanted osteoplastic material in the course of midfoot and hindfoot subtotal defects management in Charcot neuro-osteoarthropathy. Materials and methods The analysis of bone tissue and implanted osteoplastic material density was carried out in a case series that included 11 patients with Charcot neuro-osteoarthropathy who underwent a two‑stage procedure for bone defects in the hindfoot and midfoot with the Ilizarov apparatus. We studied CT and MRI scans and measured bone regenerate density before treatment, at the stages of transosseous osteosynthesis, and 3, 6, and 12 months after surgery. Results In all patients, varying increase in the amount and volume of bone tissue was visualized due to intensive periosteal bone formation along with the formation of bone ankylosis in the joints along combined with a consistent increase in the optical density of bone regenerates. The formation of the new bone tissue ran without the signs of lysis or sequestration. The conducted studies indicate that the sizes and architectonics of bone fragments are more differentiated in CT than in MRI scans. Discussion It is known that the bone, despite its high mineralization, continuously rebuilds, restores and adapts itself to certain functional conditions. This constant dynamic process of adaptive remodeling depends mostly on optimal blood supply, metabolic activity and the coordinated work of bone cell elements. The data obtained show angiogenesis in the compromised tissues in patients with Charcot foot and consistent remodeling of the graft into the new bone tissue. Conclusion The allobone in the composition of the combined bone graft does not reduce the likelihood of complete remodeling of the newly formed bone tissue. Higher bone density by filling in a bone defect with a graft differs from distraction regenerate that initially has low bone density. CT and MRI are highly effective and informative diagnostic methods for surgical treatment. In reconstructive interventions in the patients with Charcot foot under the conditions of transosseous osteosynthesis, preference among radiological study methods should be given to CT