Results and biomechanical consideration of treatment of congenital lower limb shortening and deformity using the Ilizarov method

One of the applications of the Ilizarov apparatus is the correction of congenital shortening and deformities. Ilizarov external fixator produces biomechanical structure with surrounding tissue, which is the reason why very important is correct stability of fixator. Large distraction in the case of high value of lengthening, and large deformity corection result in shear stresses that occur additionally in the regenerate, which can potentially lead to damage of the regenerating nutritive microcirculation of bone tissue and bone fragment displacements. Our objective was to assess the results of the Ilizarov method in the treatment of congenital shortening taking into account treatment strategy and the size of the axis of lengthening and correction. Our research problems include presenting the effects of biomechanics of musculoskeletal deformations on treatment results, presenting complications and their treatment. Between 1989 and 2009, 62 patients underwent surgery to correct congenital lower limb deficiencies at our Clinic; 33 patients were followed-up. In total, there were 70 surgeries (2.12/patient). Axial correction was performed in 26 patients (78.79%). Average age at the start of the treatment was 15.58 years. Mean follow-up was 8.58 years. Mean lengthening per surgery was 3.17 cm with the lengthening index of 50.7 day/cm. Results were very good for 23 patients, good for 7 patients, satisfactory for 3 patients. Complications appeared in 24 patients, problems occurred in 74.42% of the cases, obstacles in 4.65% of cases, and true complications in 20.93% of the cases. The best results were achieved in the treatment of patients with two-stage and two-segment lengthening with a total elongation of less than 7 cm, and without correction of the axis. Congenital shortening of the lower limb should be treated comprehensively because the shortening applies to all segments, and disturbs biomechanics of all lower limb. In the case of axial correction and large amount of elongation high soft tissue forces counteract the distraction forces. Hybrid construction may help to shorten treatment time, increase fixator stability and decrease rate of complications. We suggest use of hybrid Ilizarov fixator, especially when large elongation and axis corection are planned

Pedobarographic evaluation of body weight distribution on the lower limbs and balance after derotation corticotomies using the Ilizarov method

Distortion of the axis and shortening of the limbs result in multiple musculoskeletal pathologies. Rotation disorders should also be included among the disorders of the axis of the lower limb. In the case of rotational distortion, only derotation osteotomy can effectively correct torsion-associated deformations. Rotational distortion correction is accompanied by translational displacement and torsion, which results in more complex biomechanics. Using the pedobarographic platform, it is possible to evaluate static and dynamic posture and gait, percentage of body weight distribution on the lower limbs, and balance. Physiological gait and distribution of weight on the lower extremities are symmetrical. Balance is one of the determinants of proper biomechanics of the musculoskeletal system. An important aspect of treatment evaluation is pedobarographic assessment of balance and body weight distribution on the lower extremities ratio. The aim of this work was to evaluate the pedobarographic assessment of body weight distribution on the lower limbs and balance in patients with derotation corticotomies using the Ilizarov method. The study examined a group of 56 patients, who underwent derotation corticotomy using the Illizarov method between 1996 and 2012 at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System in Wrocław. The control group consisted of 54 patients, who were treated with correctional derotation-free corticotomy using the Ilizarov. Distribution of body weight on the lower limbs and balance were assessed with the pedobarographic platform. Following derotation corticotomy, the amount of body weight placed on the operated limb by subjects from the study group averaged 47.81%, 52.19% in the case of the healthy limb. These differences were not statistically significant. The difference between the average percentage of body weight placed on the diseased and healthy limb in the study group and the controls were not found to be statistically significant. There were no statistical differences in the average length of the gravity line or in the average surface area of the center of gravity position between the study and control groups. Balanced distribution of body weight on the lower limbs was achieved following derotation corticotomies using the Ilizarov method. Derotation corticotomies performed with the Ilizarov method allow for achieving normalization of body weight distribution on the lower limbs and balance, with values similar to those resulting from Ilizarov method derotation-free osteotomy

The effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov`s Method

Purpose : Exerting axial pressure on the affected lower limb remains one of the most crucial elements of Ilizarov method . Objective was to determine the effects of an early intrahospital rehabilitation on weight bearing during lower extremity lengthening with Ilizarov`s Method. Methods: Study included 15 patients who underwent lower limb lengthening. The patients were tested on the third day after surgery using the pedobarographic platform. The tests were performed four times in the standing position:twice with the support of forearm crutches and twice without crutches. Patients were asked to either remain in the relaxed standing position(two tests) or use the lower limb equipped with Ilizarov apparatus to support the body weight(two tests). Results: In relaxed stance average pressure with forearm crutches was 24.1% for affected limb, as compared to 75.9% for the healthy limb. In test without forearm crutches average pressure for affected limb was 26.1%, as compared to 73.9% for the healthy limb. Patients shifted body weight to the affected limb with forearm crutches on average, at the rate of 53.6% . In test without forearm crutches the affected limb was supporting the body weight at the rate of 48.26%. None of the patients was able to fully support the body weight on the affected leg. Conclusions: In spite of strict physiotherapy regimen,patients are, neither able to equally distribute their body weight between the two lower limbs ,nor to shift their body weight to the limb equipped with Ilizarov apparatus

Lower extremity growth and deformity

The pediatric lower extremity has well known growth patterns. When deformities or growth disturbances occur, there are several methods to measure and predict the resulting discrepancy, including the Green-Anderson, Moseley, and Multiplier methods. Many techniques exist to correct leg length discrepancy and deformity such and temporary epiphysiodesis, permanent epiphysiodesis, external fixators, and internal lengthening devices. All of these methods have numerous complications and limitations; however, with careful planning and patient selection, length and alignment can be improved with high patient satisfaction