Biomechanical Aspects of Lower Limb Torsional Deformation Correction with the Ilizarov External Fixator

The correction of torsional deformities with the Ilizarov apparatus is accompanied by rotational and translational displacement, which affects the biomechanics of the bone fragments. Understanding the biomechanical factors will assist in designing the optimal treatment strategy and mechanical properties of the fixator, thus shortening the duration of treatment and improving the outcomes. In order to determine the impact of different types of derotators on the kinematics of bone fragments in Ilizarov apparatus, physical models were studied. Translational and derotational displacement was measured using non-contact method (Optotrak Certus Motion Capture System). The results of the studies conducted on physical models have shown that regardless of the type of the derotator, the divergence between the applied angle of derotation and the obtained angle of rotation relative to fragments needs to be taken into account. Transverse displacement of fragments occur by 3.5 mm to approximately 9 mm, depending on the angle of derotation. For correction of rotational deformities up to 30°, it is advisable to use the type Z derotators because of its higher accuracy of derotation. Different types of derotators can affect the biomechanical conditions in the regenerating bone tissue through different kinematics characteristics

Sport and physical activity in patients after derotational corticotomies with Ilizarov method

Torsional distortion causes numerous musculoskeletal pathologies. Effective treatment allows restoring limb function and return to sport activity. Objectives was to assess the sport activity in patients with derotational corticotomies using the Ilizarov method. The study examined 56 patients. A mean follow-up time was 5 years and 6 months. A mean age at the start of treatment was 19 years and 10 months. Patients underwent derotational corticotomies of distal epiphysis of the femur or proximal epiphysis of the tibia using the Ilizarov method. The effect of etiology, type of treatment strategy, and rate, size, and level of derotation on the scores of four activity scales was evaluated; additionally, the activity was compared with the control group. There were no differences in the scales of activity before and after treatment in the study and control groups. In the study group, higher activity after treatment was reported in the level of GRIMBY activity. Patients with internal torsion had a higher VAS activity level after treatment as compared to patients with external torsion.Derotational corticotomies allow returning to or increasing physical and sport activity; they do not have a negative influence on physical activity after treatment as compared to the control group

A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients following Distal Radius Fractures Treated with 4- and 6-Week Cast Immobilization

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: (1) muscle strength, (2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration

THE IMPACT OF LOWER LIMB-LENGTH EQUALISATION ON POSTURAL STABILITY IN PATIENTS TREATED WITH THE ILIZAROV METHOD

Background and Objective The aim of the study was to assess postural stability in patients with varying degrees of equalisation of limb shortness in the lower leg after treatment with the Ilizarov method compared to a control group, which consisted of people with lower extremities of equal lengths. Material and Methods The study included 58 men treated with the Ilizarov method due to lower-limb length (LL) inequality in the lower leg and 61 healthy men who served as the control group. Patients with LL inequality were divided into two groups with varying degrees of limb equalisation. The measurement was made using the Biodex Balance System, which enables examination of the patient's ability to control balance and to assess the patient's lower-limb support function by determining their ability to control bilateral, dynamic postural stability on an unstable surface. Results: The study showed that not all patients treated with the Ilizarov method obtained results matching those in the control group. The largest limb-loading asymmetries were recorded in patients with a limb shortness of greater than 1 cm. People with LL asymmetry up to 1 cm obtained better results in terms of all measured parameters compared to patients whose LL discrepancy after treatment was more than 1 cm. The results of the balance parameter on an unstable surface differed between the patients subjected to treatment with the Ilizarov method and the group of healthy individuals. Conclusions People with lower limb-length asymmetry up to 1 cm obtained better results on all measured parameters compared to those with a limb-length discrepancy exceeding 1 cm. The results of the balance control parameter obtained on an unstable surface differed between groups of patients following treatment with the Ilizarov method and healthy individuals. People with limb-length asymmetry up to 1 cm following the treatment placed their weight in the lower extremities in a similar way as healthy individuals did

Radiographic Assessment of Tibiofibular Syndesmosis Injury with Different Durations and Types of Fixation

Introduction: There is no consensus among orthopedic surgeons on the number of cortical layers (tricortical or quadricortical fixation) involved or the duration of syndesmotic fixation after a tibiofibular syndesmosis (TFSD)-injury treatment. The purpose of this study was to assess radiographic parameters following the treatment of TFSD injuries, with various time-windows of syndesmotic screw removal and numbers of cortical layers involved. Materials and Methods: Fifty-five patients, aged from 25 to 75 years, were included in the study. The follow-up period ranged from 2 years to 4 years and 2 months. The patients were subdivided into groups based on the duration of the syndesmotic fixation (8–15 weeks—19 patients or 16–22 weeks—36 patients) and the number of cortices involved (tricortical—17 patients or quadricortical fixation—38 patients). Results: The quadricortical fixation group showed a significant development of ankle joint arthritis and subtalar joint arthritis at the final follow-up. The mean medial clear space was 2.84 mm in the tricortical fixation group and 3.5 mm in the quadricortical fixation group (p = 0.005). Both groups, with different screw removal times showed significant development of posttraumatic arthritis. A comparison of the two groups (with different time-windows of the screw removal) revealed a significant difference only in terms of the postoperative tibiofibular (TF) overlap and the observed rates of talonavicular arthritis at the final follow-up. Discussion: We found that the duration of the screw fixation had no effect on most of the evaluated radiographic parameters. Only the postoperative TF overlap was lower in the 8–15-week fixation group, and the proportion of patients with talonavicular joint arthritis at the final follow-up was higher in the 16–22-week fixation group. In addition, the number of cortices involved in the screw fixation had no effect on the radiographic outcomes in our patients, apart from the differences in one parameter—the medial clear space—at the final follow-up. Conclusion: We achieved similar radiographic results irrespective of the duration of the screw fixation and the number of cortices involved. All study subgroups showed the development of adjacent-joint arthritis following treatment. Considering the results of our study, the economic and medical aspects of treatment, and the possibility of a faster recovery, the most optimal solution seems to be the use of a tricortical fixation, with the screws being removed after 8–15 weeks

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

Introduction. Retrospective study to assess correlation between the sagittal alignment of the cervical spine and the long-term outcomes of long cervical fusion due to cervical spondylotic myelopathy (CSM), with the emphasis on T1 slope minus cervical lordosis (T1S-CL).Summary of background data. Growing evidence shows that the sagittal profile can play a major role in the outcomes of treatment, but the role of its correction is yet to be established.Material and methods. We conducted a retrospective analysis of 54 patients treated for CSM from 2006 to 2012. The neck pain-related disability was measured using NDI, the myelopathy was measured with the mJOA and Nurick scales. Six years after the surgery, standardised X-ray measurements were obtained, including C2–C7 lordosis (CL), C2–C7 sagittal vertical alignment (SVAC2-C7), T1 slope (T1S), and T1S minus CL (T1S-CL). The patients were divided based on the T1S-CL into two groups, using the threshold value of 16.5 degrees.Results. A statistically significant improvement was noted in the mean NDI, mJOA, and median Nurick scale during the initial two years in both groups. The better aligned group had a better outcome measured with NDI at all follow-ups. The mJOA was significantly better in the better aligned group, but only preoperatively; at all follow-ups, the difference was not significant. T1S-CL had the strongest correlation with the NDI at the final follow-up.Conclusions. T1S-CL is an effective prognostic factor of the long term outcome after long cervical fusion in CSM treatment

The Symmetry and Predictive Factors in Two-Stage Bilateral Hip Replacement Procedures

Background: Approximately 10–25% of total hip replacement patients undergo a bilateral procedure. The purpose of this study was to compare selected parameters associated with the first and second hip arthroplasty in patients undergoing two-stage treatment due to bilateral hip osteoarthritis and establish the predictive factors for the second procedure. Methods: This study compared the data on bilateral total hip replacement surgeries conducted in the period between 2017 and 2021 (42 patients). The following parameters from the first and second procedure were compared: the prosthetic stem, head, and insert cup size; type of cup insert; duration of anesthesia; duration of hospitalization; and the number of complications. Results: The mean duration of hospital stay at the time of the first total hip arthroplasty was 5.83 days and 5.4 days during the second stay. The mean stem sizes used during the first and second total hip replacement procedures were 7.11 and 7.09, respectively. The mean sizes of endoprosthetic cups used at the first and second total hip replacement procedures were 52.64 and 53.04, respectively. There were no significant differences between the mean prosthetic head size at the first and second surgery. The cup type used during the first and second surgery showed no difference. The mean duration of anesthesia used during the first and second total hip replacement surgery was 108.09 min and 104.52 min, respectively. We recorded a mean of 0.07 complications per patient at the first surgery and 0.02 at the second surgery. Conclusions: Our study results showed symmetry duration of anesthesia, length of hospital stay, number of complications per patient, stem size, prosthetic head size, cup insert size, and cup insert type at the first and second surgery in patients with two-stage bilateral total hip arthroplasty. We observed a strong correlation between the stem sizes of the first and second hip endoprostheses. There was also a strong correlation between the cup sizes used during the first and second surgery