Features of surgical treatment of posttraumatic lower limbs of different lengths in adult patients

Relevance Different lengths of the lower extremities have a negative impact on the position of the pelvis and spine and lead to secondary deformities. To prevent these consequences, early surgical correction of the shortening is necessary. Aim of study Study of the features of post-traumatic shortening of the lower extremities, mechanisms of adaptation to this condition and, on the basis of this, optimization of surgical technique when performing reconstructive and restorative operations. Material and methods A total of 276 patients with posttraumatic shortening of the lower extremities were examined, 102 of whom were operated on. Comparative radiography of both legs was used to diagnose different lengths. The Ilizarov method was used as the main method of surgical correction. Results We studied the mechanisms of adaptation of patients to post-traumatic shortening of the hip and lower leg and optimized surgical technique. A method was developed for determining the optimal elongation value. Conclusion The most effective and least traumatic method is external osteosynthesis according to Ilizarov. Distraction in the apparatus allows the formation of a regenerate of the required shape and length and the elongation of exactly the amount that is optimal for a given patient. © 2020 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved

Shorting resection and correction of the leg length in the treatment of posttramatic tibial defects complicated by osteomyelitis [Укорачивающая резекция и коррекция длины голени при лечении посттравматических дефектов большеберцовой кости, осложненных остеомиелитом]

BACKGROUND Severe fractures of the shin bones are often accompanied by the formation of defects in the tibia, suppuration and soft tissue necrosis. In the case of surgical treatment of fractures, infectious complications reach 3.6-9.1%. One of the methods of treatment of infected defects is resection of the ends of the tibia with shortening. This operation has proven to be effective in the treatment of fresh fractures. The relevance of the work is due to the prospects of using this technique in the treatment of the consequences of fractures with the formation of infected defects of the tibia. AIM OF STUDy Improving the results of treatment of patients with post-traumatic defects of the tibia complicated by osteomyelitis by performing a shortening resection with simultaneous or sequential correction of the segment length. MATERIAL AND METHODS The results of treatment of 65 patients with diaphyseal post-traumatic tibial defects complicated by osteomyelitis were analysed. They were divided into 2 groups. Group 1 was formed by 31 (47.7%) patients, they underwent shortening resection of the ends of bone fragments in the defect zone with simultaneous lengthening at another level. Group 2 included 34 (52.3%) patients who underwent a shortening resection of the tibia without lengthening. In all cases, the Ilizarov apparatus was used as a fixator. RESULTS The technique for assessing the size of the true defect of the tibia was optimized taking into account the initial shortening of the segment and the distance between the proximal and distal fragments after resection of their ends. A treatment regimen was developed depending on the level of localization of the tibial defect, and the results of treatment of patients in the compared groups were assessed. CONCLUSION Shortening resection is an effective treatment for patients with post-traumatic tibial defects complicated by osteomyelitis. Depending on the level of localization of the defect, it is advisable to carry out treatment according to one of two possible options. When the defect is localized in the upper and middle third of the tibia, shortening resection in an isolated form is shown. If the defect is localized in the lower third of the tibia, it is possible to supplement the shortening resection with an osteotomy in the upper third with Ilizarov lengthening. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved

Aesthetic surgery of the lower limbs in current orthopedic practice

Introduction Correction of the shape of the lower extremities for aesthetic puposes has specific features that are associated with the role of the patient in the treatment process and assessment of results. An important element is the relationship between the appearance of the limb and changes in the axes of the skeleton. Aim of study Assessment of many-years of experience in orthopedic correction of the shape of the lower extremities for aesthetic purposes, discussion of possibilities, analysis of problems and search for possible ways to prevent them. Methods The material of the study was 123 patients who underwent aesthetic surgical correction in the period from 2005 to 2020. Their long-term results were followed in the period from 6 months to 11 years. In all cases, operations were performed simultaneously on both limbs. The total number of operations, thus, amounted to 246. The main indication for surgery was the so-called true O-shaped curvature (varus deformity) of the lower extremities. In all cases, the main elements of the operation were osteosynthesis with the Ilizarov apparatus and osteotomy of the tibia. Wires and half-pins were used as transosseous elements. To assess the main reference lines and angles (RLA), X-ray examination of the lower extremities was performed with the capture of the hip and ankle joints. Results and discussion Corrective manipulations in the group of patients led to a change in the position of the main RLA. Before treatment, MAD value was 15 ± 7 mm, after correction MAD = -2 ± 4 mm, before surgery MPTA = 85 ± 40, after correction MPTA = 91 ± 20. Subjective satisfaction was reported in 114 (92.7 %) cases. Subjectively unsatisfactory results were recorded in 4 (3.3 %) cases; objectively unsatisfactory results were detected in 5 (4.1 %) cases. Conclusions Aesthetic surgery of the lower extremities is a part of orthopedic practice and has its specific features due to the goal of realizing the patient's wishes about changing the appearance of the lower extremities indirectly by performing operations on the skeleton. Corrective surgery should be considered as a preventive intervention aimed at preventing the development of gonarthrosis in old age. The key to a good result is a careful selection of candidates for surgery and their compliance, along with a thorough explanation of the principles and features of correction. © 2021. Artemev A.A., Brizhan L.K., Davydov D.V., Bytdaev Z.M., Kashoob Á.M., Shipulin A.A., Gululyan G.G. All rights reserved

Osteosynthesis according to ilizarov as a self-sufficient method for treatment of shin bones fractures [ОСТЕОСИНТЕЗ ПО ИЛИЗАРОВУ КАК САМОДОСТАТОЧНЫЙ МЕТОД ЛЕЧЕНИЯ ПЕРЕЛОМОВ КОСТЕЙ ГОЛЕНИ]

Shin fractures are the most common skeletal injuries. Practically all known types of osteosynthesis are used for treatment. The use of the Ilizarov method is associated with certain difficulties relating to the peculiarities of postoperative observation. Objective − to generalize the long-term experience of using the Ilizarov method in the treatment of diaphyseal fractures of the shin bones, to optimize the technique, analyze problems and assess the prospects for the development of the method. Materials and methods. The experience with treating 57 patients with diaphyseal fractures of the shin bones is presented. All patients underwent Ilizarov osteosynthesis using rod and spoke-rod devices. The dynamics of load recovery, the timing of dismantling the apparatus, the number and severity of complications were assessed. Results. The recovery times for the loads were as follows: 25 % − 5.4 + 1.4 days; 50 % − 34.7 + 11.2 days; 100 % − 76.2 + 17.6 days. The time for dismantling the apparatus is 155 + 37.3 days. The minimum period from osteosynthesis to the dismantling of the apparatus was 95 days, the maximum – 278 days. During the treatment of the group of patients under consideration, two types of complications were encountered: inflammation of the soft tissues at the points of exit of the wires in 24 (42.1 %) and delayed fusion in 1 (1.8 %) patient. Conclusion. The use of spoke-rod structures is optimal. The osteosynthesis operation involves performing a preliminary reduction. A feature of the postoperative period is constant monitoring and interaction between the doctor and the patient. Osteosynthesis according to Ilizarov in the treatment of patients with fractures of the shin bones is a self-sufficient method that provides accurate reposition, stable fixation and good anatomical and functional results. © 2021 The Charity Fund of Clinical Center of Miners' Health Protection. All rights reserved