Evaluation of clinical efficacy and safety of the Ilizarov apparatus for external fixation (literature review)

Purpose A retrospective analysis of clinical efficacy and safety of using the external fixation apparatus of G.A. Ilizarov's design. Materials and methods Analysis and evaluation of clinical data was performed using 107 literary sources. 4.200 clinical cases were studied to evaluate effectiveness, and 6.274 cases to assess safety. Results The analysis revealed a high clinical efficacy of using the Ilizarov apparatus for external fixation (various assemblies) in solving a wide range of practical problems in the field of traumatology and orthopedics. According to the results of the study, its high clinical treatment effectiveness was confirmed both on the use of the method in general (about 95 % of positive outcomes), and in specific nosological groups of patients (not lower than 90 % of positive outcomes). After having assessed the available data on the safety in the application of the Ilizarov apparatus for external fixation (various assemblies), we can conclude that the rates of adverse events, recorded in the literature analyzed, can be considered acceptable. Among all those events, the events classified as adverse effects of the product amounted to 17.03 % (5 ÷ 95 % CI: 16.11 ÷ 17.97 %). © Soldatov Yu.P., Stogov M.V., Ovchinnikov E.N., Gubin A.V., Gorodnova N.V., 2019. © 2019 Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics

ANATOMIC AND PHYSIOLOGICAL FEATURES OF DISTAL LOWER LEG AND THEIR INFLUENCE ON THE PROCESS OF OSTEOGENESIS

Osteogenesis is the process of bone tissue forming, i.e. bone or callus regeneration. This process is influenced by many factors, and the degree of bone fragments’ stability and vascularization in the fracture area are the basic local factors which determine the nature of reparative process. Regenerative process of all bone structures increases with increasing of blood supply.The distal lower leg has its specific biomechanical features, and plays an important role in the transfer of body weight to foot. The distal part of tibia has a small diameter, which as a consequence has reduced diameter in medullar cave. Through this anatomic feature, the medullar network in the lower tibia part is also reduced.As for anatomic aspect, vascularization in the lower end of tibia is poor. It primarily depends on periosteal vascularization, because medullar vascularization is reduced. Fasciae, tendons and skin cover the lower part of the leg, and there is no muscle mass. These tissues have poor vascular network and that is why the extraosseous blood circulation in tibia is poor, and does not participate in the osteogenesis process. For these reasons, distal lower leg represents a predelection site for delayed osteogenesis and pseudoarthrosys development.Osteosynthesis causes secondary damage to bone and soft tissue circulation. The screw plate damages the periosteal circulation – in the lower part of tibia it is the main source of vascularization, and for this reason, this method of osteosynthesis should not be applied. The external fixator has a sparing role regarding vascularization, and that is the reason why this method is recommended for fracture stabilization at the level of distal lower leg

The stable-functional osteosynthesis of clavicular fractures with external fixator

Department of Trauma, Emergency Medicine Institute, Chisinau, District Hospital Rascani, the Republic of MoldovaBackground: Over the past two decades has been paid insufficient attention to the treatment of patients with clavicle fractures. Analysis is of the recent available literature and the personal practice allow us to have a special position to this issue, solving the problem of the clavicle fractures treatment with a new and more efficient method. Material and methods: For a better deduction and appreciation of the fracture fixation methods results we established a task based on the effectiveness evaluation of the external fixator utilization as a way for a stable osteosynthesis of the fragments performance. It was tested experimentally the efficacy of clavicle fragments fixation with different fixators. The experiment was performed at 30 anatomical specimens of clavicle aged from 38 to 70 years. The mechanical force of the osteosynthesised fragments fixation at flexion and stretching was appreciated in the Alfred G. Amsler German machine with a deviation from 0 to 50 Kn/cm and the capacity of a unit equal to 0.5 Kn/cm. Results: After the application of the stable-functional osteosynthesis method in clavicle fractures treatment with the external fixator’s help, the experimental samples prove objectively the qualities of the proposed fixator, which has an essential priority in the mechanical force of fixing the fragments compared to the traditional fixators used in most cases at the patients with clavicle fractures. Conclusions: The new method of stable-functional osteosynthesis of the clavicle fractures by using the external fixator, which is simple in assembly and manufacture, excludes the shortcomings of the traditional methods of surgical treatment and allows its application at any level of specialized surgical aid

Complicaţii în tratamentul chirurgical al fracturilor acetabulare

În Centrul Naţional Ştiinţifi co-Practic de Medicină Urgentă, pe parcursul anilor 2000- 2007 tratamentului chirurgical al fracturii de acetabul au fost supuşi 76 de pacienţi, inclusiv 48 trataţi prin metoda osteosintezei interne, 14 – prin metoda osteosintezei extrafocare, 7 – intervenţia de artroplastie totală de şold primară, combinată cu osteosinteza, şi 7 pacienţi cu artroplastie totală de şold secundară a coxartrozei posttraumatice, efectuată după o fractură de acetabul, tratată operator în antecedente. Rezultatele cercetării au demonstrat că după un interval de 4,5±0,1 ani coxartroza şi NACF au apărut în 29,2% cazuri după osteosinteza internă şi în 28,6% – după osteosinteza extrafocală, osificatele paraarticulare Brooker dezvoltându-se în 10,4% cazuri după osteosinteza internă

Abordul posterior în tratamentul chirurgical al fracturilor de platou tibial

Background. Tibial plateau fractures represent approximately 1% of the total fractures in the general population and 8% among the senile age population. Objective of the study. Analysis of the results of surgical treatment of patients with tibial plateau fractures in which the posterior approach was performed isolated or associated with other surgical approaches in the orthopedic and traumatology clinic „V. Bețișor” during 2014-2020. Material and Methods. We analyzed 25 clinical cases: 15 women, 10 men. According to the Schatzker classification, type IV-5, V-13, VI-7 were determined, all were closed, and the fracture of the posterior column was present in all of them. In five cases only the posterior approach was performed, in the remaining 20 associated with the antero-lateral approach. Surgical treatment consisted of open reduction and internal osteosynthesis performed using at least one plate and screws. Results: Patients were evaluated clinically and imaging postoperatively, the functional result was assessed according to the Lysholm Knee Scoring Scale, obtaining an average result of 92 points. Bone healing was determined at an average period of 14 weeks. Mild postoperative complications developed in three patients. The results were dependent on the quality of the reduction, the stability of the osteosynthesis, the precocity, and the correctness of the functional recovery and the compliance of the patients. Conclusion: The posterior approach is considered the best choice in cases of tibial plateau fractures with involvement of the posterior column, as it allows qualitative reduction, stable osteosynthesis, early and correct functional recovery.Introducere. Fracturile de platou tibial reprezintă aproximativ 1% din totalul fracturilor în populația generală și 8 % în rândul populației de vârstă senilă. Scopul lucrării. Analiza rezultatelor tratamentului chirurgical al pacienților cu fracturi de platou tibial la care s-a realizat abordul posterior izolat sau asociat cu alte aborduri chirurgicale în clinica de ortopedie și traumatologie „Vitalie Bețișor” în perioada 2014-2020. Material și Metode. Am analizat 25 cazuri clinice: 15 femei, 10 bărbați. Conform clasificării Schatzker s-au determinat tip IV-5, V-13, VI-7, toate au fost închise, la toate a fost prezentă fractura coloanei posterioare. În 5 cazuri s-a realizat doar abordul posterior, în restul 20 asociat cu abordul antero-lateral. Tratamentul chirurgical a constat în reducere deschisă și osteosinteza internă realizată prin utilizarea a cel puțin a unei plăci și șuruburi. Rezultate. Pacienții au fost evaluați clinic și imagistic postoperator, rezultatul funcțional a fost apreciat conform Lysholm Knee Scoring Scale, obținându-se un rezultat mediu de 92 puncte. Consolidarea osoasă o fost determinată la o perioadă medie de 14 săptămâni. La 3 pacienți s-au dezvoltat complicații postoperatorii ușoare. Rezultatele au fost dependente de calitatea reducerii, stabilitatea osteosintezei, precocitatea, corectitudinea recuperării funcționale și complianței pacienților. Concluzii. Abordul posterior este considerat de elecție în cazul fracturilor de platou tibial cu implicarea coloanei posterioare, deoarece permite reducerea calitativă, osteosinteza stabilă, recuperare funcțională precoce și corectă

Utjecaj oblika kontaktne površine na torzijsku krutost osteosintetskih pločica

U radu su dana rješenja za konstruiranje uređaja za uvijanje. Posebna pozornost se treba posvetiti čvrstoći konstrukcijskih elemenata s izraženim geometrijskim diskontinuitetima kao što su utori i provrti. Na tim mjestima dolazi do lokalnog povećanja naprezanja koja su nekoliko puta veća od nominalne vrijednosti. Ta naprezanja mogu dovesti do bitnog smanjenja vijeka trajanja, pa i do lomova, što je naročito izraženo kod dinamički opterećenih konstrukcijskih dijelova. U svim slučajevima kada je numerička simulacija složena zbog geometrijskih karakteristika, rubnih uvjeta ili zbog nepoznavanja ulaznih parametara kao što su mehanička svojstva materijala, eksperiment je jedino rješenje. U ovom radu razvijen je uređaj za ispitivanje konstrukcijskih elemenata na uvijanje. Razvoj uređaja bio je motiviran potrebom da se ispita torzijska krutost novokonstruiranih pločica za osteosintezu. Pločice pored dobrih kliničkih svojstava trebaju imati i zadovoljavajuće mehaničke karakteristike. Iako je uređaj prvenstveno razvijen za ispitivanje pločica za osteosintezu, svojim konstrukcijskim rješenjima omogućuje ispitivanje na uvijanje konstrukcijskih elemenata proizvoljnog oblika. U radu su prikazana rješenja za način mjerenja momenta uvijanja kao i kuta zakreta

POSTERIOR APPROACH IN SURGICAL TREATMENT OF TIBIAL PLATEAU FRACTURES

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Fracturile de platou tibial reprezintă aproximativ 1% din totalul fracturilor în populația generală și 8 % în rândul populației de vârstă senilă. Scopul lucrării. Analiza rezultatelor tratamentului chirurgical al pacienților cu fracturi de platou tibial la care s-a realizat abordul posterior izolat sau asociat cu alte aborduri chirurgicale în clinica de ortopedie și traumatologie „Vitalie Bețișor” în perioada 2014-2020. Material și Metode. Am analizat 25 cazuri clinice: 15 femei, 10 bărbați. Conform clasificării Schatzker s-au determinat tip IV-5, V-13, VI-7, toate au fost închise, la toate a fost prezentă fractura coloanei posterioare. În 5 cazuri s-a realizat doar abordul posterior, în restul 20 asociat cu abordul antero-lateral. Tratamentul chirurgical a constat în reducere deschisă și osteosinteza internă realizată prin utilizarea a cel puțin a unei plăci și șuruburi. Rezultate. Pacienții au fost evaluați clinic și imagistic postoperator, rezultatul funcțional a fost apreciat conform Lysholm Knee Scoring Scale, obținându-se un rezultat mediu de 92 puncte. Consolidarea osoasă o fost determinată la o perioadă medie de 14 săptămâni. La 3 pacienți s-au dezvoltat complicații postoperatorii ușoare. Rezultatele au fost dependente de calitatea reducerii, stabilitatea osteosintezei, precocitatea, corectitudinea recuperării funcționale și complianței pacienților. Concluzii. Abordul posterior este considerat de elecție în cazul fracturilor de platou tibial cu implicarea coloanei posterioare, deoarece permite reducerea calitativă, osteosinteza stabilă, recuperare funcțională precoce și corectă.Background. Tibial plateau fractures represent approximately 1% of the total fractures in the general population and 8% among the senile age population. Objective of the study. Analysis of the results of surgical treatment of patients with tibial plateau fractures in which the posterior approach was performed isolated or associated with other surgical approaches in the orthopedic and traumatology clinic „V. Bețișor” during 2014-2020. Material and Methods. We analyzed 25 clinical cases: 15 women, 10 men. According to the Schatzker classification, type IV-5, V-13, VI-7 were determined, all were closed, and the fracture of the posterior column was present in all of them. In five cases only the posterior approach was performed, in the remaining 20 associated with the antero-lateral approach. Surgical treatment consisted of open reduction and internal osteosynthesis performed using at least one plate and screws. Results: Patients were evaluated clinically and imaging postoperatively, the functional result was assessed according to the Lysholm Knee Scoring Scale, obtaining an average result of 92 points. Bone healing was determined at an average period of 14 weeks. Mild postoperative complications developed in three patients. The results were dependent on the quality of the reduction, the stability of the osteosynthesis, the precocity, and the correctness of the functional recovery and the compliance of the patients. Conclusion: The posterior approach is considered the best choice in cases of tibial plateau fractures with involvement of the posterior column, as it allows qualitative reduction, stable osteosynthesis, early and correct functional recovery

Экспериментальное исследование стабильности остеосинтеза проксимального отдела плечевой кости различными фиксаторами

Universitatea de Stat de Medicină şi Farmacie Nicolae TestemiţanuSummary: Different intensity of mechanisms that produce naturally proximal humerus fracture, is difficult to obtain în Vivo and depends to the age of the patient and bone quality, so this made the impossible comparison between them. Biomechanical analysis on human fresh cadaveric humerus uses numerous fixation techniques and fixators. We have used 50 fresh cadaveric humerus and have made 8 osteosynthesis models divided into 3 big groups applying 4 variants taction in different directions. The aim was to study deformity in fixation system to action of different forces (axial traction, pure bend, perpendicular bend in osteosynthesis plane, torsion with bend) and their capacity to maintain osteosynthesis uniform between reduced fragments. Implants as K-wires completed with metallic tension band thanks to its limited contact with bone and thanks of its elastic properties lead to stress stultification between bone-implant made them optimum for qualitative and osteoporotic fracture fixation.Резюме: Меxанизмы разной интенсивности, которые ведут к переломам проксимального отдела плечевой кости, очень тяжело выявить in vivo, они зависят от возраста пациентов и остеопороза кости и делают невозможной разницу между ними. Биомеханический анализ на свежих трупных плечевых костях использует множество хирургических техник и фиксаторов. Мы использовали 50 трупных плечевых костей, которые были сгруппированы по 8 моделей и 3 группы, на которые были нанесены 4 варианта вытяжений в разные стороны. Задача исследования – установить деформацию в системе фиксации при действии разных сил (аксиальное вытяжение, сгибание, перпендикулярное сгибание в плане остеосинтеза, ротация со сгибанием) и их возможность удерживать остеосинтез между фрагментами. Такие импланты как спицы с добавлением натянутой металлической проволокой, благодаря уменьшенному контакту с костью и своим эластичным свойствам, уменьшают стресс между имплантами и костью, что делает оптимальной фиксацию переломов здоровых и порозных костей

Učinkovitost osteosinteze s košarastom pločicom kod multifragmentnih prijeloma ivernog vrška - Procjena ekstenzije koljena u kasnom poslijeoperacijskom razdoblju

The aim of the study was to assess functional status of the knee extensor system in the late postoperative period (at least two years of the operation and implant removal) in patients submitted to basket plate osteosynthesis for transverse or comminuted fracture of the apex of patella. The study included 71 patients with comminuted patellar apex fracture who had undergone basket plate osteosynthesis. The status of the knee extensor system was evaluated by a modified Cincinnati test. Excellent results were recorded in 59.2%, good in 30.6% and satisfactory in 10.2% of study patients. There were no poor results. In addition to ensuring osteosynthesis stability and the potential of early weight bearing, basket plate osteosynthesis meets the requirements of modern traumatology and the authors are inclined to consider it the method of choice to treat comminuted or transverse fractures of the apex of patella.Cilj ove prospektivne studije bila je procjena funkcijskog statusa ekstenzornog sustava koljena u kasnom poslijeoperacijskom razdoblju (najmanje dvije godine nakon operacije i uklanjanja usatka) u bolesnika podvrgnutih osteosintezi s košarastom pločicom zbog poprečnog ili multifragmentnog prijeloma ivernog vrška. Procjena je obuhvatila 71 bolesnika s multifragmentnim prijelomom patelarnog vrška u kasnom poslijeoperacijskom razdoblju nakon osteosinteze s košarastom pločicom. Status ekstenzornog sustava koljena procjenjivan je modificiranim testom Cincinnati. Izvrsni rezultati su zabilježeni u 59,2%, dobri u 30,6% i zadovoljavajući u 10,2% bolesnika. Loši rezultati dosad nisu zabilježeni. Uz osiguranje stabilnosti osteosinteze i mogućnost ranog opterećenja, osteosinteza s košarastom pločicom ispunjava zahtjeve suvremene traumatologije, te prema našem mišljenju predstavlja metodu izbora u zbrinjavanju multifragmentnog ili poprečnog prijeloma ivernog vrška