Subjective and Objective Outcomes of Ankle Joint Arthrodesis with Either Ilizarov or Internal Fixation.

After arthroplasty, arthrodesis of the ankle joint is the most common method to treat advanced ankle osteoarthritis. The goal of the study was to assess the subjective and objective outcomes in 2 different types of fixation for ankle joint arthrodesis. We retrospectively assessed 47 patients who had undergone ankle joint arthrodesis with fixation either via an Ilizarov apparatus (group 1) (n = 21) or cannulated screws (group 2) (n = 26). The outcomes were measured by: (1) the quantity of analgesics administered, (2) the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, (3) general patient satisfaction, (4) the patients' decision to undergo the same procedure given another chance, and (5) the necessity of blood transfusion during hospitalization. Data was collected at the last postoperative follow-up visit. The AOFAS scores in group 1 and group 2 patients were 73.9 ± 13 and 72.7 ± 14.3, respectively. In group 1, 17 patients (81%) were very satisfied with the results, while in group 2, 19 patients (73%) were very satisfied with the results (p = .043). Two group 1 patients (10%) and four group 2 patients (15.3%) reported that they were satisfied with the outcomes (p = .035). Two patients (10%) from group 1 and three patients (11%) from group 2 were fairly satisfied. Seventeen patients (81%) after arthrodesis with Ilizarov fixation and 21 patients (81%) after arthrodesis with internal fixation would choose the same procedure given the opportunity to choose again. In group 1 there were no patients who required blood transfusion; in group 2 one patient (4%) required blood transfusion; the difference was statistically significant (p = .039). Nineteen group 1 patients (90%) were administered an analgesic preoperatively, while postoperatively only 6 (29%) required analgesics. In group 2, 24 patients (92%) were administered analgesics preoperatively, with 8 (31%) of them still requiring analgesics postoperatively. Ankle arthrodesis patients from both group 1 and group 2 achieved good subjective and objective results of treatment. We noted slightly better results in the Ilizarov apparatus group.

Kinematic parameters after tibial nonunion treatment using the Ilizarov method.

BACKGROUND: Analysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an important measure for assessing musculoskeletal disorder treatments that aim to restore normal gait. The purpose of our study was to compare the kinematic parameters in patients with tibial nonunion treated using the Ilizarov method and those in a control group of healthy volunteers. METHODS: The study population consisted of 23 patients (age 54.9 ± 16.4 years) who were treated for tibial nonunion using the Ilizarov method, as well as 22 healthy adult controls (age 52.7 ± 10.6 years). Kinematic parameters were measured using a Noraxon MyoMOTION System. We measured hip flexion and abduction, knee flexion, ankle dorsiflexion, inversion, and abduction during walking. RESULTS: Our analysis showed significant differences between the patients' operated limbs (OLs) and the controls' nondominant limbs (NDLs) in the ranges of hip flexion, hip abduction, and knee flexion. We observed no significant differences in knee flexion between the OL and the NOL in patients or between the dominant limb (DL) and NDL in controls. Our evaluation of the kinematic parameters of the ankle joint demonstrated significant differences between the patients' OLs and the controls' NDLs in the ranges of ankle dorsiflexion, ankle inversion, and ankle abduction. There were also significant differences in the range of ankle dorsiflexion and ankle abduction between the patients' NOLs and the controls' DLs. CONCLUSION: Tibial nonunion treatment using the Ilizarov method does not ensure complete normalization of kinematic parameters assessed 24-48 months following the completion of treatment and rehabilitation.

Dynamic Gait Parameters in Patients With Nonunion of the Tibia Following Treatment With the Ilizarov Method.

The purpose of this study was a comprehensive assessment of the dynamic parameters of gait in patients who underwent Ilizarov treatment for nonunion of the tibia. The experimental group consisted of 24 individuals treated with the Ilizarov method for nonunion of the tibia. The control group comprised 31 healthy individuals, matched for BMI, sex, and age. The dynamic gait parameters in patients and in the control group were measured with a Zebris pedobarographic platform. The treatment group and the control group showed statistically significant differences in terms of the following gait parameters: maximum force during braking nonoperated-limb (NOL), time maximum force during braking operated-limb (OL), time maximum force during braking NOL, maximum force during push-off NOL, time maximum force during push-off OL, and maximum force forefoot OL. Most of the evaluated gait parameters were bilaterally similar in patients group. The only significant differences between the operated and nonoperated limb were seen in terms of Time maximum force during push-off and Maximum force forefoot. The most pronounced abnormalities in dynamic gait parameters were observed in the forefoot (maximum force forefoot OL was 13.3% lower than in the control group, maximum force forefoot OL was 12.4% lower than in NOL). The patients treated with the Ilizarov method did not achieve a complete normalization of dynamic gait parameters, as their gait parameters did not equal those measured in the control group. The Ilizarov method for the treatment of tibial nonunion helps restore a symmetrical distribution of gait parameter values between the affected limb and the healthy limb. Patients continue to show the following abnormalities in their dynamic gait parameters after treatment: higher values maximum force during braking NOL, Time maximum force during braking OL, time maximum force during braking NOL, maximum force during push-off NOL, contact time forefoot NOL, contact time midfoot NOL, contact time heel NOL and smaller values of time maximum force during push-off OL.

Assessment of Lower Limb Load Distribution in Patients Treated with the Ilizarov Method for Tibial Nonunion.

BACKGROUND Successful treatment of tibial nonunion should lead to a complete bone union, lack of pain, and pathological mobility of the lower extremity, as well as to the achievement of satisfactory joint mobility and muscle strength, which in turn improves its biomechanics. The objective of this study was to assess the load placed on the lower limbs in patients subjected to treatment with the Ilizarov method due to aseptic tibial nonunion. MATERIAL AND METHODS This research involved 24 participants (average age, 55 years). All were diagnosed with aseptic tibia nonunion and treated with the Ilizarov external fixator between 2000 and 2017. The control group was matched to the treated group in terms of sex and age. This study used pedobarography evaluation to assess lower limb load distribution. RESULTS No differences were found in the distribution of the load over the entire foot or of the forefoot and hindfoot of the treated limb in comparison to the non-dominant limb of the controls, or in the healthy limb of the treated group compared to the dominant limb of the control group. Similarly, differences in load distribution between the operated and healthy limbs of the treated group were insignificant. CONCLUSIONS Patients subjected to treatment with the Ilizarov external fixator for aseptic tibial nonunion show symmetrical load distribution on both lower limbs following treatment, which does not differentiate them in this respect from healthy individuals. Treated patients presented with a symmetrical distribution of the load on the lower extremities over the entire foot surface, including the forefoot and hindfoot. Finally, the Ilizarov external fixator enables restoration of correct static biomechanics of the treated limbs over the period of aseptic tibial nonunion therapy.

Assessment of Gait after Treatment of Tibial Nonunion with the Ilizarov Method.

BACKGROUND: Tibial nonunion is a common bone union disorder leading to abnormal gait, and thus reducing quality of life in the social dimension. RESEARCH QUESTION: The aim of our work was to comprehensively assess gait parameters of patients who had undergone Ilizarov treatment for tibial nonunion compared to a control group of healthy individuals. METHODS: This study evaluated patients treated for aseptic tibial nonunion with the Ilizarov method. 24 patients with a mean age of 55.0 years were included in the study. The control group consisted of 32 healthy volunteers with no significant medical history who were selected to match the gender and age of patients in the study group so that the groups were homogeneous. A Zebris Medical GmbH pedobarographic platform was used to assess the gait parameters. RESULTS: For all gait parameters examined, force forefoot max, force backfoot max, step length, stance phase, swing phase and step time, we observed statistically significant differences between the group that had undergone treatment and the control group. In the group of patients, statistically significant differences between the operated lower limb and the non-operated limb were only observed for the force forefoot max and step time parameters (p = 0.029 and p = 0.045, respectively). Patients presented a longer loading of the operated limb (0.720 s) than the non-operated limb (0.635 s). For the stride time, step cadence and gait velocity parameters, healthy subjects achieved much better results during locomotion, and these differences were statistically significant at p < 0.001. SIGNIFICANCE: Treatment of tibial nonunion with the Ilizarov method did not restore normal gait parameters in our group of patients. In fact, the gait parameters of patients were significantly worse than the healthy individuals in the control group. Furthermore, gait parameters following treatment were not symmetrical, and the dynamics of the musculoskeletal system remained impaired.

A new criterion for assessing Ilizarov treatment outcomes in nonunion of the tibia.

INTRODUCTION: The purpose of this study was to assess a population of patients with nonunion of the tibia treated with the Ilizarov method in terms of achieved union rates and maintained union rates, determination of re-fracture factors, with a subsequent comparison of our findings with those reported in the available literature. MATERIALS AND METHODS: This study was a retrospective assessment of 102 patients with nonunion of the tibia treated with the Ilizarov method in the period 2008-2015. The assessed parameters were bone union achieved during treatment, duration of stabilization with an Ilizarov external fixator, and maintained bone union at the last follow-up visit. RESULTS: The mean age at the start of treatment was 46.7 years (11-84 years). The mean follow-up period was 7 years (2-12 years). Bone union was achieved in all patients. The mean duration of Ilizarov stabilization in the study group was 7.9 months (2.8-20.7 months). The rate of union maintained at the last follow-up visit was 95.1%. CONCLUSIONS: All patients in our study achieved bone union, which constitutes a better outcome than those reported on average in the literature (73.7-100%). The mean length of time which the Ilizarov external fixator was in place in our patients was 8.3 months, which is consistent with the data from literature. Infection, atrophic nonunion, nonunion in 1/3 distal of tibia, and close surgery technique are risk factors of re-fracture. None of the analyzed studies assessed the proportion of patients with maintained bone union. In our study, maintained bone union was observed in 95.1% of patients at the follow-up visit at least 2 years after treatment, which indicates excellent long-term treatment outcomes in nonunion of the tibia treated with the Ilizarov method.

The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques.

Nonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques. A total of 75 patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients's mean age at the beginning of treatment was 46 years. The mean follow-up period was 10 years and 11 months. The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression. The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay. Bone union was achieved in all of the 75 evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me = 6.00 vs. Me = 4.00). We observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group. The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union, length of hospital stay, duration of Ilizarov treatment, or ASAMI bone scores. For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression. The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia-a retrospective comparative analysis.

INTRODUCTION: This study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia. MATERIAL AND METHODS: In a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000-2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity. RESULTS: Union rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827). DISCUSSION: Our study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Assessment of body balance of patients treated with the Ilizarov method for tibial nonunion.

PURPOSE: The biomechanics of the musculoskeletal system in patients after tibial nonunion treatment using the Ilizarov method have not yet been fully explored. From the orthopaedic and patient point of view, after the treatment, an assessment should be carried out of the biomechanics of the musculoskeletal system. The aim of this study was to assess the body balance of patients treated with the Ilizarov method for tibial nonunion. METHODS: The research group included 24 individuals with a mean age of 55 years, who were treated for aseptic tibial nonunion with the Ilizarov method. The control group was matched to the study group in terms of gender and age, and consisted of 32 subjects with a mean age of 50.5 years and no significant medical history. This study evaluated the balance of patients with the use of pedobarography. RESULTS: In the control group, a statistically significantly shorter path of centre of gravity was observed. There were no statistical differences between the study and control groups for the field area of the centre of gravity. There were no statistical differences between the study and control groups for the minor axis length or major axis length of the centre of gravity. There was a relationship between the centre of pressure path length and the age of the participants in both the control group and the study group. CONCLUSIONS: Treatment of patients with tibial nonunion with the Ilizarov fixator achieves similar balance to healthy volunteers. In the pedobarographic evaluation, patients treated for tibial nonunion using the Ilizarov method had similar statics of the musculoskeletal system to healthy volunteers.

Ankle Arthrodesis with Simultaneous Lengthening of the Lower Limb Using the Ilizarov Fixator.

BACKGROUND: Patients with advanced ankle arthrosis or joint deformities and co-existing lower limb shortening present a complex therapeutic problem. This paper presents the Ilizarov treatment as a comprehensive method of simultaneous ankle arthrodesis and equalisation of lower limb length in 18 patients. MATERIAL AND METHODS: Eighteen patients with arthrosis, deformities or other conditions of the ankle joint and ipsila-teral lower limb shortening were treated with the Ilizarov method. The patients were assessed with the Foot and Ankle Outcomes Questionnaire before the treatment and one year after Ilizarov Fixator removal. RESULTS: The Ilizarov Fixator allows early weight-bearing of the operated limb, which is undoubtedly convenient for the patient. The mean treatment duration was 8.2 months (range 4-18 months). Lower limb lengthening was 4.1 cm on ave-rage (range 2.5-8.5 cm). Bone union was achieved in all cases. Radiological and clinical outcomes were satisfactory in all 18 cases. Prolonged regenerate calcification was recorded in 1 patient. Ten patients developed soft tissue pin-tract infec-tions and in 1 patient the Kirschner wire broke. According to the Foot and Ankle Outcomes Questionnaire, patients achiev-ed a notable improvement in daily functioning and quality of life. CONCLUSIONS: 1. The outcomes of a comprehensive treatment con-sisting of ankle arthrodesis and lower-leg leng-then-ing using the Ilizarov method confirm its effec-tiveness. 2. The Ilizarov Fixator allows early weight-bearing of the operated limb and evaluation at all treat-ment stages, creating an optimal biological envi-ron-ment for bone healing. 3. The patient recovers functionally to allow satis-fac-tory and pain-free functioning as well as re-sum-ption of daily responsibilities. The low inci-den-ce of complications adds to the attractiveness of the method.

Comminuted Fractures of the Distal Femur Treated with Ilizarov External Fixator. Case Series Study.

BACKGROUND: Distal femoral fractures constitute a type of lower limb injuries that is rare and difficult to treat. Despite advances in surgical technique and development of implants used for internal fixation of fracture fragments, the treatment continues to result in numerous complications. The Ilizarov External Fixator reduces the risk of complications and allows for bone union. MATERIAL AND METHODS: Six men with distal femoral fractures resulting from multisite and multiorgan injuries were treated at the Department of Orthopaedics and Musculoskeletal Traumatology of the Medical Uni-versity of Warsaw between 2008 and 2016. Mean age of the patients was 42.6 years. Four of them were mana-ged with the Ilizarov method as a primary treatment and two wore the apparatus as a second-line treatment following unsuccessful plate osteosynthesis. RESULTS: Mean treatment duration with the Ilizarov apparatus was 29 weeks. Bone union was achieved in all patients. After the treatment, the patients ambulated unassisted, without orthopaedic aids. All patients re-turned to work. CONCLUSIONS: 1. The Ilizarov method allows for efficient fixation of comminuted distal femoral fractures, in-clud-ing C2 and C3 intra-articular fractures (AO/ASIF classification). 2. The use of the Ilizarov apparatus re-duces soft tissue laceration, preserves blood supply to the bone fragments, and allows for easier skin care, which is particularly important in the case of open fractures. 3. Early rehabilitation with the patient fully loading the operated limb reduces muscle atrophy and stimulates bone union.