RESUMO
Bone-screw loosening in monolateral external fixators is a significant problem. This study classifies the radiographic appearance of the bone-screw interface and predicts which screws will become loose and those that will remain solidly fixed to bone. Five radiographic features were identified at the bone-screw interface. The classification of these features was validated using interobserver and intraobserver studies. The reliability of the classification was improved by image enhancement with simple filters. Some radiographic features predicted which screws would eventually become loose, allowing the clinician to make earlier management decisions regarding the adjustment of screws.
Assuntos
Parafusos Ósseos , Fixadores Externos , Técnica de Ilizarov/instrumentação , Pediatria/métodos , Falha de Prótese , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Criança , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Estudos RetrospectivosRESUMO
The Vilarrubias method of limb lengthening is a percutaneous procedure with soft tissue releases. This reduces soft tissue tension and prevents joint contractures during longer lengthenings. This method has been used for 99 lower limb lengthenings. The mean length gained was 92 mm and the mean Bone Healing Index was 41.3 days/cm. There were 45 pin site problems, 33 flexion contractures, 33 angular deformities and 15 stress fractures. This complication rate compares well with other techniques. We recommend that the Vilarrubias method can be considered for lengthenings, where the aim is greater than 15% of the bone length with potential soft tissue problems.
Assuntos
Fêmur/cirurgia , Fíbula/cirurgia , Osteogênese por Distração/métodos , Tíbia/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
A retrospective study of 32 patients who underwent tibial lengthening was performed in order to establish the need for distal tibio-fibular fixation. In 16 patients stabilization of the inferior tibio-fibular joint was carried out and in the other 16 no stabilization was performed. Three established and one new radiographic index of the tibio-fibular relationship at the ankle were used to assess proximal fibular migration. All patients showed proximal migration of the distal fibula, but those without stabilization demonstrated marked migration of the fibula associated with a valgus tendency. The difference between the groups was statistically significant ( <0.001), confirming the need for fibular fixation.
