Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods.

Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods / Tratamento de fraturas do planalto tibial com fixador externo circular: Uma análise comparativa de duas formas de montagem

Abstract Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences (p> 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Resumo Objetivo Comparar os resultados funcionais entre duas técnicas de fixação externa circular utilizadas no tratamento de fraturas complexas da extremidade proximal da tíbia. Materiais e Métodos Trata-se de um estudo de coorte retrospectivo, com 51 pacientes submetidos ao tratamento cirúrgico de fraturas complexas do planalto tibial com fixador externo circular. Os pacientes foram divididos em dois grupos: 12 pacientes tratados com a técnica clássica e 39 pacientes tratados com a técnica simplificada. As variáveis analisadas incluíram idade, sexo, mecanismo da lesão, energia do trauma, lesões associadas, tipo de fixador, tempo de uso do fixador e resultados clínico-radiográficos. A técnica clássica lança mão principalmente de fios de Kirschner transfixantes, e a simplificada substitui os fios de Kirschner por pinos de Schanz no bloco distal do fixador externo circular. Resultados A partir da comparação das montagens, não encontramos diferenças estatisticamente significativas (p> 00,5) entre os dois grupos em relação aos resultados clínico-radiográficos, incluindo a consolidação da fratura, a qualidade da redução da fratura articular, a amplitude de movimento, a discrepância residual na medida dos membros inferiores e a dor do paciente no pós-operatório. Conclusão Sugerimos que a técnica simplificada, utilizando pinos de Schanz no lugar dos fios de Kirschner, pode ser uma alternativa viável e eficaz no tratamento de fraturas complexas da extremidade proximal da tíbia com fixador externo circular. Essa abordagem simplificada pode oferecer benefícios, como menor taxa de infecção e maior conforto para o paciente, sem comprometer os resultados clínicos e radiográficos, o que justifica, o seu uso.

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing.

Objective This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing. Methods Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test. Results Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated. Conclusions The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Treatment of Infected Pseudarthrosis of the Tibia Using the Ilizarov Method and the Orr Dressing / Tratamento das pseudoartroses infectadas da tÍbia pelo mÉtodo de Ilizarov associado ao curativo de Orr

Abstract Objective This study aims to analyze outcomes and clinical and epidemiological data of infected tibial pseudarthrosis using the Ilizarov method and the Orr dressing. Methods Data from n = 43 patients diagnosed with infected tibial pseudarthrosis were analyzed by descriptive and inferential statistical methods. In addition, Paley's assessment criteria evaluated bone and functional outcomes. Qualitative variables were presented as the distribution of absolute and relative frequencies. The presentation of quantitative variables followed the D'Agostino-Pearson test. Results Thirty-seven (86.04%) subjects were males, and six (13.95%) were females. The most frequent age group among patients was 50 to 59 years old (25.6%), with a p-value = 0.8610. The treatment time was longer for the trifocal treatment (23.8 months) when compared to the bifocal treatment (15.6 months), with a p-value = 0.0010* (highly significant). Excellent bone outcomes represented 72.09% of the sample; 23.25% of outcomes were good. Functional outcomes were excellent in 55.81%, good in 6.97%, and regular in 27.90% of subjects. The Orr dressing (using Vaseline gauze) proved effective, achieving wound healing with soft tissue coverage in all patients evaluated. Conclusions The Ilizarov method resulted in a substantial change in the treatment of bone infections, especially infected pseudarthrosis. The versatility of this method has turned it into an effective tool, allowing the healing of the infectious process and the correction of potential deformities and shortening.

Resumo Objetivo Analisar os resultados e os dados clínicos e epidemiológicos do tratamento das pseudoartroses infectadas da tíbia pelo método de Ilizarov associado ao curativo de Orr. Métodos Para analisar os dados de n = 43 pacientes com diagnóstico de pseudoartrose infectada da tíbia foram aplicados métodos estatísticos descritivos e inferenciais e os resultados ósseos e funcionais foram avaliados de acordo com os critérios de avaliação de Paley. As variáveis qualitativas foram apresentadas por distribuição de frequências absolutas e relativas. As variáveis quantitativas foram apresentadas pelo teste de DAgostino-Pearson. Resultados Foi encontrado que 37 (86,04%) eram do sexo masculino, 6 (13,95%) femininos. A faixa etária mais frequente entre os pacientes foi de 50 a 59 anos (25.6%), p-valor = 0.8610. O tempo de tratamento é maior no tratamento trifocal (23.8 meses) quando comparado com o Bifocal (15.6 meses), p-valor =0.0010* (altamente significante). Os resultados ósseos excelentes representaram 72,09%, 23,25% foram de resultados considerados bons. Os resultados funcionais considerados excelentes foram 55,81%, os resultados bons foram 6,97%, resultados regulares foram 27,90. O curativo com gaze vaselinada (curativo de Orr) mostrou-se eficaz, alcançando assim a cicatrização das feridas com cobertura de partes moles em todos os pacientes avaliados. Conclusões O método de Ilizarov proporcionou uma mudança substancial no tratamentos das infecções ósseas, especialmente das pseudoartroses infectadas. A versatilidade deste método se transformou em uma ferramenta eficaz, permitindo a cura do processo infeccioso, bem como correção das possíveis deformidades e do encurtamento.

Compresión-distracción en el tratamiento de pseudoartrosis de tibia distal utilizando el aparato de Ilizarov: reporte de casos / Compression-distraction in the treatment of distal tibial no union using the Ilizarov apparatus: case report / Compressão-distração no tratamento da pseudoartrose distal da tibia com Ilizarov: relato de caso

El método de Ilizarov, con sus diferentes variantes y mediante la utilización de su aparato, desarrollado en la década del 50, continúa vigente, sobre todo en el tratamiento de las complicaciones de fracturas, principalmente aquellas vinculadas a la infección y a las dificultades de la consolidación. Reportamos 2 pacientes adultos con diagnóstico de pseudoartrosis hipertrófica, rígida, con deformidad, sin infección activa y sin dismetría, tratados mediante el método de distracción y compresión realizado con el aparato de Ilizarov. En ambos casos se logró la alineación y consolidación del miembro con escasas complicaciones.

The Ilizarov method, with its different variants and using its apparatus, developed in the 1950s, is still valid, especially in the treatment of fracture complications, mainly those linked to infection and consolidation difficulties. We report 2 adult patients with a diagnosis of hypertrophic, rigid nonunion, with deformity, without active infection and without dysmetria, treated by the distraction and compression method performed with the Ilizarov device. In both cases, the alignment and consolidation of the limb was achieved with few complications.

O método de Ilizarov, com suas diferentes variantes e pelo uso de seu aparato, desenvolvido na década de 1950, ainda é válido, principalmente no tratamento de complicações de fraturas, principalmente aquelas ligadas à infecção e dificuldades de consolidação. Relatamos 2 pacientes adultos com diagnóstico de pseudoartrose hipertrófica, rígida, com deformidade, sem infecção ativa e sem dismetria, tratados pelo método de distração e compressão realizado com o dispositivo de Ilizarov. Em ambos os casos, o alinhamento e a consolidação do membro foram alcançados com poucas complicações.

Ilizarov Ring External Fixation for Complex Tibial Plateau Fractures / Fixação externa do anel de Ilizarov para fraturas complexas do platô tibial

Abstract Objective To analyze the results of clinical, radiological, and functional outcomes of tibial plateau fracture (Schatzker Type V, VI) treated with Illizarov ring external fixator with or without minimum opening. Methods A total of 52 tibial plateau fractures of type V, VI were treated with Ilizarov ring external fixator with or without mininum internal fixation were studied. Functional outcome assessment was done using the American Knee Society (AKS) score with clinical, radiological union, and complications were analyzed. Results There were 37 (71.15%) male and 15 (28.84%) female patients, with a mean age of 39.07 ± 12.58 years old. Road traffic accidents (RTAs) were the major cause of fracture, accounting for 32 cases (61.53%) followed by fall injury, with 16 cases (30.76%), and direct impact, with 4 cases (7.69%). Twenty-one (40.38%) cases were type V and 31 (59.61%) cases were type VI fractures, and there were 24 (46.15%) cases of open fracture. The mean AKS score of Type V and Type VI fractures were 82.8 and 80.70, respectively, but this was statistically not significant at p<0.05. The mean AKS score of closed and open fractures were also statistically not significant at p<0.05. Conclusions For Schatzker Types V and VI complex tibial plateau fractures, Ilizarov external fixation is a safe, cost-effective and efficient treatment method that presents a satisfactory outcome.

Resumo Objetivo Analisar os resultados clínicos, radiológicos e funcionais da fratura do planalto tibial (Schatzker Tipo V, VI) tratada com fixador externo do anel Illizarov com ou sem abertura mínima. Métodos Um total de 52 fraturas do planalto tibial dos tipos V e VI foram tratadas com fixador externo do anel Ilizarov com ou sem fixação interna mínima. A avaliação do desfecho funcional foi feita utilizando-se o escore da American Knee Society (AKS, na sigla em inglês) com consolidação clínica, radiológica e complicações encontradas. Resultados Foram 37 (71,15%) pacientes do sexo masculino e 15 (28,84%) do sexo feminino, com idade média de 39,07 ± 12,58 anos. Acidentes de trânsito (ATs) foram a principal causa das fraturas, contabilizando 32 casos (61,53%), seguidos por lesão por queda, com 16 casos (30,76%), e impacto direto, com 4 casos (7,69%). Foram 21 (40,38%) casos de fraturas tipo V, 31 (59,61%) casos do tipo VI e 24 (46,15%) casos de fratura exposta. Os escores médios da AKS para as fraturas tipo V e VI foram de 82,8 e 80,70, respectivamente, mas não foi estatisticamente significativo em p <0,05. O escore médio da AKS para fraturas fechadas e abertas também não foi estatisticamente significativo em p <0,05. Conclusões Para a fratura do planalto tibial complexa dos tipos V e VI de Schatzker, a fixação externa de Ilizarov é um método de tratamento seguro, econômico e eficiente que resulta em resultados satisfatórios.

Evaluation of the Quality of Life of Patients Using Circular External Fixator in a Trauma Hospital.

Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

Evaluation of the Quality of Life of Patients Using Circular External Fixator in a Trauma Hospital / Avaliação da qualidade de vida dos pacientes em uso de fixador externo circular em um hospital de trauma

Abstract Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.

Resumo Objetivo Avaliar a qualidade de vida dos pacientes em uso do fixador externo do tipo Ilizarov para tratamento de fraturas complexas e de suas sequelas Método Trata-se de um estudo observacional e transversal, em que foi aplicado o questionário 36-item short form survey (SF-36) (traduzido para a língua portuguesa) durante as consultas ambulatoriais em 2 períodos, nos meses de julho de 2018 e janeiro de 2019. Os pacientes que participaram do estudo realizaram seus procedimentos cirúrgicos no período de janeiro a junho de 2018. Resultados Foram avaliados 36 pacientes em uso de fixador externo do tipo Ilizarov. Foi observado predomínio do sexo masculino e idade média de 37,9 anos. As fraturas de ossos da perna e suas complicações representaram metade da amostra. Foi observada melhora na capacidade funcional e nos aspectos emocionais dos pacientes ao longo do tratamento. Conclusão O uso do fixador externo circular constitui um método importante e eficaz para o tratamento cirúrgico de fraturas complexas e de suas sequelas. Este trabalho permitiu concluir que, após o tratamento, os pacientes alcançaram retorno funcional às atividades diárias com adequada qualidade de vida.

Bioinspired design proposal for a new external bone fixator device.

The article presents a new medical device through an authorial and interdisciplinary approach. It consists of a flexible external fixator, whose flexible property may bring advantages over rigid mechanisms. Its design was inspired by the DNA biological mechanism of condensation, while the modeling was based on the pseudo-rigid modeling technique. From the models obtained, this study conducted prototyping and computational tests to obtain a proof-of-concept of the bioinspired theory and dynamic functioning effectiveness. The prototyping relied on hot glue manufacturing and the computational simulations consisted of linear static analysis. The experimental analysis concluded that the prototype with fewer beams and thinner beams delivered better results in all three parameters: flexibility, height variation and rotation arc. In the computational analysis, among the design models with the variation of the number of beams, the model with 8 beams performed better. Concerning thickness variation, the one whose beams measured 8 mm in thickness showed better results. Among the models with length variation, the design made with 100 mm long beams better equilibrated the parameters.

Limb Salvage after Lower-Leg Fracture and Popliteal Artery Transection-The Role of Vessel-First Strategy and Bone Fixation Using the Ilizarov External Fixator Device: A Case Report.

Open traumatic lesion of the popliteal artery is relatively rare. Ischemia time longer than 6 h and severity of limb ischemia have been shown to be associated with an increased risk of limb loss. Severe local infection is critical in the presence of major soft tissue trauma or open fractures. We report the case of a young female who suffered a traumatic transection of the popliteal artery associated with an open fracture of the distal tibia and fibula managed by direct vessel reconstruction with an end-to-end repair and skeletal stabilization initially with half-pin external fixation, then replaced by an Ilizarov circular frame. The patient had a very satisfactory outcome, but the fracture healed malunited, later corrected by open reduction and internal fixation with lag-screwing and a neutralization plate.

Evaluation of Tibia Bone Healing by Infrared Thermography: A Case Study.

BACKGROUND: Thermal imaging has been used as a clinical follow-up technique in several medical specialties. PURPOSE: The aim of this study was to investigate the feasibility of using medical thermography in the diagnosis and follow-up assessment of a severe orthopedic trauma that requires the use of an external circular fixator. PATIENTS AND METHODS: Twenty clinical follow-ups of thermal imaging correlated with X-ray images were performed in a male volunteer, diagnosed with bone nonunion, during 11 months of treatment, in the hospital trauma and reconstruction department. Data were acquired in the regions of interest of the proximal tibia, diaphysis and distal, with a Flir T530 medical grade infrared camera from Flir Systems®, and the data processed by the Matlab® 2019 custom made software. RESULTS: Statistical analysis was performed by Wilcoxon signed-rank test. The results showed a median temperature of 22.2°C, and thus some periods of interruption in the healing process between the third and twentieth clinical follow-up, and a significant increase of the temperature to 34.6°C synchronous with a diagnosis of bone infection by the eleventh clinical follow-up. The thermal images acquired during the 20 clinical follow-ups allow a correlation with the data from the X-ray exams and also with the contralateral limb of the evaluated patient, showing thermal alterations greater than 0.3°C, which are significant of physiological abnormality. CONCLUSION: The thermography exam can be a useful tool for applying on the follow-up of patients after trauma or bone fracture. The results showed important physiological data related to the vascularization necessary for bone repairing, being therefore a good indicator of the healing process. In addition, as infrared thermography does not use ionizing radiation, it can be used countlessly, in complement to the traditional X-ray exams that focus on anatomical data analysis.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility.

Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Pain and Satisfaction Levels upon Removal of External Fixator at an Outpatient Facility / Nível de satisfação e dor na retirada de fixador externo em um ambulatório

Abstract Objective To quantify the levels of satisfaction and pain of patients submitted to external fixation removal without anesthesia at an outpatient facility. Methods The present was a prospective study involving 28 patients using external fixators who answered 3 questionnaires associated with the Visual Analogue and Numerical Pain Scale during different moments of the removal. Results The average pain prior to fixator removal was of 3.61. Shortly after the procedure, the patients reported that, on average, the most intense pain scored 6.68, and the least intense pain, 2.25 points. The average pain variation was of 4.43 points, and pain after 1 week scored, on average, 2.03 points. The recollection of the pain after fixator removal scored lower than the pain reported immediately after the procedure (mean value: 5.29). Most patients were middle-aged men, and 89.3% used circular external fixators. The main limb segment involved was the leg, and most patients (71.4%) had never used an external fixator before; they preferred the removal at an outpatient facility because it was faster (75%), and to avoid hospitalization (25%). The most intense pain was felt during the removal of Schanz pins (60.7%), being worse in the extremities of the limbs for 75% of the patients. An absolute majority of 85.7% was satisfied with the removal, and 82.1% stated that they would undergo the procedure again. Conclusion External fixator removal at an outpatient facility without anesthesia is a well-tolerated option for patients, with good levels of approval and satisfaction.

Resumo Objetivo Quantificar os níveis de satisfação e dor dos pacientes submetidos a retirada ambulatorial de fixadores externos sem anestesia. Métodos Estudo prospectivo envolvendo 28 pacientes usando fixadores externos submetidos a três questionários associados à Escala Visual Analógica e Numérica da dor durante diferentes etapas da retirada. Resultados A média de dor prévia à retirada foi de 3,61. Logo após o término do procedimento, encontramos média de 6,68 para a dor mais intensa, e de 2,25 para a dor menos intensa. A variação da dor média foi de 4,43, e a dor após uma semana teve média de 2,03. A lembrança dolorosa da retirada foi menor do que a dor referida imediatamente após a retirada (média de 5,29). A predominância no estudo foi de pacientes do sexo masculino de meia-idade, e 89,3% usavam fixador externo do tipo circular. O principal segmento dos membros envolvido foi a perna, e a maior parte dos pacientes não havia feito uso de fixador externo previamente (71,4%); eles optaram pela retirada ambulatorial por se tratar de opção mais rápida (75%), e para evitar internação hospitalar (25%). O momento de dor mais intensa ocorreu durante a retirada dos pinos de Schanz (60,7%), sendo pior nas extremidades dos membros para 75% dos entrevistados. Uma maioria absoluta de 85,7% mostrou-se satisfeita após a retirada, e 82,1% afirmaram que se submeteriam novamente ao procedimento. Conclusão A retirada ambulatorial de fixadores externos sem anestesia é uma opção bem tolerada pelos pacientes, tratando-se de um procedimento com bons níveis de aceitabilidade e satisfação.

Evaluation of the Treatment of Patients Subjected to Osteogenesis Induced by Tibia Bone Distraction / Avaliação do tratamento de pacientes submetidos a osteogênese por distração na tíbia

Abstract Objectives To evaluate the management of tibial fractures resulting in bone loss (traumatic or infection-related) and the complications occurring during treatment with external fixator and immediately after apparatus removal. Methods Forty patients were selected from 2010 to 2017. The mean age of the patients was 33.02 years; 34 subjects were male and 6 were female. All patients had tibial bone regeneration, suffered trauma (mainly related to motorcycle accident) and were followed-up at an outpatient facility. Results Proximal tibial bones of up to 17 cm in length and distal tibial bones of up to 14 cm in length were obtained. The largest trifocal transport had the same length as the regenerated bone tissues, which was 14.5 cm. Regarding complications, 29 (72.5%) patients had infections in the pin and wire paths. There were 9 (22.5%) cases of de novo fracture, 6 of which were managed with the implantation of a new circular fixator, and 2 cases of infection of the regenerated bone. On average, patients were subjected to 4.72 procedures (ranging from 2-12), had the fixator for 20.75 months (ranging from 7-55 months), and stayed at the hospital for 53.7 days (ranging from 5-183 days), mainly because of soft-tissue complications, intravenous antibacterial therapy, and even social issues. Two (5%) patients presented symptomatic gonarthrosis, and two other patients had symptomatic ankle arthritis. Three of the patients showed lower limb discrepancy of 3.0, 3.7, and 5.0 cm. Conclusion Despite not being widely available, the Ilizarov method is useful for solving the majority of tibial bone losses, regardless of their etiology.

Resumo Objetivo Avaliar o tratamento das fraturas de tíbia que evoluíram com perda óssea (traumática ou secundária a infecção) e as complicações ocorridas durante o tratamento com fixador externo e no período imediatamente após sua retirada. Métodos Foram selecionados 40 pacientes tratados entre 2010 e 2017, com a idade média de 33,02 anos, sendo 34 do sexo masculino e 6 do sexo feminino. Todos os pacientes portavam regenerado ósseo da tíbia, foram vítimas de trauma (sobretudo motociclístico), e estavam em seguimento ambulatorial. Resultados Foram obtidos regenerados ósseos da tíbia proximal de até 17 cm e da tíbia distal de 14 cm. O maior transporte trifocal teve a soma do tamanho dos tecidos dos ossos regenerados, medindo 14,5 cm. Como complicações, 29 (72,5%) pacientes tiveram infecção no trajeto dos pinos e fios. Houve 9 (22,5%) casos de refratura, sendo 6 deles tratadas com novo fixador circular, e 2 infecções no osso regenerado. Os pacientes foram submetidos a uma média de 4,72 procedimentos cirúrgicos (2-12), portaram fixador por 20,75 meses (7-55 m.) e permaneceram internados por 53,7 dias (5-183) devido principalmente a complicações de partes moles, a antibioticoterapia intravenosa ou até mesmo a questões sociais. Dois (5%) pacientes apresentaram gonartrose sintomática e outros 2 artrite sintomática do tornozelo. Três apresentaram discrepância de membros inferiores de 3,0; 3,7; e 5,0 cm. Conclusão Apesar de não ser um método de tratamento amplamente disponível, o método de Ilizarov é útil para solucionar a maioria das falhas ósseas da tíbia, independente da sua etiologia.

Stenotrophomonas maltophilia: A Rare Case of Osteomyelitis After an Open Distal Tibial Fracture.

Stenotrophomonas maltophilia is a gram-negative rod rarely associated with osteomyelitis. To date, only 3 cases of osteomyelitis due to this pathogen have been previously referenced. We describe the case of a 77-year-old male who developed osteomyelitis secondary to S. maltophilia infection after an open distal tibial fracture sustained by falling off a ladder. The purpose of the present case report was to highlight this highly resistant microbe as an infectious etiology.

Experience in fixation of infected non-union tibia by Ilizarov technique - a retrospective study of 42 cases.

OBJECTIVE: The aim of the study is to evaluate the clinical and functional outcome in treatment of infected tibial nonunion by the Ilizarov method. METHODS: The authors retrospectively analyzed 42 patients with infected tibial nonunion with bone loss; shortening and deformity treated at this institution during the period of February 2012 to April 2015 were included in the study. The results were evaluated according to Association for the Study and Application of the Methods of Ilizarov (ASAMI) criteria. Pin tract infections were assessed by Moore and Dahl score. RESULTS: Bone results were excellent in 60% of patients (n = 25), good in 15% (n = 6), fair in 25% (n = 11), and poor in none. The functional results were excellent in 55% of patients, good in 30%, fair in 5%, and poor in 10%. The most common complication found in this study was pin tract infection. CONCLUSION: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion, as it addresses the problems associated with the condition, although the procedure is cumbersome.

OBJETIVO: O objetivo do estudo é avaliar o desfecho clínico e funcional no tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov. MÉTODOS: Os autores analisaram retrospectivamente 42 pacientes com pseudartrose infectada da tíbia com perda óssea. Os casos de encurtamento e deformidade tratados nesta instituição durante o período de fevereiro de 2012 a abril de 2015 foram incluídos no estudo. Os resultados foram avaliados de acordo com os critérios da Associação para o Estudo e Aplicação dos Métodos de Ilizarov (Association for the Study and Application of the Methods of Ilizarov [ASAMI]). As infecções no trajeto dos fios e pinos foram avaliadas pela classificação de Moore e Dahl. RESULTADOS: Os resultados ósseos foram excelentes em 60% dos pacientes (n = 25), bons em 15% (n = 6) e moderados em 25% (n = 11); nenhum paciente apresentou resultados ruins. Os resultados funcionais foram excelentes em 55% dos pacientes, bons em 30%, razoáveis em 5% e ruins em 10%. A complicação mais comum encontrada neste estudo foi infecção no trajeto dos fios e pinos. CONCLUSÃO: Embora seja um procedimento complicado, a fixação de Ilizarov continua a ser uma modalidade de tratamento excelente para pseudartrose da tíbia, uma vez que aborda os problemas associados à condição.

Experience in fixation of infected non-union tibia by Ilizarov technique - a retrospective study of 42 cases / Experiência na fixação de pseudartrose infectada da tíbia com a técnica de Ilizarov - Estudo retrospectivo de 42 casos

ABSTRACT OBJECTIVE: The aim of the study is to evaluate the clinical and functional outcome in treatment of infected tibial nonunion by the Ilizarov method. METHODS: The authors retrospectively analyzed 42 patients with infected tibial nonunion with bone loss; shortening and deformity treated at this institution during the period of February 2012 to April 2015 were included in the study. The results were evaluated according to Association for the Study and Application of the Methods of Ilizarov (ASAMI) criteria. Pin tract infections were assessed by Moore and Dahl score. RESULTS: Bone results were excellent in 60% of patients (n = 25), good in 15% (n = 6), fair in 25% (n = 11), and poor in none. The functional results were excellent in 55% of patients, good in 30%, fair in 5%, and poor in 10%. The most common complication found in this study was pin tract infection. CONCLUSION: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion, as it addresses the problems associated with the condition, although the procedure is cumbersome.

RESUMO OBJETIVO: Avaliar o desfecho clínico e funcional no tratamento da pseudartrose infectada da tíbia pelo método de Ilizarov. MÉTODOS: Os autores analisaram retrospectivamente 42 pacientes com pseudartrose infectada da tíbia com perda óssea. Os casos de encurtamento e deformidade tratados nesta instituição de fevereiro de 2012 a abril de 2015 foram incluídos no estudo. Os resultados foram avaliados de acordo com os critérios da Associação para o Estudo e Aplicação dos Métodos de Ilizarov (Association for the Study and Application of the Methods of Ilizarov [ASAMI]). As infecções no trajeto dos fios e pinos foram avaliadas pela classificação de Moore e Dahl. RESULTADOS: Os resultados ósseos foram excelentes em 60% dos pacientes (n = 25), bons em 15% (n = 6) e moderados em 25% (n = 11); nenhum paciente apresentou resultados ruins. Os resultados funcionais foram excelentes em 55% dos pacientes, bons em 30%, razoáveis em 5% e ruins em 10%. A complicação mais comum encontrada neste estudo foi infecção no trajeto dos fios e pinos. CONCLUSÃO: Embora seja um procedimento complicado, a fixação de Ilizarov continua a ser uma modalidade de tratamento excelente para pseudartrose da tíbia, uma vez que aborda os problemas associados à condição.

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital.

OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann­Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Clinical evaluation of patients submitted to osteogenic distraction in the lower limb at a university hospital / Avaliação clínica de pacientes submetidos à distração osteogênica no membro inferior em hospital universitário

ABSTRACT OBJECTIVE: To evaluate the clinical characteristics from patients submitted to osteogenic distraction to correct bone gap at a university hospital. METHODS: Retrospective transversal study, with a convenience sample, from 2000 to 2012, evaluating clinical aspects of patients treated, submitted to osteogenic distraction (bone transport) with Ilizarov's external fixation device. The chi-squared, Fisher's, and Mann-Whitney's U tests were used with a 5% level of significance (p < 0.05). RESULTS: 33 patients were studied, of whom 28 men (84.8%). The more frequent age was from 21 to 40 years. Most patients were from the metropolitan region of the capital (57.6%). The leg was the most affected limb (75.8%), and the left side was the most affected (66.7%). The most common cause was infected pseudoarthrosis (75.8%). The most common bone transportation type was bifocal (75.8%). Mean previous surgery at others institutions were 2.62 (1.93 standard deviation), and mean surgeries after treatment were 1.89 (1.29 standard deviation). Ilizarov's external fixation device was used for 1.94 years (1.34 mean deviation), from one to six years. The most common complications were pin infection (57.6%), equinus (30.3%), deep infection (24.2%), and shortening (21.2%). CONCLUSION: Osteogenic distraction for bone gaps were more frequent in young adults, men, in the leg, with bifocal transportation, after several previous surgeries, treated for a mean of two years, with many complications (infections were the most common).

RESUMO OBJETIVO: Avaliar as características clínicas dos pacientes submetidos à distração osteogênica por falha óssea em hospital universitário. MÉTODOS: Estudo transversal, retrospectivo, com amostra de conveniência, de 2000 a 2012, das características clínicas de pacientes tratados e submetidos à distração osteogênica (transporte ósseo) com uso de fixador externo circular tipo Ilizarov. Foram usados os testes de qui-quadrado, exato de Fisher e U de Mann-Whitney, com nível de significância de 5% (p < 0,05). RESULTADOS: Foram 33 casos, 28 homens (84,8%). A idade mais frequente foi entre 21 e 40 anos. A maioria dos pacientes (57,6%) era da região metropolitana. O segmento mais afetado foi a perna (75,8%) e o lado foi o esquerdo (66,7%). A causa mais frequente foi a pseudoartrose infectada (75,8%). O tipo de transporte ósseo feito foi principalmente o bifocal (75,8% dos casos). A média de procedimentos prévios em outra instituição foi de 2,62 cirurgias (desvio padrão de 1,93) e a dos feitos após o início do tratamento foi de 1,89 cirurgia (desvio padrão de 1,29). O tempo de uso de fixador externo foi de 1,94 ano (desvio padrão de 1,34), com mínimo de um ano e máximo de seis. As quatro complicações mais encontradas foram infecção de base de pinos (57,6% dos casos), equino (30,3%), infecção profunda (24,2%) e encurtamento (21,2%). CONCLUSÃO: A necessidade de distração osteogênica por falhas ósseas foi mais frequente em adultos jovens, homens, na perna, com transporte bifocal, após múltiplas cirurgias prévias, com média de aproximadamente dois anos de tratamento e com várias complicações (as infecções foram as principais).

Alargamiento de extremidades: actualización y revisión del tema / Limb lengthening: review and update

El alargamiento de extremidades trata las discrepancias de longitud de extremidades superiores e inferiores. Lograr un adecuado tratamiento temprano evita secuelas irreversibles como la artrosis. El estudio de las discrepancias se realiza con una telerradiografía estandarizada, la cual entrega la información de cuál es el segmento óseo comprometido y cuál es el largo total a corregir. Menos de 15mm de discrepancia se ha demostrado que no tiene influencia sobre la mecánica de la marcha ni de las articulaciones. Más de 15mm produce una alteración en las cargas articulares, rangos de movimiento articular, compensaciones musculares, compensaciones de columna (escoliosis compensatoria), entre otras, que producen secuelas a largo plazo. Los métodos de tratamiento existentes son conservadores y quirúrgicos. Dentro de estos últimos están los fijadores externos e internos. Los fijadores externos tienen una alta frecuencia de infecciones superficiales a través de las agujas, sin embargo, son versátiles y capaces de corregir prácticamente cualquier deformidad. Los fijadores internos (por ejemplo, clavos intramedulares) no pueden corregir grandes deformidades, así como tampoco realizar grandes alargamientos, sin embargo, su frecuencia de complicaciones es mucho menor y son mucho mejor tolerados por el paciente. Estos métodos de tratamiento logran resultados muy precisos. Tienen un margen de error de 3,5 mm de longitud, lo cual no tiene consecuencias mecánicas para una extremidad. La tasa de satisfacción es de alrededor del 90 por ciento y logran un alivio del dolor significativo...

Limb lengthening can be used to correct upper and lower limb length discrepancies. To obtain an appropriate treatment early in life prevents irreversible consequences, such as arthritis. The limb length discrepancies study is performed with a standardised leg length X-ray. This X-ray shows the compromised bone segment and what the total limb length discrepancy is. A limb length discrepancy of less than 15mm has no influence on factors such as, gait mechanics, joint range of motion, or long term joint degeneration. Over 1.5cm, several consequences appear such as: joint overload, decreased joint range of motion, muscle compensations and compensatory spine malalignment. Existing treatment includes non-surgical and surgical methods. Among the latter are internal and external fixations. External fixations have a high frequency of superficial infections, but are highly versatile, being able to correct virtually any deformity. The internal fixation (e.g. intramedullary nails) cannot correct large deformities, or make big lengthenings, but its complication rate is much lower and is much better tolerated by the patient. These treatment methods achieve very accurate results. They have an error of 3.5mm in length, which has no mechanical consequences to an extremity. The satisfaction rate is high, with around 90 percent achieving a significant pain relief...