Limb reconstruction after traumatic bone loss.

A variety of options exist to reconstruct limbs following traumatic bone loss. The management of these injuries is challenging and often requires prolonged and potentially painful treatment. The Ilizarov technique of bone transport using circular external fixators is widely used for limb reconstruction of large bone defects. Other techniques include vascularised fibular grafting, the use of induced pseudosynovial membranes combined with cancellous autologous bone grafts and the use of autologous, allogeneic or synthetic bone grafts on their own for smaller defects. Future directions include further research on bone tissue engineering using stem cell therapy and growth factors such as bone morphogenetic proteins. The purpose of this Continuing Medical Education article is to describe the key limb reconstructive techniques that may be employed to treat traumatic bone loss. In particular, this article is intended to serve as a revision tool for those preparing for postgraduate examinations.

The Ilizarov paradigm: thirty years with the Ilizarov method, current concerns and future research.

The Ilizarov method of bone lengthening, reconstruction and osteosynthesis has developed immensely since its introduction by G.A. Ilizarov in the Soviet Union in the 1960s and in the Western countries in the early 1980s. It has become an integral part of the arsenal used by the orthopaedic community worldwide. The evolutionary development of the method and its current role has considerably improved the quality of life for millions of people around the whole world. Despite the great versatility of its possible applications for bone injuries and diseases, the Ilizarov method could not and cannot be the alternative to a range of other methods that are applied for some specific bone conditions, but rather is a method of choice. Its combination with the current methods of internal fixation or the means of internal fixation that use the biological principles that were laid down by G.A. Ilizarov have demonstrated the importance of tension stress, blood supply, functional loading, and fragment control during bone treatment. The objective of this study was to present an overview of the current state and concerns in the application of the Ilizarov method and define the prospective research trends aimed at regeneration stimulation, better control of treatment, infection barriers and patient comfort.

Distraction osteogenesis for bone repair in the 21st century: lessons learned.

Bone regeneration obtained by distraction osteogenesis is influenced by a series of factors. These include factors that are related to the mechanical stability of the system of distraction (internal or external devices), and to factors directly depending on the biology of the bone tissue, such as the method of bone interruption (osteotomy), the delay and rhythm of distraction, the anatomical site of the osteotomy, and the histological characteristics of the bone requiring reconstruction. The stability of the system of bone fixation depends on the rigidity of the frame, the connexion of the apparatus to the bone (wires, pins) and the intrinsic stability of the segment (length and level of maturation of bone regenerate). The radiological characteristics of bone regeneration (hypo- or hypertrophy) lead to the adaptation of the rhythm of distraction. Following more than 28 years of experience of application of the Ilizarov method for bone reconstruction, the authors describe the technique of frame assembly and the methods of evaluation and treatment of the complications of new bone formation.

[Maxillofacial surgery and distraction osteogenesis--history, present, perspective]. / Litsevo-cheliustna khirurgiia i distraktsionna osteogeneza--istoriia, nastoiashte i perspektivi.

The distraction osteogenesis is processes of planning and controlled tension over a bone after osteotomy or corticotomy. The purpose is lengthening on the base of forming a new bone tissue with normal biological characteristics. It presents historical development. The distraction osteogenesis adapts to the needs of oral maxillo-facial surgery in last ten years. The first step was a lengthening of the lower jaw with extraoral apparatus (McCarthy 1992). The surgical techniques and the principals of G. Ilizarov are shown in the overview. It describes the biological aspects of the distraction osteogenesis--the phenomena tension--stress, as such as the effect not only over the bone but over the surrounding soft tissues, blood vessels and nerves. It presents the distraction osteogenesis used in maxillo-facial surgery--mandibular distraction, distraction of alveolar bone, of mid-third face, cranio-orbito-maxillar distraction osteogenesis. Because of easy surgical technique, clinically proved by stable functional and aesthetic results, the distraction osteogenesis has perspectives in future time.

Resultados de alargamiento tibial con la técnica de ilizarov

Entre enero de 1992 y junio de 1997, 21 tibias en 21 pacientes se alargaron usando la técnica de ilizarov. El seguimiento fue de 5 meses a 5 años. La etiología del acortamiento en el miembro fue adquirido en 12 tibias y congénitas en 9. 20 tibias tuvieron tratamiento unifocal y una bifocal. El promedio de alargamiento fue de 6.0 cm, con un rango de 4 a 12 cm, el cual fue equivalente al 22.6 por ciento del promedio total de aumento en la longitud del segmento afectado, rango de 8.8 por ciento a 41 por ciento. El tiempo de corticalización del alargamiento fue en promedio 7 meses, con un rango de 4 a 12 meses. Las complicaciones a nivel óseo requirieron 7 cirugías adicionales, incluyendo 4 recolocaciones de clavos, 2 correcciones de deformidad angular en antecurvatum medinate recolocación del fijador y una por articotomía incompleta. 5 pacientes presentaron contractura en flexión de rodilla, 3 se movilizaron bajo anestesia y a 2 se les realizó deflexión de rodilla. Los resultados de este trabajo confirman que no hay alargamiento sin riesgo, pero existen ventajas evidentes con el método ilizarov, apoyo precoz, corrección simultánea de deformidades angulares coexistentes, lo que es difícil con otras técnicas quirúrgicas. La tasa de alargamiento y el índice de alargamiento obtenido en esta serie confirman el uso continuo de una distracción gradual previa selección del paciente.

Tratamento da osteortrose do joelho com artroscopia e osteotomia valgizante da tíbia empregando o aparelho de ilizarov / Tibial osteotomy in gonoarthrosis using the Ilizarov device for fixation

Os resultados obtidos em dez pacientes com genum varoartrosico submetidos a artroscopia cirúrgica e osteo tomia valgizante da tíbia empregando o aparelho de Ilizarov foram analisados. A avalizaçäo subjetiva foi realizada segundo questionário pré e pós-operatório. O estudo objetivo utilizou um protocolo da Vanderbilt University Medical Center, Tennessee, USA. Resuldados bons e exceletes foram obtidos em nove pacientes, em um paciente o resultado foi considerado regular