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PubMedDate not supplied

Lower extremity angular malunion: evaluation and surgical correction.

The lower extremity has a mechanical axis with joint orientation that allows joint longevity and efficiency in bipedal gait. When normal alignment is lost because of trauma or other conditions, deviations from this anatomic norm may be deleterious to long-term joint function. In fractures that have healed with angular malunion, all facets of the deformity must be carefully considered, including alteration in length, rotation, alignment, and translation. Once all elements are fully defined, the effects of the malunion on mechanical axis and joint orientation can be understood. Techniques for surgical correction include wedge, dome, and oblique osteotomies and distraction osteogenesis. Each method possesses characteristics appropriate for certain clinical situations. Judicious patient selection and thoughtful preoperative planning may allow restoration of normal mechanics.

Biomechanical Phenomena↗
PubMedDate not supplied

Management of posttraumatic segmental bone defects.

Because of difficulty in managing posttraumatic segmental bone defects and the resultant poor outcomes, amputation historically was the preferred treatment. Massive cancellous bone autograft has been the principal alternative to amputation. Primary shortening or use of the adjacent fibula as a graft also has been used to attempt limb salvage. Of more recent methods of management, bone transport with distraction osteogenesis has been suggested as the leading option for defects of 2 to 10 cm, but problems include delayed union at the docking site and prolonged treatment time. Free vascularized bone transfer has been suggested as the leading option for defects of 5 to 12 cm, but hypertrophy of the graft is unreliable and late fracture, common. Bone graft substitutes continue to be developed, but they have not yet reached clinical efficacy for posttraumatic segmental bone defects. Although each of the new techniques has shown some limited success, complications remain common.

Amputation, Surgical↗
PubMedDate not supplied

Use of the Ilizarov method to correct lower limb deformities in children and adolescents.

The introduction to the West in the early 1980s of the Ilizarov circular external fixator and method resulted in rapid advances in limb lengthening, deformity correction, and segmental long-bone defect reconstruction. The mechanical features of and biologic response to using distraction osteogenesis with the circular external fixator are the unique aspects of Ilizarov's contribution. The most common indications for children and adolescents are limb lengthening and angular deformity correction. Surgical application and postoperative management of the device require diligent attention to detail by both patient and surgeon. Also required of the surgeon is a thorough appreciation of the basic principles of the apparatus, mechanical axial realignment, potential complications, and biologic response to stretching.

Adolescent↗
PubMed2005

Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts.

Chronic posttraumatic osteomyelitis and infected nonunion of the tibia are complex problems that result in considerable morbidity and can threaten viability of the limb. Development of infection may result from compromised soft tissue and bone vascularity, systemic compromise of the host, and virulent or resistant organisms. Biofilm formation on implant and devascularized bone surfaces protects pathogens and may lead to persistence of infection. Management is based on a detailed evaluation of the patient, the involved bone and soft tissues, degree of associated lower extremity injury, and type of bacterial pathogens. Infection control is achieved with radical débridement, skeletal stabilization, and microbial-specific antibiotics. Local antibiotic delivery is a useful supplement to systemic administration. Local or free muscle flaps may be necessary to achieve soft-tissue coverage. Restoration of bone defects and bony union can be accomplished with bone grafting. However, large defects require complex reconstructive procedures, such as distraction osteogenesis and vascularized bone grafting.

Chronic Disease↗
PubMed2006

Vascularized fibula graft for the traumatically induced long-bone defect.

Long-bone defects resulting from trauma can be managed with a variety of techniques, including conventional bone grafting, distraction osteogenesis, bone graft substitutes, prosthetic devices, and vascularized bone grafting. Although there is an array of available methods for long-bone reconstruction of bony defects, vascularized bone transfer is particularly useful in large defects (> 6 cm) and in cases in which osteomyelitis and unstable soft-tissue or beds make conventional techniques difficult.

Bone Transplantation↗
PubMed1999

Neuro-ophthalmic complication after maxillary surgery.

We report an unusual case of ophthalmoplegia after maxillofacial surgery. A thirteen year old girl with unilateral left cleft lip and palate underwent maxillary advancement by distraction osteogenesis. Postoperatively she developed diplopia. The diplopia was not due to orbital lesions, most often seen after maxillofacial surgery, but to a haemorrhage posterior to the cavernous sinus.

Adolescent↗
PubMed1999

[Use of Ilizarov fixator in the treatment of post-osteomyelitis pseudoarthroses in children].

PURPOSE OF THE STUDY: The aim of this study was to emphasize the importance of the distraction osteogenesis technique in the treatment of post-osteomyelitis nonunion. We report 12 cases. PATIENTS AND METHODS: Mean patient age was 9.5 years. There were 7 cases of nonunion of the femur and 5 involving the tibia. Nonunion was associated with 5.9 cm shortening in 10 cases, 8.4 cm circumferential bone defect in 1 case, shortening and bone defects in 6 cases, and shortening and joint deformities in 2 cases. RESULTS: Consolidation was obtained in 11 cases with an average delay of 11.6 months. Infection was eradicated in 75 per cent of the cases. Average residual shortening was 0.4 cm. Joint deformities and axial deviations were corrected at the same time in all cases. DISCUSSION: The advantages of the Ilizarov technique are well known for the treatment of such deformities and musculoskeletal system disorders subsequent to osteomyelitis: nonunion, infection, shortening, joint deformities and malunion.

Adolescent↗
PubMed2000

[Tissue regeneration and growth during exposure to graded directed mechanical loads].

The paper gives the results of experimental morphological and biochemical studies made under the author's supervision in the subdivisions of the Kurgan Branch of the South Urals Research Center, Russian Academy of Medical Sciences, which death with distraction osteogenesis in long tubular, flat, and spongy bones, with the mechanism of osteogenesis and the modes of its management by mechanical and biochemical factors, with the use of methods for computer aided image analysis, three-dimensional reconstruction, and stereological analysis for quantitative characteristics of osteogenesis, with the definition of indications for its correction and with evaluation of its efficiency, with the clinical use of experimental developments in vertebrology and craniosurgery.

Animals↗
PubMedDate not supplied

Growth patterns after lengthening of congenitally short lower limbs in young children.

The purpose of this study was to assess growth patterns after lengthening of the congenitally short femur or tibia in children younger than 6 years. Twenty such children underwent 28 bone segment lengthenings (13 femora and 15 tibiae) by distraction osteogenesis. Our results show that femoral lengthening in children younger than 6 years does not lead to growth inhibition, whereas isolated femoral lengthening may be associated with growth stimulation. Isolated tibial lengthening in children younger than 6 years does not lead to growth inhibition, whereas simultaneous femoral and tibial lengthening or two tibial lengthenings in close succession can lead to tibial growth inhibition.

Age Factors↗
PubMed2000

[Fifty years of plastic surgery in the Netherlands. VIII. Craniofacial surgery].

Craniofacial surgery has developed its own identity in the last 3 decades. The Frenchman Tessier can be seen as the founding father. His concept of intracranial correction of craniofacial malformations is still valid today. There have been many new developments such as distraction osteogenesis and biodegradable miniplate fixation. Microvascular surgery and vascularised calvarial bone grafts help to obtain more predictable results. Three-dimensional CT imaging techniques and modelling result in better surgical planning and help to understand the underlying pathology. Biomolecular knowledge of gene mutations leads to better understanding of the clinical diagnosis. The future will bring minimalisation of surgery and more therapy focused on biomolecular science. The psychosocial welfare of the patient will play a central role in the multidisciplinary team treatment.

Craniofacial Abnormalities↗
PubMed2000

[Reconstruction of post-traumatic diaphyseal bone loss by segmental bone transfer].

Until the beginning of the 1980s, reconstruction of major post-traumatic diaphyseal bone loss as an alternative to amputation was possible only by massive autologous bone grafts. Such a technique was limited by the amount of available bone required for grafting. Ilizarov explained the distraction osteogenesis principle and designed a circular external fixation material that was suitable for compression-extension. He described the concept of segmental bone transfer, which allows bone regeneration to take place within the actual injured limb. Our present experience is based on the literature and the study of 12 cases. All patients presented with significant post-traumatic tibial bone loss ranging from 45 to 145 mm. In this article, we discuss the indications, benefits and risks of such a technique compared to classic methods. Mainly indicated in patients who have sustained significant bone loss, bone transfer is the method of choice for preserving bone stock and correcting limb discrepancy, although it does not reduce consolidation time. Moreover, circular external fixations are often poorly tolerated and may be replaced by unilateral devices that are easier to install.

Diaphyses↗
PubMed2001

[Mechanism of bone lengthening by the Ilizarov technique].

Distraction osteogenesis relies on two local factors: 1 degree mechanical stretching multiplicates the fibroblastic population; 2 degrees hypoxia, by vessel elongation and cellular compaction, induces osteogenic stress protein metabolism. Progressive return to aerobic conditions assumes permanency of the new osseous structures. The precise technical procedure of Ilizarov brings under control the osteogenic process with unprecedented human clinical results.

Aerobiosis↗
PubMed2001

Surgical management for snoring and sleep apnea.

Obstructive sleep apnea is a serious medical problem producing both physical and behavioral derangement. It is essential to provide a thorough workup and evaluation of all patients seeking care for snoring or OSA. Polysomnography is the standard for evaluation and assessment of the severity of OSA in every patient. The evaluation and workup for surgical intervention should include a thorough history, complete head and neck evaluation, nasopharyngeal laryngoscopy with a flexible fiberoptic endoscope, and appropriate imaging (e.g., cephalometrics). This workup allows pathologic entities of the upper airway (e.g., neoplasia, cysts) to be ruled out and regions of disproportionate anatomy (e.g., large soft palate, uvula, base of tongue, and a hypoplastic mandible) to be documented. Treatment of site-specific based on the finding of the evaluation. Treatment of snoring is often addressed by more conservative palatal procedures such as LAUP, RVTR, or electrocautery of the soft palate. The more aggressive palatal procedures such as UPPP are generally reserved for OSA. Nasal airway reconstruction may aid in the treatment of OSA, because increased nasal resistance and obstruction may significantly increase the negative pressure of the upper airway, leading to collapse of the velopharyngeal, base-of-tongue, and hypopharyngeal regions. Children with OSA usually respond well to adenotonsillectomy. Occasionally, uvulopalatopharyngeal procedures may be necessary. Craniofacial anomalies and significant skeletal anomalies such as severe mandibular hypoplasia have historically been problematic. Tracheostomies were at one time the only way to secure the airway in these patients. New developments in distraction osteogenesis have enabled mandibular lengthening and airway improvement, leading to earlier decannulation of these patients. The combined phase I and phase II treatment has a success rate of greater than 90%. Phase I treatment may include nasal reconstruction, uvulopalatopharyngeal, base-of-tongue, and hypopharyngeal surgery. Phase I surgery has a documented success rate of about 70% to 80%. Phase II surgery (MMA) has a success rate approaching 100%. In certain cases, MMA may be used as the primary treatment of OSA.

Adenoidectomy↗
PubMed2001

Realities of craniofacial growth modification.

Facial growth modification can be an effective method of resolving skeletal discrepancies. There still is much controversy regarding our understanding of the nature and extent of skeletal orthopedic change possible in individual patients and the most effective appliances and timing of such treatment. In the treatment of class II patients, growth modification can lead to an improvement, if not complete correction of the class II malocclusion. Although two-phase treatment with an early first prepubertal phase can be effective, a later single-phase approach during early puberty seems to be equally effective. Certainly, before surgical correction of the mild to moderate skeletal class II problem in a growing patient is considered, an orthopedic phase of treatment prior to the pubertal growth spurt is an appropriate first step. Skeletal class III patients with a maxillary deficiency stand to gain significant benefits from early orthopedic treatment. However, such therapy may produce more favorable changes for older children and adolescents than previously thought. Nevertheless, orthopedic correction of the mild to moderate skeletal class III should be accompanied by regular progress evaluations to avoid creating significant dental compensations in the face with little skeletal change that ultimately requires surgery anyway. Skeletal class III patients with mandibular excess and/or vertical excess are poor candidates for growth modification. Orthopedic palatal expansion appears to be effective and stable at any time prior to late puberty, a stage of development when ossification of the maxillary sutures is more advanced. Consequently, the timing for expansion may be better determined by the specific needs of each patient. A functional shift resulting from a crossbite is optimally corrected early, so that asymmetric growth of the mandible can be reduced or even prevented. Postpubertal orthopedic expansion is likely to result in bone bending, which will reverse itself over time, potentially leaving periodontal compromise of the maxillary posterior teeth. Therefore, surgically assisted expansion should be considered in such cases. Vertical maxillary excess is challenging to treat with growth modification. The combination of interocclusal acrylic bite blocks combined with a high-pull headgear presently appears to be the best means available. Unfortunately, this treatment has limited success, it must be continued over many years owing to the long-term nature of vertical growth, and it is counterproductive in achieving a balanced sagittal jaw relationship in class I or class III patients with vertical excess. Future research will permit us to have a greater understanding of the nature and extent of facial growth modification possible in individual patients and the optimal appliances and timing of treatment to achieve the best outcome. The development of intraoral osseointegrated attachments such as implants and onplants hold promise for a future means of dissipating orthopedic forces to prevent unwanted dentoalveolar changes that presently occur with our tooth-borne appliances. Analogous attachments presently are undergoing clinical testing for surgically assisted orthopedic movements associated with distraction osteogenesis.

Adolescent↗
PubMed2002

Ilizarov technique in the treatment of chronic osteomyelitis caused by Vibrio alginolyticus.

We present a case of 26-year-old woman with posttraumatic chronic osteomyelitis caused by Vibrio alginolyticus, contracted after contamination of a tibial fracture with seawater. The patient underwent bone resection and bifocal osteosynthesis according to Ilizarov and was treated with a combination of ciprofloxacin and tetracycline. The patient responded in the same way to distraction osteogenesis as any other patient with chronic osteomyelitis with large defects.

Accidents, Traffic↗
PubMed2003

Restoring soft and hard dental tissues using a removable implant prosthesis with digital imaging for optimum dental esthetics: a clinical report.

Currently, most dental implants are placed in the esthetic zone with a delayed surgical protocol. This delay can result in loss of both soft and hard oral tissues following the healing period, necessitating guided tissue regeneration, distraction osteogenesis, or bone expansion and grafting procedures either prior to or at the time of implant placement. If a delayed placement protocol is used, or if grafting procedures are ineffectual, the prosthetic phase of implant dentistry must restore the missing structures artistically and functionally to integrate with the patient's existing dentition. This article presents the option of using a removable implant prosthesis for an esthetic anterior restoration of soft and hard tissues. A computer-assisted camera was used to record speaking, smiling, and active facial positions, with digital imaging to achieve realism for tooth position during the prosthetic phase. The captured patient images with the esthetic setups were transmitted by e-mail for direct viewing by both dentist and dental technician prior to case completion. These images were viewed as reference files during laboratory construction of the prosthesis to achieve the desired esthetic and functional results.

Adult↗
PubMed1992

Rigidity of half-pins for the Ilizarov external fixator.

The success of the Ilizarov technique is due to the combination of the biomechanics of its external fixator and the biology of distraction osteogenesis. The stability and stiffness of the conventional Ilizarov fixator is attributed to its use of a K-wire cross structure. The disadvantages of this structure include pain, and possible neurologic and vascular injuries when the wires are introduced into crucial neurovascular areas, as well as increased frame complexity and construction. Reducing the number of wires decreases these problems, but also decreases the stiffness of the system. Hybrid (wire and half-pins) Ilizarov fixators and half-pin fixators are also being used in an attempt to alleviate these problems. Half-pins have been described by Fleming et al. and Green as causing minimal transfixation of the surrounding soft tissues and capable of and being inserted into anatomically safe areas. The stiffnesses of the hybrid systems have not been measured. This study reports on the stiffness of different wire and half-pin systems that were biomechanically tested in axial loading, anterior-posterior bending, medial-lateral bending, and torsional loading. The results demonstrated that the conventional Ilizarov fixator with wires possesses a high axial stiffness, whereas the fixator with half-pins possesses higher stiffness under bending and torsional loads. To obtain adequate stability, the use of hybrid Ilizarov frames with one wire and two or more half-pins (5 or 6 mm in diameter), or larger half-pin frames (5 or 6 mm) with three pins is recommended.

Biomechanical Phenomena↗
PubMed1992

[The Ilizarov apparatus in pseudoarthrosis of the long bones].

Distraction osteogenesis with the Ilizarov technique is effective in achieving bone healing in both atrophic and infected pseudoarthrosis. In 10 patients with atrophic and 14 with infected pseudoarthrosis treated by this method, solid bone union with reconstruction of anatomical limb length was achieved in all except 1. They ranged in age from 16-80, with a mean of 44. The mean treatment time was 9.4 months for the femur, 4.5 months for the tibia and 8 months for the radius. Patients could be actively rehabilitated all during the course of treatment and they achieved independent ambulation by the time the apparatus was removed. There were no complications.

Adolescent↗