Search

Introduction Long duration of distraction osteosynthesis remains an unsolved problem. One of the promising ways to stimulate reparative regeneration of bone tissue is the technology of combined osteosynthesis with intramedullary elastic reinforcement with titanium wires coated with hydroxyapatite. A significant drawback of this combined distraction osteosynthesis is the planned removal of intramedullary wires several months after disassembling the Ilizarov apparatus. The purpose of this work is to demonstrate the possibility of stimulating reparative regeneration and reducing the duration of distraction osteosynthesis using an intramedullary degradable implant with bioactive filling. Methods We present the first in clinical practice case of surgical leg lengthening in a female 10-year-old patient using the Ilizarov apparatus an intramedullary degradable implant made of polycaprolactone (PCL) saturated with hydroxyapatite to stimulate reparative regeneration in the tibia. Monthly radiographic monitoring of the process of reparative regeneration of bone tissue was supplemented by computed tomography after disassembling the Ilizarov apparatus. Results The process of lengthening the tibia was accompanied by pronounced formation of a bone “sleeve” around the implant, which was directly connected to the endosteum of the tibia. The density of bone substance in the medullary canal reached 496.6 HU. The cortical layer of the tibia in the elongation zone increased to 4 mm, and its density was equal to 1288.8 HU. Discussion Leg lengthening of 4 cm was achieved along with simultaneous correction of valgus recurvatum bone deformity at IO = 15 days/cm, that is two times shorter than the generally accepted excellent IO in distraction osteosynthesis according to Ilizarov. Conclusions Biodegradable polycaprolactone implants saturated with hydroxyapatite might be not inferior to titanium wires coated with hydroxyapatite in regard to the degree of osteoinduction and do not require repeated surgical intervention to remove them.

Reconstructing long bone defects following intercalary tumor resection presents an exciting challenge with a greater range of surgical solutions than more typical situations requiring arthroplasty. Segmental bone transport (distraction osteogenesis) is the least utilized option for intercalary reconstruction; however, it arguably provides patients with the most desirable result. Distraction osteogenesis can be used in the management of multiple skeletal conditions including deformity (congenital or acquired), or in the presence of bone defects (by trauma or planned surgical excision). Lack of broader adoption of transport is likely due to the highly technical demands and common complications of utilizing fine-wire fixators via the Ilizarov method. More recently, internal lengthening nails such as the PRECICE nail have been employed to facilitate distraction osteogenesis without the added complexity of external fixation. This review will examine the literature on the indications, design, and safety of the PRECICE nail (NuVasive) for intercalary reconstruction after tumor resection. Bone transport using the PRECICE nail represents a viable alternative to Ilizarov distraction and has the benefit of avoiding the complications of an external fixator. For large defects, the PRECICE nail can be supplemented with a locking plate for additional stability and maintenance of limb length. [ABSTRACT FROM AUTHOR]

This review analyzes and assesses the existing methods and approaches to prediction and control of the course of distraction osteogenesis (DO). The analysis of the literature revealed few works that recommended specific predictors or methods for prognosis of the course of distraction osteogenesis at the stages of limb lengthening. The authors identified some diagnostic criteria for assessing the distraction regenerate as potential criteria for predicting its development and maturation. It was found that all available predictors and potential diagnostic criteria for assessing the state of the distraction regenerate in clinical practice are used to further correct the distraction regime (respectively, at the stage of distraction) and to determine the timing of the removal of the apparatus, as well as prognosis of recurrence, fracture, and deformity of the regenerate in the non-apparatus period. It was shown that all known diagnostic methods can be applied for the assessment and prediction of the DO course: radiological, physiological, ultrasound diagnostics, laboratory tests. It is stated that a quantitative assessment of the informative value of most of the known predictors of DO disorders is necessary from the point of view of the evidence-based medicine. Difficulties and problems of the development and application of prognostic tests for assessing DO are described. The directions to the development of this topic are proposed. Predicting the DO course is an essential element for monitoring the tissue repair of the segment under lengthening. Prediction and subsequent prophylaxis of DO disorders is a promising solution for optimizing and improving the quality of treatment of patients with orthopedic diseases by using the Ilizarov method of transosseous distraction osteosynthesis.

Research objective was the estimation of combination distraction osteosynthesis with bone plastic in treatment of children with congenital lower limb discrepancy. Results of surgical treatment of 26 children (17 girl and 9 boys) with congenital lower limb-length discrepancy are analyzed. The method consists in creation of superfluous osteogenesis in the field of prospective lengthening. The control group included 10 patients with whom lengthening was carried out by typical way. Results: at the analysis of roentgenograms faster formation of a new bone has been revealed in basic group (on the average for 7,8 days faster on each centimetre of lengthening). Combination of distraction osteosynthesis and combined bone plastics shortened the treatment period by accelerating new bone regeneration during distraction osteogenesis of the children with congenital low limb-length discrepancy.

Aim: To study the redistribution of microelements in bone tissue in osteosynthesis in high-altitude destinations. Material and Methods. The study was performed on 72 mongrel dogs of both sexes aged 1-3 years, weighing 10—15 kg. 32 dogs have been experienced the extended leg in lowlands destinations, another group of 32 animals have been experienced elongation produced in high-altitude destinations. The control group consisted of 8 healthy dogs of low mountain areas. The standard technique of surgery has been used in the research. Microelement composition has been studied by atomic absorption spectrophotometer AAS-1 N (Germany) in the long bones and the distraction regenerate. Shapiro —Wilk test was applied to analyze the normality. The data evaluation has been done by Student's t-test for unpaired samples. Results. Calcium and microelement imbalance has been obtained during transosseous osteosynthesis in high-altitude destinations, which causes functional changes in the musculoskeletal system, with similar clinical picture of Kashin — Beck. In the conditions of high-altitude destinations elongation of bones causes changes in microelements in the distraction regenerate. Conclusion. During distraction osteosynthesis in high-altitude destinations phase changes of microelements have been formed in the bone regenerate, which prognoses physiologically the formation of a false joint.

The purpose - to study the morphofunctional changes of upper extremities in patients with brachymetacarpia. Material and methods. The results of the examination and surgical treatment by distraction osteosynthesis of six patients (10 hands, shortening of the 18-metacarpal bones) with brachymetacarpia are presented. Results. All patients noted dissatisfaction with the cosmetic state of hands and tiredness during physical activities with the hand. IV ray was shortened in 50%, V ray - in 33% of cases and III ray - in 17%. Limitation of active flexion was noted in all patients, an average flexion was 58.9 ± 7,1°. After treatment flexion increased an average on 20.5 ° (22.7%). Complications were obtained in two patients on three hands. Conclusions. Brachymetacarpia is a rare disease, the etiology of which is still unknown and requires further study. In all cases of brachymetacarpia there is a restriction of active flexion of the MCP joint of the affected ray and the indications for treatment are caused not only by a cosmetic defect, but also functional impairment. Surgical treatment of brachymetacarpia by distraction osteosynthesis gives predictably good results. Complications during the treatment of brachymetacarpia are rare and mostly related to the appearance of contractures, in order to prevent which in the postoperative period should be used preventive conservative therapy.

The knee articular cartilage and synovial membrane have been studied for metadiaphyseal leg lengthening using the methods of light miscroscopy, computer morpho- and stereometry. The manner of bone integrity breaking, the rate and rhythm of distraction conformed to the lengthening technique most often used in the clinic. The results of the histomorphometric analysis have demonstrated that when osteotomy at the level of metadiaphysis and manual distraction by 1 mm a day for 4 times is performed, synovitis of mild and moderate degree develops through subsynovial layer hypervascularization, as well as reactive-destructive changes in nerve fibers with the tendency to regeneration. The structural-functional changes of reactive and/or destructive-reparative character have been revealed in the articular cartilage, and the manifestation degree of these changes correlates with synovial membrane changes. The intensity of the destructive-reparative processes in the articular cartilage and synovial membrane depends on fixation stability.

In order to study the specific features of central nervous system reaction to restoration of the cranial vault bone defects by distraction, osteosynthesis method, the electroneuromyographic examination was performed in 28 patients of 16—62 years (average age — 40,1 ± 2,6 years) with pyramidal syndrome in late recovery or residual period, of the disease (severe brain injury cerebral stroke). The main trends in electroneuromyographic indice — "cerebrospinal index" — in patients during the replacement process of post-traumatic or simulated cranial vault bone defects using transosseous distraction osteosynthesis were analyzed. The specific features of the central nervous system responses to surgical treatment, age, etiology, the brain structures initial lesion severity and disease duration were studied. As the results of the research it was established that replacement of defects of calvarium bones by transosseous distraction osteosynthesis in patients with consequences of craniocerebral trauma or stroke had. more intensive positive influence on motor zones of cerebral cortex, that shows itself in increase of effectiveness of motor control, in middle age people, at traumatic etiology of disease, at moderate pyramidal insufficiency and. at remoteness of the disease up to 1 year. Obtained data is expedient to take into account at primary selection of patients for operative treatment.

The experiment was performed on 10 adult dogs underwent tibial lengthening by 14—18 % from the initial length using a "fan" technique interchanging weekly active periods of dosed lengthening on various muscle groups and. their weekly rest. This effect created sufficiently favourable conditions for bone distraction regenerate formation and functioning of the first sensitive neurons of the motor analyzer.

The changes of reactive and/or destructive-and-reparative character, the degree of which depends on distraction parameters, have been revealed in articular cartilage during leg lengthening by the methods of scanning electron microscopy and histomorphometry analysis. The analysis of quantitative data has demonstrated, that autodistraction by 3 mm per day for 180 times (increment и 17 μm) appears to be less traumatic for the articular cartilage than manual distraction by 1 mm per day for 4 times, and, at the time, the period of experiment decreases significantly. The articular cartilage recovery occurs in the most intense manner in case of autodistraction with the same increment, but with the daily rate of 1 mm.

The changes in quantitative electromyographic characteristics have been analyzed in patients suffering from pathologic consequences of stroke or severe traumatic brain injury and undergoing treatment with transosseous distraction osteosynthesis. The specific features of the central nervous system's response to this surgical treatment have been studied in patients depending on the patient's age and the etiology and severity of the initial damage of brain structures. The stages and mechanisms of the reactive reorganization of the cerebral cortex duiring rehabilitation with transosseous distraction osteosynthesis in the patients of these nosologic groups are discussed. [ABSTRACT FROM AUTHOR]

An Ilizarov apparatus was used to lengthen the shin in nine adult mongrel dogs. Neurohistological and quantitative methods were used to study the morphofunctional state of neurons in the sensory ganglia of the LVII spinal nerve, which contribute to the innervation of the shin, after distraction at a rate of 1 mm/day in four fractions over a period of 28 days, after fixation for one month, and one month after removal of the apparatus. Controls consisted of specimens from three intact animals. The most intense increases in structural changes in different populations of sensory neurons occurred during the distraction period, but changes were also present one month after removal of the apparatus. Populations of large, intermediate, and small neurons, as compared with those in intact animals, showed decreases, by factors of 2-3, in the numbers of normochromic cells with centrally positioned nuclei and nucleoli, along with proportionate increases in the numbers of cells with peripheral chromatolysis combined with dislocation of the nuclearnucleolar apparatus. [ABSTRACT FROM AUTHOR]

The effects of Stimbone-1, a complex of growth factors deposited by osteal tissue, on maturation of distraction regenerative substrate are studied in dogs. At the end of distraction, the preparation is injected into the regenerative connective tissue interlayer. Roentgenological, biochemical, and quantitative morphological data show that Stimbone-1 stimulates reparative osteogenesis. [ABSTRACT FROM AUTHOR]

We studied circulatory changes in dog hindlimb after tibial thickening by the Ilizarov method. Distraction osteosynthesis promoted the increase in blood supply to hindlimb tissues. Changes in blood flow were most pronounced in a distraction bone regenerate after the distraction period. The increase in the volume of distraction bone regenerate determined more pronounced and long-lasting stimulation of circulation in the extremity. [ABSTRACT FROM AUTHOR]

Abstract: The monobloc advancement with distraction is a treatment modality for syndromic craniosynostosis, to correct exorbitism, upper airway compromise and malocclusion. In this report orbital volume and movements of (peri-)orbital structures and globes of seven patients following monobloc distraction are evaluated. In preoperative and postoperative CT-scans orbital volume was assessed and a 3D coordinate system with eleven landmarks was used to measure the movements of orbital structures and globes and to measure the change of exorbitism. Correlation between orbital volume, movements of the orbital structures and change in exorbitism was studied. The orbital volume increased by 49.9% (left) and 50.4% (right). The average anterior movement of the bone was 13.6 mm (left) and 13.9 mm (right). The mean anterior movement of the left globe was 5.8 mm and of the right globe 5.3 mm. The ratio of globe/bone movement was 0.4. Exorbitism decreased with 7.8 mm (left) and 8.1 mm (right). Differences between left and right for orbital volume, for movements and for the decrease in exorbitism were not significant. Volume enlargement and decrease in exorbitism were correlated (p ≤ 0.05). Following monobloc advancement orbital volume increases, (peri-)orbital structures and the globe move forward and exorbitism diminishes. [Copyright &y& Elsevier]