Forearm realignment with elbow reconstruction using the Ilizarov fixator. A case report.
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A case of osteogenesis imperfecta, presenting with bowed deformity of both forearm bones and dislocation of the radial head was treated by separate elongation of both bones using Ilizarov's external fixator. (+info)
Lengthening for congenital short femur. Results of different methods.
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We have reviewed the results in 37 patients with unilateral congenital short femur (Pappas classes III to IX), treated by different lengthening procedures. The increase in the length of the femur varied from 15.6% to 142%, excellent or good results being obtained in 32 patients (86%). There was an average of 1.9 complications per case, most being seen earlier in the series when the Wagner technique was used. With the Orthofix and the Ilizarov techniques, we used callus distraction in all cases. We found that the proximal diaphysis of the congenitally abnormal femur healed less well, and we now prefer to perform corticotomy and callus distraction of the distal metaphysis. The Ilizarov method gave the best results, offering the possibilities of the simultaneous use of a Hoffmann fixator across the hip and the treatment of knee dislocation and instability. (+info)
Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting.
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Seventy-nine open tibial fractures were treated with unilateral uniplanar tubular external fixators. Excellent stability allowed early weight-bearing. All comminuted fractures, with or without bone loss, and some transverse or short oblique fractures with intermediate fragments were treated by early bone grafting through a posterolateral approach. The external fixator was dynamised as soon as periosteal callus was seen on the radiograph. Bone healing times ranged from 11 to 40 weeks (mean 20). Significant ankle stiffness occurred in 10.9% and leg shortening in 2.8%. Pin track infection was seen in 45.2% but was easily controlled with standard management. The external fixation frame allowed excellent functional freedom for Oriental patients to sit cross-legged and squat. Combined with early bone grafting, external fixation is an excellent method for the management of open tibial fractures. (+info)
Oblique pelvic osteotomy in the exstrophy/epispadias complex.
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We reviewed retrospectively 45 patients (46 procedures) with bladder exstrophy treated by bilateral oblique pelvic osteotomy in conjunction with genitourinary repair. The operative technique and post-operative management with or without external fixation are described. A total of 21 patients attended a special follow-up clinic and 24 were interviewed by telephone. The mean follow-up time was 57 months (24 to 108). Of the 45 patients, 42 reported no pain or functional disability, although six had a waddling gait and two had marked external rotation of the hip. Complications included three cases of infection and loosening of the external fixator requiring early removal with no deleterious effect. Mid-line closure failed in one neonate managed in plaster. This patient underwent a successful revision procedure several months later using repeat osteotomies and external fixation. The percentage pubic approximation was measured on anteroposterior radiographs pre-operatively, post-operatively and at final follow-up. The mean approximation was 37% (12% to 76%). It varied markedly with age and was better when external fixation was used. The wide range reflects the inability of the anterior segment to develop naturally in spite of close approximation at operation. We conclude that bilateral oblique pelvic osteotomy with or without external fixation is useful in the management of difficult primary closure in bladder exstrophy, failed primary closure and secondary reconstruction. (+info)
Biomechanical study of a hat type cervical intervertebral fusion cage.
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The purpose of this study was to evaluate the biomechanical effect of a hat type cervical intervertebral fusion cage (HCIFC). In this in vitro biomechanical study, 48 goat cervical spines (C2-5) were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method using a nonconstrained testing apparatus, and three-dimensional displacement was measured. Autologous iliac bone and cervical spine intervertebral fusion cage were implanted according to manufacturers' information after complete discectomy (C3-4). Eight spines in each of the following groups were tested: intact, autologous iliac bone graft, Harms cage, SynCage C, carbon cage, and HCIFC. The mean apparent stiffness values were calculated from the corresponding load-displacement curves. Additionally, cage volume and volume-related stiffness were determined. The stiffness of the SynCage C was statistically greatest in all directions. After implantation of the HCIFC, flexion stiffness increased compared with that of the intact motion segment. There was no significant difference in stiffness between the HCIFC and carbon cage. The stiffness of the HCIFC was statistically higher than that of the Harms cage in axial rotation and significantly lower in flexion, extension, and lateral bending. Volume-related stiffness of all cages was higher than that of iliac bone graft. The Harms cage was highest in volume-related stiffness in all directions. The HCIFC can provide enough primary stability for cervical intervertebral fusion. (+info)
The effects of silver coated external fixation pins.
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We performed a randomized controlled trial in order to assess the effect silver coating of an external fixator pin has on pin infection. The experimental silver coated pins (SC) were compared to control stainless steel (SS) pins. A clamp design monolateral fixator was used, and pins were randomized to clamp position to allow side-by-side comparisons of pins in a similar environment. Nineteen patients and 33 clamps were entered and completed the study. There were no significant differences between the two types of pins in the rate of pin tract infection, clinical appearances of the pin sites, bacteriology of the pin tracts, torque to remove the pins, or radiographic lucency around the pin. We concluded that with the numbers available in this study, there were no detectable differences between the performance of SC and SS pins. (+info)
Correction of genu recurvatum secondary to Osgood-Schlatter disease: a case report.
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Complications secondary to Osgood-Schlatter disease are rare, and there have been few reports on their treatment. Partial growth arrest of the proximal tibial physis as a result of Osgood-Schlatter disease has been infrequently described. Genu recurvatum from partial physeal arrest can cause cosmetic deformity, instability, pain, and weakness. We report a case of genu recurvatum secondary to Osgood-Schlatter disease treated successfully with proximal tibial osteotomy and distraction with a Taylor spatial frame. (+info)
Distraction osteogenesis for ulnar lengthening in Kienbock's disease.
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Ulnar lengthening is an accepted modality of treatment to achieve joint levelling in Kienbock's disease. The conventional method of ulnar lengthening with a plate and bone graft is fraught with complications including graft site morbidity, non-union, hardware removal and difficulty in the achievement of a proper length. We used a Umex distractor to achieve distraction osteogenesis in a group of 12 patients and assessed them over an average follow-up period of 29.5 months. We had one excellent, ten good and one fair result. We conclude that distraction osteogenesis addresses all the complications of coventional lengthening in addition to providing an increase in the local blood supply, which might be beneficial in a disease that is primarily an avascular necrosis. This procedure addresses both the biomechanical and the biological aspects of this disease. (+info)