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Lascombes P.,Nancy Teaching Hospital Center | Popkov D.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Huber H.,Nancy Teaching Hospital Center | Huber H.,University of Zurich | And 2 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2012

Introduction: Long bone lengthening surgery using progressive surgical methods has been the source of frequent complications. Some authors have classified these complications either descriptively, according to the date of onset after the operation, or based on their severity. The Caton classification (1985) has had the virtue of contributing the notion of the treatment contract stipulating the objective to reach in treatment. Within the context of the preoperative information delivered to patients and their family, this contract can be improved by adding a notion of maximum treatment duration. The objective of this study was therefore to propose a classification that includes honoring a triple contract associating the planned gain in bone length, the duration of treatment, and the occurrence of sequelae. Materials and methods: The classification of complications proposed includes four grades: grade I: triple contract honored, including a few treatments without general anesthesia; grade II: triple contract fulfilled, but with unplanned interventions under general anesthesia; grade III: the time stipulated was not honored because the time to obtain bone union was too long or because the program was interrupted; grade IV: sequelae are present. This classification was assessed based on a consecutive series of 34 surgical procedures in 32 patients (two patients underwent two lengthening procedures during this period) at 43 bone segments associating progressive lengthening with external fixation or with nail lengthening. The grade of each complication was determined by each of the authors according to the classification proposed and other classifications reported in the literature (Caton, Paley, Popkov, and Donnan). Results: Approximately one-third (10) of the 34 lengthening procedures did not present any complications. Two-thirds (24) presented 30 complications. Consensus was obtained between all the authors on the grades proposed for our classification and the Caton classification, but consensus was not reached with the other classifications in which part of the interpretation was subjective (Paley, Popkov, and Donnan). Discussion: The classification proposed required respecting predetermined objectives during limb lengthening surgery based on a triple contract: gain, duration, and function. It is reliable and reproducible by different operators because the criteria are objective. It can also be applied to diverse surgical techniques, whether with external fixation and/or internal osteosynthesis. Level of evidence: Level IV: retrospective study or historical series. © 2012 Elsevier Masson SAS. Source

Borzunov D.Y.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Sovremennye Tehnologii v Medicine | Year: 2016

The aim of the investigation was to reveal the features of tibial recovery during multilevel fragment lengthening for filling in an extensive bone defect in the conditions of maintained and disturbed intraosseous artery blood flow bed in the experiment. Material and methods. The experiment modeled the conditions of tibial bone defect filling by bi-level lengthening of the proximal and distal fragments in the conditions of a preserved and disturbed medullary blood flow. The experiment included 54 dogs divided into 4 groups. Radiographic, angiographic, histological, and statistical methods were used in the study. Results. Changes in the architecture of the tibial vascularity net were not accompanied by rough hemodynamic circulatory disorders and depended on the period of the study and initial features of blood supply to the fragments. The conditions of the proximal fragment lengthening were more beneficial for medullary blood flow recovery and new bone formation. Both periosteal and endosteal bone structures took an active part in the distraction osteogenesis. Active periosteal osteogenesis resulted in formation of new bone layers on the periphery of the transported fragments in all the cases. Unified intraosseous nutrient artery vascular bed was formed six months after the external fixator removal. Distraction regenerates by multilevel lengthening of the distal tibial fragment were formed mainly due to the periosteal osteogenesis. Distal fragment lengthening featured a hypoplastic type of bone formation. No active bone tissue remodeling was observed in distal fragment lengthening. Periosteal layers of cancellous bone tissue were not identified on the entire periphery of bone fragments. Conclusion. Prolonged disturbance in the major medullary blood flow occurs in multilevel lengthening of the distal fragment. Blood supply to the transported fragments is provided by periosteomedullary anastomoses. There is no complete recovery of the tibial nutrient artery net at 1.5-year follow-up. © 2016, Nizhny Novgorod State Medical Academy. All rights reserved. Source

Popkov D.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Lascombes P.,University of Geneva | Berte N.,Childrens Hospital of Nancy | Hetzel L.,Childrens Hospital of Nancy | And 3 more authors.
Skeletal Radiology | Year: 2015

Introduction The development of reconstructive surgery of the lower limbs aimed at multilevel correction demands a precise knowledge of the physiological variations in general radiological parameters of the lower limbs in children of various age groups. It is crucial in systemic skeletal diseases, when deformities affect limbs and the surgeon does not have an intact limb as a reference. The aim of this retrospective study was to establish the normal radiological values of lower limb parameters used in the surgical correction of deformities in children of various age groups. Material and methods Teleradiographs of the lower limbs taken in children with unilateral congenital or posttraumatic deformity were retrospectively reviewed.Weight-bearing fulllength anteroposterior radiographs of the entire lower extremities were taken in a standing position. The study involved 215 extremities of 208 children (93 girls and 115 boys); the ages ranged from 2 years 1 month to 15 years 11 months old. Key variables included the anatomic medial proximal femoral angle (aMPFA), anatomic lateral distal femoral angle (aLDFA), anatomic medial proximal tibial angle (aMPTA), anatomic lateral distal tibial angle (aLDTA), mechanical axis deviation (MAD), the angle formed by the femoral anatomical axis and the mechanical axis of the lower limb. Results The means and dynamics of variations, standard deviations (SD) and 95 % confidence intervals of each parameter were calculated for each age and gender group. Simple regression analysis was performed to determine the relationship between the patient’s age and the magnitude of aMPFA, aLDFA, aMPTA and aLDTA. Simple regression analysis showed a significant inverse correlation between patient age and the magnitude of aMPFA: the correlation coefficient was −0.77. A statistically significant inverse correlation between theMAD and the angle between the anatomic femoral axis and mechanical limb axis was found: the correlation coefficient was −0.53. Conclusion In general, the received values were concordant to results of other studies. It concerned the MAD, aLDFA, aMPTA and angle between the mechanical limb axis and anatomic femoral axis. This is the first chronological evaluation of aMPFA and aLDTA from a relavively large series of patients. These normative data should be taken into consideration when evaluating lower limb alignment in children or applied in practice for planning and evaluation of the quality of surgical correction of complex deformities. © Springer-Verlag Berlin Heidelberg 2014. Source

Borzunov D.Y.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Chevardin A.V.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
International Orthopaedics | Year: 2013

Purpose: The purpose of this study was to present a retrospective comparative overview of the Ilizarov non-free bone plasty techniques of one-stage multilevel fragment lengthening and gradual tibilisation of the fibula used for extensive tibial defect management. Methods: Extensive tibial defects in 83 patients were managed either by multilevel fragment lengthening (group I, n = 41, mean defect size 13.1 ± 0.9 cm) or gradual tibilisation of the fibula (group II, n = 42, mean defect size 12.5 ± 1.2 cm) using the Ilizarov apparatus. The initial findings, treatment protocols and outcomes of those patients treated within the period 1972-2011 were studied retrospectively by medical records and radiographs, and statistically assessed with Microsoft Excel and Attestat software. Results: Group I had multilevel fragment lengthening over one stage that averaged 288.0 ± 14.4 days. The mean total period of gradual tibilisation of the fibula in group II was 316.0 ± 29.7 days. The patient's age in the latter group had an effect on the completeness of leg-length equalisation. Conclusions: The techniques can be used to manage extensive tibial defects as all the defects bridged, leg-length discrepancy and deformity were corrected and patients were able to load their limbs. © 2013 Springer-Verlag Berlin Heidelberg. Source

Popkov D.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Popkov A.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
International Orthopaedics | Year: 2016

Purpose: The sufficient length of congenital forearm stump is essential for prosthetic fitting. In our study we reviewed the results of a series of forearm stump lengthening, observed complications and their outcomes. We evaluated possibilities of combined technique to reduce or avoid problems and complications in forearm stump lengthening. Methods: We retrospectively reviewed 18 children who have undergone forearm stump lengthening. In all patients the forearm lengthening was performed by means of Ilizarov frame. Additional flexible intramedullary nailing (FIN) was applied in two cases. Results: The mean lengthening gain was 4.6 cm. The planned lengthening gain was obtained in all cases. The mean healing index (HI) was 34.1 days/cm. The most reduced HI was observed in two cases of combined technique (Ilizarov frame with FIN): 25.4 and 27.0 days/cm. Considering complications and outcomes the results were classified according to Lascombes: grade I—5 cases, IIa—10 cases, IIb—2 cases, IIIa—1 case. In the long term follow-up all patients used their prostheses fixed at the forearm stump with natural function of elbow joint. Conclusion: Forearm progressive lengthening in children with congenital transverse deficiency of the forearm is justified in order to facilitate prosthetic procedures and to preserve natural function of elbow joint. Sufficient lengthening can be achieved within one operation with a low rate of major complications. In our experience a repeated lengthening of forearm stump is not mandatory. © 2016, SICOT aisbl. Source

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