Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics

Priozërsk, Russia

Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics

Priozërsk, Russia

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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.


Novikov K.I.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Subramanyam K.N.,Sri Sathya Sai Institute of Higher Medical SciencesPrasanthigram | Muradisinov S.O.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Novikova O.S.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Kolesnikova E.S.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Clinical Orthopaedics and Related Research | Year: 2014

Background: Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication.Questions/purposes: We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes.Methods: The study was retrospective by reviewing data from medical records and radiographs. Between 1983 and 2006, we treated 138 somatically normal patients with bilateral lower-limb distraction osteogenesis for cosmetic purposes at our center using an Ilizarov external fixator, of whom 131 (95%; 65 males, 66 females) had complete clinical and radiographic data a minimum of 1 year after treatment (mean, 6 years; range, 1–14 years) and were reviewed for this report. The mean age of these patients was 25 years (range, 14–68 years) and their mean preoperative height was 159 cm (range, 130–174 cm). One hundred twenty-four (95%) patients had lengthening of the tibia alone, of which 66 (53%) were monofocal and 58 (47%) were bifocal. Six patients (4.58%) had crossed contralateral lengthening of the femur and tibia and one patient (0.76%) had bilateral lengthening of the femur. The mean height gained was 6.9 cm (range, 2–13 cm), 7.3 cm (range, 3.5–13 cm) in males and 6.5 cm (range, 2–13 cm) in females. The mean lengthening, maturation, and external fixator indexes were 12 days/cm (range, 4.3–24 days/cm), 19 days/cm (range, 5.2–63 days/cm), and 31 days/cm (range, 12–78 days/cm), respectively.Results: Forty-eight patients (37%) had 59 complications related to treatment. Thirty-seven were soft tissue related (28%), of which 17 (46%) needed reinterventions, and 22 were bone related (17%), of which 16 (73%) needed reinterventions. At final followup, the outcome was excellent for 72 patients (55%), good for 52 (40%), satisfactory for six (4.58%), and poor for one (0.77%). One hundred thirty of 131 patients subjectively felt satisfied and had improved self-esteem.Conclusions: Distraction osteogenesis using the Ilizarov external fixator is an option for carefully selected motivated patients with awareness of this technique. Soft tissue and bone-related complications including those that necessitate reinterventions should be expected during the course of treatment, although most can be managed without permanent sequelae or disability. Future studies with more robust methods will need to determine whether the risks and benefits of this procedure are well balanced. Preoperative counseling, considering the ethical questions this procedure can raise, is of paramount importance for the patient to weigh the risk versus anticipated benefits. Studies from other centers will be important as we move forward.Level of Evidence: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence. © 2014, The Association of Bone and Joint Surgeons®.


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.


Popkov A.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Aranovich A.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Popkov D.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
International Orthopaedics | Year: 2015

Purpose: This study aimed to evaluate development of the tibia after Ilizarov lengthening and deformity correction depending on whether or not the simultaneous resection of fibular anlage was performed in children with fibular aplasia type II, who did not undergo early surgery. Methods: The study analyses results of reconstructive treatment in 38 children at the age of over four years. Two groups of children are compared: bifocal tibial lengthening with the Ilizarov device (group I) and bifocal lengthening associated with resection of the fibular anlage (group II). The results were estimated at 12 months and in the long-term exceeding three years. Results: Radiological data of measurement of the anatomical lateral distal tibial angle (aLDTA) show surgical correction of deformities achieved in both groups. During the further limb growth a tendency to normalisation of the aLDTA was observed only in the group II. Quick relapse of the angular deformities of the tibial shaft in the first group occurred mainly during further growth of the limb regardless of complete correction at the time of treatment. On the other hand, there were no recurrences of diaphyseal deformities in the group II. Conclusions: In children with congenital fibular deficiency of type II at the age of four years, the bone lengthening and deformity correction should be associated with fibular anlage resection. That approach improves conditions for distal tibia development and prevents or decreases significantly the recurrence of deformities of the tibia and ankle joint in long-term follow-up. © 2015, SICOT aisbl.


Popkov A.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Aranovich A.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Popkov D.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
International Orthopaedics | Year: 2015

Background: The operative procedures to correct multiplanar bone deformities may be indicated for prevention of secondary orthopaedic complications in children with X-linked hereditary hypophosphatemic rickets (XHPR). Different problems related to surgical correction were reported: increased rate of non-union, delayed union, recurrent deformity, deep intramedullary infection, refracture, nerve palsy, and pin tract infection. The aim of this retrospective study was comparison of results of correction in children with XHPR who underwent the treatment with either the Ilizarov device alone or a combined technique: the Ilizarov fixator with flexible intramedullary nailing (FIN) with hydroxyapatite bioactive coating and FIN. Material and methods: We retrospectively analysed 47 cases (children of age under 14 years) affected by XHPR. Simultaneous deformity correction in femur and tibia was performed with the Ilizarov device (group I) or the combined method (group II). This article is based on the results of a historical comparative retrospective study from the same institution. Results: The duration of external fixation is noted to be shorter applying the combined technique: 124.7 days (group I) vs 87.4 days (group II). In both groups deformity correction was achieved with a proper alignment. Nevertheless, while a child continues to grow during long-term follow-up, deviations of the mechanic axis from the centre of the knee joint have been developing again and values of mLDFA, mMPTA have become pathologic in the most of the cases. In group I location of a newly developed deformity resembled a pre-operative one, whereby both diaphyseal and metaphyseal parts were deformed. In group II in all the cases an apex of deformity was located in distal metadiaphyseal zone of the femur and proximal metadiaphyseal zone of the tibia. It is important to note that all of those in group II were out of the zone of the intramedullary nail. Conclusion: Simultaneous correction of femoral and tibial deformities by means of circular external fixators is preferable. Application of a combined osteosynthesis allows to considerably reduce the duration of external fixation and decrease the number of complications. There were no recurrent deformities in parts of bone reinforced by intramedullary nails. © 2015, SICOT aisbl.


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.


Borzunov D.Y.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Chevardin A.Y.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Mitrofanov A.I.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
International Orthopaedics | Year: 2016

Purpose: Our study compared the rates of union achieved with the Ilizarov method in congenital pseudarthrosis of the tibia (CPT) associated with neurofibromatosis type 1 (NF1) or CPT of idiopathic origin in paediatric patients. Methods: We studied the outcomes of 28 children that were treated for CPT between 2005 and 2013. Group 1 included children (n = 14, mean age = 9.7 years) with CPT associated with NF1 while group 2 were CPT cases that had radiographic confirmation of dysplastic lesions in the tibia but lacked clinical NF1 manifestations (n = 14, mean age = 8.6 years). There was no statistical difference between the groups regarding their age or number of previous operations per patient. Individual technical solutions were planned for each patient but coaptation of bone fragments and autologous local tissue grafting to achieve a greater bone thickness and contact area at the pseudarthrosis level were mainly used. Refracture-free rate after the first operation, number of re-operations per patient, and union rates in the groups were compared. Results: Bone union and weight bearing were obtained in all the cases after the first operation. Refracture-free rate was 42.86 % in group 1 and 35.71% in group 2 (no statistical difference, p > 0.05). Mean number of re-operations per patient was 1.07 and 0.78 respectively (p > 0.05). Subsequent treatment for refractures with the Ilizarov techniques gained 92.86% of union in both groups at the follow-ups by completion of the study (range, 2–9 years). Conclusions: The Ilizarov method yields comparable results in the management of CPT associated with NF1 or tibial dysplasia of idiopathic origin in paediatric cases. Further research should focus on the ways to support the Ilizarov method in order to reduce the number of repetitive surgeries or eliminate them. © 2015, SICOT aisbl.


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.


Stupina T.A.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
Bulletin of Experimental Biology and Medicine | Year: 2016

We developed and adapted a technology for preparation of articular cartilage specimens for scanning electron microscopy. The method includes prefixation processing, fixation, washing, and dehydration of articular cartilage specimens with subsequent treatment in camphene and air-drying. The technological result consists in prevention of deformation of the articular cartilage structures. The method is simpler and cheaper than the known technologies. © 2016 Springer Science+Business Media New York


Prudnikova O.G.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics | Shchurova E.N.,Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
International Orthopaedics | Year: 2016

Purpose: The aim of our study was to analyze clinical and radiographic outcomes of operative management of L5 high-grade dysplastic spondylolisthesis with the apparatus for external transpedicular fixation (AETF), and to compare the results of its use for reduction and spondylodesis. Methods: There were 13 patients with L5 dysplastic spondylolisthesis of grade 4 (Meyerding grading) and having a mean age of 25.0 ± 3.6 years. The management included two stages: gradual reduction with the AETF, followed by either isolated anterior spondylodesis with the same AETF (group 1, n = 8), or by spondylodesis using a combined method (internal transpedicular instrumentation and posterior lumbar interbody fusion [PLIF]) (group 2, n = 5). Clinical evaluation included pain (VAS scale) and functional status (Oswestry questionnaire [ODI]). Reduction and fusion completeness were assessed radiographically after treatment and at a mean follow-up of 2.1 ± 0.4 years. Results: Initial slippage was reduced by 51.6 % with AETF and was of grade 1 or 2. Reduction made up 31.1 % at follow-ups (grade 2 or 3). Pain decreased by 57.6 % (p < 0.01). The functional status improved. ODI decreased by 37.7 % (p < 0.01) after treatment and by 41.7 % (p < 0.01) at follow-ups. Fusion at the level of the involved segment was poor in group 1. All the cases fused in group 2. Conclusions: The use of AETF for L5 high-grade dysplastic spondylolisthesis provides gradual controlled reduction of the slipped vertebra, decompression of cauda equine roots, and recovery of the local sagittal spinal column balance. It creates conditions for achieving stability of lumbosacral segments with combined spondylodesis (internal transpedicular instrumentation and PLIF). AETF is not suitable for spondylodesis due to a high rate of pseudarthrosis. © 2016, SICOT aisbl.

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