EXPERIMENTAL APPROVAL OF COMBINED FIXATION FOR FEMUR LENGTHENING

Cover Page


Cite item

Full Text

Abstract

Elimination of congenital shortening of lower limb still remains a complex and unsolved orthopaedic task which requires an improved fixation technique as well as adjusted tactics of treatment and rehabilitation procedures.

Purpose of the study — experimental approval of femur lengthening technique by external fixation with Ilizarov apparatus and internal fixation by plate.

Materials and methods. Femur lengthening was performed in 6 mongrel dogs. Average animal age was 1,5±0,3 years, average weight — 20±5 kg, femur length — 22±2 sm. External apparatus with two supports and a titanium plate of an original design were applied under general anesthesia on the right femur of animals. Lengthening was performed manually at a rate of1 mm per day in 4 stages at a distance of 10% from initial segment length. External apparatus was removed on the last day of distraction after locking the plate. X-ray examination was done on the day of surgery, in 7, 14 and 25 days from the onset of distraction as well as in 14, 30, 60 and 90 days after completion of distraction and removal of external apparatus. Three animals were taken out of experiment in 30 days of fixation, remaining three animals — in 90 days. After euthanasia the authors performed autopsy of the organic femur complex and tissues contacting the plate.

Results. The use of operated limb was not restricted during the whole distraction period. The authors observed first roentgenological signs of distraction osteogenesis on 7th day of lengthening. By the end of distraction period, at 25th day, shadows of regenerates demonstrated longitudinal striated structures in all cases. Median lucency area of 1–5 mm was located diagonally and across the regenerate or was intermittent. In 60 days of fixation X-rays demonstrated homogeneous regenerate. External fixation index was 13,9±1,5 days/sm (p≤0,05). The authors observed no cases of implants fracture or deformity during the experiment.

 Conclusion. Application of the developed plate in combination with external apparatus demonstrated high efficiency for femur lengthening in experiment study.

About the authors

M. A. Stepanov

Ilizarov Russian Scientific Center Restorative Traumatology and Orthopedics

Email: fake@neicon.ru

Mikhail A. Stepanov — Cand. Sci. (Veterinary), Leading Researcher, Experimental Laboratory 

6, ul. M. Ulyanova, Kurgan, 640014

Россия

N. I. Antonov

Ilizarov Russian Scientific Center Restorative Traumatology and Orthopedics

Author for correspondence.
Email: aniv-niko@mail.ru

Nikolay I. Antonov — Cand. Sci. (Biology), Researcher Experimental Laboratory 

6, ul. M. Ulyanova, Kurgan, 640014

Россия

D. Yu. Borzunov

Ilizarov Russian Scientific Center Restorative Traumatology and Orthopedics;
Tyumen State Medical University

Email: fake@neicon.ru

Dmitry Yu. Borzunov — Dr. Sci. (Med.), Deputy Director for Science, Ilizarov Russian Scientific Center "Restorative Traumatology and Orthopedics"; Professor of the Traumatology and Orthopedics Chair, Tyumen State Medical University 

54, ul. Odesskaya, Tyumen, 625023

Россия

References

  1. Колчев О.В., Борзунов Д.Ю. Устранение врожденного укорочения нижней конечности (историческая справка). Гений ортопедии. 2010;(2):57-63. Kolchev O.V., Borzunov D.Yu. [Elimination of the lower limb congenital shortening (historical reference)]. Genij оrtopedii [Orthopaedic Genius]. 2010;(2):57-63. (in Russian).
  2. Шаповалов В.М., Хоминец В.В., Михайлов С.В., Шакун Д.А., Капилевич Б.Я. Комбинированный способ восстановления длины бедра и голени при лечении больных с последствиями травм и дефектами развития Гений ортопедии. 2010;(1):116-121. Shapovalov V.M., Khominets V.V., Mikhailov S.V., Shakun D.A., Kapilevich B.Ya. [Combined technique of restoring the length of femur and leg when treating patients with injury consequences and developmental defects]. Genij ortopedii [Orthopaedic Genius]. 2010;(1):116-121. (in Russian).
  3. Степанов М.А., Кононович Н.А., Горбач Е.Н. Репаративная регенерация костной ткани при удлинении конечности методикой комбинированного дистракционного остеосинтеза. Гений ортопедии. 2010;(3): 89-94. Stepanov M.A., Kononovich N.A., Gorbach E.N. [Reparative regeneration of bone tissue when limb lengthening using the technique of combined distraction osteosynthesis]. Genij ortopedii [Orthopaedic Genius]. 2010;(3):89-94. (in Russian).
  4. Соколовский О.А., Сердюченко С.Н., Бродко Г.А., Урьев Г.А. Уравнивание длины нижних конечностей — исторические ракурсы и современные тенденции. Медицинские новости. 2011;(7):11-19. Sokolovskii O.A., Serdyuchenko S.N., Brodko G.A., Ur’ev G.A. [Equalization of the lower limb length — historical perspectives and current trends]. Meditsinskie novosti [Medical news]. 2011;(7):11-19. (in Russian).
  5. Шевцов В.И., Шрейнер А.А. Удлинение трубчатых костей у собак с использованием внутрикостного стержня (предварительные результаты). Гений ортопедии. 1999;(3):76-78. Shevtsov V.I., Shreiner A.A. [Lengthening of canine tubular bones using an intraosseous rod (preliminary results)]. Genij ortopedii [Orthopaedic Genius]. 1999;(3):76-78. (in Russian).
  6. Min W.K., Min B.G., Oh C.W., Song H.R., Oh J.K., Ahn H.S., Park B.C., Kim P.T. Biomechanical advantage of lengthening of the femur with an external fixator over an intramedullary nail. J Pediatr Orthop. 2007;16(1):39-43. doi: 10.1097/01.bpb.0000236221.91453.90.
  7. Li Z., Zhang X., Duan L., Chen X. Distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur. Can J Surg. 2009; 52(2):103-111.
  8. Gordon J.E., Manske M.C., Lewis T.R., O’Donnell J.C., Schoenecker P.L., Keeler K.A. Femoral lengthening over a pediatric femoral nail: results and complications. J Pediatr Orthop. 2013;33(7):730-736. doi: 10.1097/BPO.0b013e3182a122a1.
  9. Rozbruch S.R., Kleinman D., Fragomen A.T., Ilizarov S. Limb lengthening and then insertion of an intramedullary nail: a case-matched comparison. Clin Orthop Relat Res. 2008;466(12):2923-2932. doi: 10.1007/s11999-008-0509-8.
  10. J asiewicz B., Kacki W., Tesiorowski M., Potaczek T. Results of femoral lengthening over an intramedullary nail and external fixator. Chir Narzadow Ruchu Ortop Pol. 2008;73(3):177-183.
  11. П опков Д.А., Ерофеев С.А., Чиркова А.М. Удлинение голени с использованием интрамедуллярного напряженного армирования (экспериментальное исследование). Гений ортопедии. 2005;(4):81-89. Popkov D.A., Erofeev S.A., Chirkova A.M. [Leg lengthening using intramedullary stressed reinforcement (an experimental study)]. Genij ortopedii [Orthopaedic Genius]. 2005;(4):81-89. (in Russian).
  12. П опков А.В., Аранович А.М., Новиков К.И., Чибиров Г.М., Попков Д.А. Комбинированный высоко дробный дистракционный остеосинтез бедра у детей. Гений ортопедии. 2016;(1):140-146. Popkov A.V., Aranovich A.M., Novikov K.I., Chibirov G.M., Popkov D.A. [Combined distraction femoral osteosynthesis of high division in children]. Genij ortopedii [Orthopaedic Genius]. 2016;(1):140-146. (in Russian).
  13. Harbacheuski R., Fragomen A.T., Rozbruch S.R. Does lengthening and then plating (LAP) shorten duration of external fixation? Clin Orthop Relat Res. 2012;470 (6):1771-1781. doi: 10.1007/s11999-011-2178-2.
  14. Endo H., Asaumi K., Mitani S., Noda T., Minagawa H., Tetsunaga T., Ozaki T. The minimally invasive plate osteosynthesis (MIPO) technique with a locking compression plate for femoral lengthening. Acta Med Okayama. 2008;62(5):333-339.
  15. Uysal M., Akpinar S., Cesur N., Hersekli M.A., Tandoğan R.N. Plating after lengthening (PAL): technical notes and preliminary clinical experiences. Arch Orthop Trauma Surg. 2007;127(10):889-893. doi: 10.1007/s00402-007-0442-4.
  16. Iobst C.A., Dahl M.T. Limb lengthening with submuscular plate stabilization: a case series and description of the technique. J Pediatr Orthop. 2007;27(5):504-509. doi: 10.1097/01.bpb.0000279020.96375.88.
  17. Oh C.W., Song H.R., Kim J.W., Choi J.W., Min W.K., Park B.C. Limb lengthening with a submuscular locking plate. J Bone Joint Surg Br. 2009;91(10):1394-1399. doi: 10.1302/0301-620X.91B10.22325.
  18. Oh C.W., Shetty G.M., Song H.R., Kyung H.S., Oh J.K., Min W.K., Lee B.W., Park B.C. Submuscular plating after distraction osteogenesis in children. J Pediatr Orthop B. 2008;17(5):265-269. doi: 10.1097/BPB.0b013e32830688d8.
  19. Kulkarni R., Singh N., Kulkarni G.S., Kulkarni M., Kulkarni S., Kulkarni V. Limb lengthening over plate. Indian J Orthop. 2012;46(3):339-345. doi: 10.4103/0019-5413.96378
  20. П опков Д.А., Попков А.В., Данильченко Г.В., Аборин С.А. Современное состояние проблемы оперативного удлинения бедра (обзор литературы). Гений ортопедии. 1999;(3):105-111. Popkov D.A., Popkov A.V., Danil’chenko G.V., Aborin S.A. [The current state of the problem of surgical femoral lengthening (review of the literature)]. Genij ortopedii [Orthopaedic Genius]. 1999;(3):105-111. (in Russian).
  21. Paley D., Herzenberg J.E., Paremain G., Bhave A. Femoral lengthening over an intramedullary nail. A matched-case comparison with Ilizarov femoral lengthening. Bone Joint Surg Am. 1997;79(10):1464-1480.
  22. Hasler C.C., Krieg A.H. Current concepts of leg lengthening. J Child Orthop. 2012;6(2):89-104. doi: 10.1007/s11832-012-0391-5.
  23. Said G.Z., Said H.G., el-Sharkawi M.M. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop. 2011;35(7):1089-1092. doi: 10.1007/s00264-010-1192-4.
  24. Fragomen A.T., Rozbruch S.R. The mechanics of external fixation. HSS J. 2007;3(1):13-29. doi: 10.1007/s11420-006-9025-0.
  25. Kuiken T.A., Butler B.A., Sharkey T., Ivy A.D., Li D., Peabody T.D. Novel intramedullary device for lengthening transfemoral residual limbs. J Orthop Surg Res. 2017;12(1):53. doi: 10.1186/s13018-017-0553-8.
  26. Paley D. Problems, obstacles, and complications of limb lengtheni8ng by the Ilizarov technique. Clin Orthop Relat Res. 1990;(250):81-104.
  27. Burghardt R.D., Paley D., Specht S.C., Herzenberg J.E. The effect on mechanical axis deviation of femoral lengthening with an intramedullary telescopic nail. J Bone Joint Surg Br. 2012;94(9):1241-1245. doi: 10.1302/0301-620X.94B9.28672.
  28. Paley D. PRECICE intramedullary limb lengthening system. Expert Rev Med Devices. 2015;12(3):231-249. doi: 10.1586/17434440.2015.1005604.
  29. Степанов М.А., Шрейнер А.А. Моделирование комбинированного дистракционного остеосинтеза у собак. Гений ортопедии. 2001;(2):155-156. Stepanov M.A., Shreiner A.A. [Combined distraction osteosynthesis modeling in dogs]. Genij оrtopedii [Orthopaedic Genius]. 2001;(2):155-156. (in Russian).

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c)



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies