BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in...BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.展开更多
The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixa...The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.展开更多
The clinical behavior of nonossifying fibroma （NOF） appears to be a benign lesion without recurrence or canceration.[1] Ewing＇s sarcoma （ES） is usually regarded as a differential diagnosis of NOF.[2] There has no...The clinical behavior of nonossifying fibroma （NOF） appears to be a benign lesion without recurrence or canceration.[1] Ewing＇s sarcoma （ES） is usually regarded as a differential diagnosis of NOF.[2] There has not been any report on NOF and ES appearing in the same position simultaneously. Here, we first report a case that the simultaneous onset of two entities was mistaken for the development of NOF into ES. A17-year-old boy referred to hospital in October 2010 for a durative ache in his right knee after an injury during football training. Initial radiographs revealed a low-density area with sclerotic margin on the proximal part of the right tibia. Computed tomography （CT） scan showed a radiolucent, eccentric, and cortically based lesion in the posterolateral metaphysis of the right tibia. Then, the patient underwent magnetic resonance imaging （MRI）, in which a lesion revealed long mixed signs on T1-weighted imaging （T1WI） and short signs on T2WI accompanied with bone contusion around it. These reports suggested that the eccentric area could be an osteoid osteoma or a NOF. A percutaneous biopsy of the right proximal tibia lesion was performed, and then NOF was pathologically confirmed. Hence, curettage and bone grafting were performed.展开更多
Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The ear...Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The earlier treatment outcomes have been poor due to the high rate of infection and avascular necrosis.However,more recent literature advised reimplanting the talus whenever practical,and providing with meticulous cleaning of the talus.In the presence of infection and severe trauma,tibiocalcaneal fusion achieved by the Ilizarov external fixator can be an effective salvage method.展开更多
文摘BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.
文摘The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
文摘The clinical behavior of nonossifying fibroma （NOF） appears to be a benign lesion without recurrence or canceration.[1] Ewing＇s sarcoma （ES） is usually regarded as a differential diagnosis of NOF.[2] There has not been any report on NOF and ES appearing in the same position simultaneously. Here, we first report a case that the simultaneous onset of two entities was mistaken for the development of NOF into ES. A17-year-old boy referred to hospital in October 2010 for a durative ache in his right knee after an injury during football training. Initial radiographs revealed a low-density area with sclerotic margin on the proximal part of the right tibia. Computed tomography （CT） scan showed a radiolucent, eccentric, and cortically based lesion in the posterolateral metaphysis of the right tibia. Then, the patient underwent magnetic resonance imaging （MRI）, in which a lesion revealed long mixed signs on T1-weighted imaging （T1WI） and short signs on T2WI accompanied with bone contusion around it. These reports suggested that the eccentric area could be an osteoid osteoma or a NOF. A percutaneous biopsy of the right proximal tibia lesion was performed, and then NOF was pathologically confirmed. Hence, curettage and bone grafting were performed.
文摘Talar extrusions are the rare extreme case of talar fractures and dislocations which are associated with high-energy trauma.Given the rarity of talar extrusion,no proper treatment protocol has been established.The earlier treatment outcomes have been poor due to the high rate of infection and avascular necrosis.However,more recent literature advised reimplanting the talus whenever practical,and providing with meticulous cleaning of the talus.In the presence of infection and severe trauma,tibiocalcaneal fusion achieved by the Ilizarov external fixator can be an effective salvage method.
