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Balance and Weight Distribution over the Lower Limbs Following Calcaneal Fracture Treatment with the Ilizarov Method
Background: The biomechanical outcomes of intra-articular calcaneal fracture treatment have not been fully explored. The purpose of this study was to analyze pedobarographic assessments of balance and body weight distribution over the lower limbs in patients following calcaneal fracture treatment with the Ilizarov method and to compare the results with those of a control group. Materials and Methods: The data for our retrospective study came from cases of intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method in the period between 2021 and 2022. The experimental group (21 patients; 7 women, 14 men) included Sanders classification calcaneal fractures type 2 (n = 3), type 3 (n = 5), and type 4 (n = 13). The control group comprised 21 sex-matched healthy volunteers, with no significant differences from the experimental group in terms of age or BMI. The examination included an assessment of balance and weight distribution over the lower limbs. The device used was a FreeMED MAXI pedobarographic platform (SensorMedica). Results: The mean displacement of the center of gravity in the experimental group was significantly higher at 1307.31 mm than in the control group (896.34 mm; p = 0.038). The mean area of the center of gravity was not significantly different between the groups. An analysis of weight distribution over the operated and uninjured limb in the experimental group and the non-dominant and dominant limb, respectively, in the control group revealed no significant differences. We observed no significant differences in the percentage of weight distribution over the lower limbs between the operated limb in the experimental group and the non-dominant limb in the control group, or between the uninjured limb in the experimental group and the dominant limb in the control group. Conclusions: The use of the Ilizarov method in calcaneal fracture treatment helps normalize the percentage weight distribution in the lower limbs, with the results comparable with those obtained in the healthy control group. The mean displacement of the center of gravity was worse in the experimental group than in controls; whereas the mean area of the center of gravity was comparable between the two groups. Treatment of calcaneal fractures with the Ilizarov method does not help achieve completely normal static parameters of lower-limb biomechanics. Patients treated for calcaneal fractures with the Ilizarov method require longer and more intense rehabilitation and follow-up.
The Use of Osteogenon as an Adjunctive Treatment in Lower Leg Fractures
Background: The goal of the orthopedic treatment of fractures is to achieve bone union as rapidly as possible in the largest possible number of patients and to minimize the number of complications. The purpose of this study was to assess if the use of Osteogenon would have a positive effect on radiological and clinical parameters in patients with lower leg bone fractures treated with the Ilizarov method. Methods: We evaluated 26 patients who had their lower leg bone fractures treated with the Ilizarov method and received Osteogenon at our clinic in the years 2021â2023. The control group comprised 25 patients with lower leg bone fractures treated with the Ilizarov method who did not receive Osteogenon. We assessed the following parameters: time to achieving bone union, bone union rate, time to resuming normal physical activity, time to achieving pain relief, the number of patients reporting pain relief, and the rate of complications. Results: The median time to achieve bone union after lower leg bone fracture treated with the Ilizarov method was shorter in the Osteogenon group (108.5 days) compared to the control group (134 days), p < 0.001. Bone union was achieved in all the patients in the Osteogenon group and in 96% of the patients in the control group; the difference was not statistically significant. The median time to resuming normal physical activity was shorter in the Osteogenon group (22.5 weeks) compared to the control group (27 weeks), p < 0.001. The median time to achieving pain relief was shorter in the Osteogenon group (21 weeks) compared to the control group (30 weeks), p < 0.001. The proportion of patients who reported pain relief was 88.46% in the group receiving Osteogenon and 76% in the control group; this difference was not statistically significant. The number of complications was lower in the Osteogenon group (8 patients; 30.77%) compared to the control group (15 patients; 60%), p = 0.035. Conclusions: The use of Osteogenon has a beneficial impact on the treatment of lower leg bone fractures with the Ilizarov method. Osteogenon shortens the time to achieve bone union. Moreover, the use of the osseinâhydroxyapatite complex helps reduce the number of complications and shortens the time to achieve pain relief and to resume normal activities.
The Use of OsseinâHydroxyapatite Complex in Conjunction with the Ilizarov Method in the Treatment of Tibial Nonunion
Background: Patients with nonunion experience pain, mobility problems, and physical activity limitations; require long-term, costly treatment; and cannot resume work. Some authors recommend the use of pharmaceutical agents as an adjunct therapy in fracture and nonunion treatment. The aim of this study was to assess the effects of osseinâhydroxyapatite complex used as an adjunct therapy in nonunion treatment with the Ilizarov external fixator. Methods: In this retrospective study, we assessed 31 patients (nine women, 22 men) at a mean age of 47 years (29â68 years), who were receiving osteogenon, with aseptic tibial shaft nonunion treated with the Ilizarov external fixator in the period 2019â2023, designated as Group 1. The control group comprised 29 patients (five women, 24 men), at a mean age of 48 years, with aseptic tibial shaft nonunion treated with the Ilizarov external fixator, who did not receive osteogenon during treatment, designated as Group 2. We assessed the following parametersâduration of Ilizarov fixation, achieved bone union, time to resuming normal physical activity, maintained bone union, time to complete pain relief, the number of patients reporting complete pain relief, the number of patients who were fitted with a cast or splint following Ilizarov fixator removal, and the rate of complications. Results: The median time to Ilizarov fixator removal was 275 days in Group 1 and 218 days in Group 2. In Group 1, bone union was observed in 100% of patients, in Group 2, 93% of patients achieved bone union. This difference was statistically significant, p = 0.041. Maintained bone union was observed in 85.7% of patients from the osteogenon group and in 79.3% of patients from the control group, and the difference was not statistically significant. There were no differences between groups in the median time to resuming normal physical activity, the median time to achieving pain relief, the rate of complications, and the rate of pain relief. Conclusions: The use of osseinâhydroxyapatite complex has a beneficial effect on fracture nonunion treatment with the Ilizarov method. The use of osteogenon helps increase the proportion of patients with fracture nonunion who achieve bone union following treatment with the Ilizarov method. Osteogenon does not significantly affect complication rates, time to fixator removal, time to achieving pain relief, time to resuming normal physical activity, maintained bone union rates, or the proportion of patients who achieve pain relief.
Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study
Abstract Background Chevron osteotomy is one of the most common approaches to hallux valgus corrective surgery. This procedure is often combined with Akin osteotomy of the proximal phalanx of the hallux. There are no definitive guidelines specifying the indications for a given osteotomy technique nor data on postoperative loss of correction or the effect of the type of first-ray surgery on the development of adjacent-joint arthritis. The aim of this study was to assess radiographic treatment outcomes via chevron osteotomy with and without Akin osteotomy. Methods The study evaluated 117 patients treated in the period 2016â2019. Ninety-nine of those patients underwent distal chevron osteotomy alone, and 18 patients underwent a combined chevronâAkin double osteotomy. The analyzed radiograms had been obtained preoperatively, at 6 weeks after surgery, and after a long-term follow-up. The following parameters were assessed: the intermetatarsal angle (IMA), hallux valgus angle (HVA), interphalangeal angle (IPA), postoperative recurrence of valgus deformity, adjacent-joint arthritis, and complications. Results Chevron-Akin osteotomy helped maintain lower HVA and IPA values in long-term follow-up in comparison with those in the patients who underwent chevron osteotomy alone. The chevron osteotomy group showed a significant increase in the mean HVA from 18.37° at the first follow-up visit to 20.81° at the last follow-up visit. There were no differences between the groups in terms of the remaining assessed radiographic parameters. Hallux valgus surgery does not increase adjacent-joint arthritis. Conclusion The use of combined chevron-Akin osteotomy does not affect HVA or IMA correction. The combination of chevron and Akin osteotomies reduces the risk of increased HVA and IPA in long-term follow-up. The additional Akin osteotomy does not increase the risk of adjacent-joint arthritis. Combining chevron osteotomy with Akin osteotomy is recommended in hallux valgus deformity correction.
Assessment of Function in Patients after Calcaneal Fracture Treatment with the Ilizarov Method
Background: Up to 75% of calcaneal fractures are intra-articular fractures, which may severely impair foot function and lead to disability. Methods: We retrospectively analyzed 21 patients with intra-articular calcaneal fractures who had been treated with the Ilizarov method in the period 2021â2022. The mean patient age was 47 years (range 25â67 years). We analyzed the following functional parameters: foot function with a revised foot function index (FFI-R) questionnaire and the level of physical activity, with the University of California Los Angeles (UCLA) activity scale, a visual analog scale (VAS), and a Grimby physical activity level scale; and ankle range of motion. Results: We observed a significant improvement in the UCLA activity scores and Grimby activity score at long-term follow-up. Functional outcomes based on the FFI-R questionnaires showed an improvement, from 292 points prior to surgery to 127 points at follow-up, p = 0.013. The post-treatment follow-up measurements revealed a median dorsiflexion at the treated ankle joint of 20 degrees, whereas that at the intact ankle was 40 degrees, p = 0.007. The plantar flexion showed asymmetry, with a median 15 degrees at the treated ankle and 30 degrees at the intact ankle, p = 0.007. The median range of inversion at the ankle joint was 5 degrees in the treated limb and 15 degrees in the intact limb, p = 0.039. Conclusions: Patients with calcaneal fractures treated with the Ilizarov method are recommended to have a longer and more intensive rehabilitation. The range of ankle motion in the treated limb was limited in comparison with that in the intact limb; however, this did not greatly affect the patientsâ return to their earlier, pre-injury level of physical activity.
WpĆyw pandemii COVID-19 na epidemiologiÄ urazĂłw stawu skokowego u dorosĆych i dzieci
Background. Ankle joint injuries are an important orthopedic issue due to their high incidence and the variety of treatment methods available. This study assessed the effect of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. There is lack of papers which address this problem.Material and methods. This study compared epidemiological data on ankle joint injuries in adults and children collected during the period of the COVID-19 pandemic (2020) and a corresponding prepandemic period (2019). Epidemiological data, demographic data, treatment methods, hospital stay duration, and injury-to-surgery time were analyzed.Results. The total number of patients hospitalized for ankle fractures in the evaluated pandemic period was lower by 34% than that in the corresponding prepandemic period in 2019. The pediatric patient subpopulation showed a 70% decline during the analyzed period of COVID-19 pandemic. The number of hospitalized females declined by 12%, and the number of hospitalized males dropped by 53%. Conclusions. 1. Our study showed the impact of the COVID-19 pandemic on the epidemiology and treatment of ankle joint injuries. 2. The COVID-19 pandemic effected a decrease in the number of patients with ankle joint injuries, particularly pediatric and male patients with these injuries. 3. National lockdown measures had a considerable effect on lowering the numbers of pediatric patients with ankle joint injuries treated conservatively. 4. Importantly, the tendency can be noted among orthopedic surgeons and emergency room doctors to more readily qualify orthopedic patients for a trial of conservative treatment. This only prolongs the duration of treatment and time to the ultimate therapeutic surgery.
Assessment of Biomechanics Following Calcaneal Fracture Treatment with Internal Plate Fixation or Ilizarov External Fixation: A Retrospective, Two-Center Study
Background: There is no consensus on the best treatment method for calcaneal fractures. The topic of lower limb biomechanics following calcaneal fracture treatment with various fixation methods has not been fully explored. The aim of the study was to assess the balance and load distribution of the lower limbs in patients after various methods of stabilization of calcaneal fractures. Methods: In this two-center study, we retrospectively collected data from 19 patients treated with internal plate fixation at a mean age of 46 years and 27 patients treated with Ilizarov external fixation at a mean age of 50 years. Using the Zebris Medical pedobarophragmatic platform, we assessed the percentage distribution of lower limb loads and balance. Results: There were no significant differences in total load distribution for both the operated (p = 0.489) and non-operated limb (p = 0.46), between the Ilizarov method group and the internal plate group. In the Ilizarov fixation group, total load distribution was 46.89% on the treated limb, and 53.11% on the uninjured limb, p = 0.077. In the internal plate fixation group, the mean total load distribution was 41.57% in the treated limb, and 57.89% in the uninjured limb, p = 0.008. The median CoG (center or gravity) sway path length was 132.41 cm and 170.21 cm in the Ilizarov and internal plate group, respectively, p = 0.023. The median CoG sway areas were 0.84 cm2 and 7.57 cm2 in the Ilizarov method group and internal plate fixation group, respectively, p < 0.001. Conclusions: The Ilizarov method was associated with more symmetrical load distribution and improved balance performance compared to internal plate fixation. Static biomechanical parameters of calcaneal fracture treatment were better in the Ilizarov group compared to patients with internal plate fixation.
Body Weight Distribution and Balance in Patients with Valgus or Varus Knee Deformity Treated with Hemiepiphysiodesis
Background: Biomechanical disorders may result from joint deformities. The purpose of this prospective research was to assess total load distribution over the lower limbs and balance in individuals before and after an hemiepiphysiodesis procedure performed due to valgus or varus knee deformity. Methods: Thirty-five patients, mean age 12 years, who underwent hemiphysiodesis for valgus or varus deformity of the knee were evaluated in comparison to a healthy control group. In patients, the percentage distribution of weight-bearing capacity between the operated and unoperated limbs was analyzed before and after surgery. Balance was assessed based on CoG (center of gravity) sway area and the CoG path length. Results were collected using the FreeMED MAXI pedobarographic platform. Results: Before surgery, statistically significant lower load on the entire affected limb was noted compared to unaffected limb. The values of path of center of gravity improved statistically significantly after surgery, compared to the values before surgery. There were no differences in the load on the treated lower limb in the study group and the non-dominant limb in the control group. There were no differences between the load on the non-operated limb in the study group and the load on the dominant limb in the control group. In the hemiepiphysiodesis group there were no significant differences between the mean total load on the treated and untreated limb after surgery. The median CoG sway area and path length in the group of patients after hemiphysiodesis and in the healthy control group did not differ. Conclusions: After hemiphysiodesis, the percentage load distribution did not differ between the operated and non-operated lower limb. Hemiepiphysiodesis allows for achieving balance similar to the healthy control group. Performing hemiepiphysiodesis allows for the improvement of balance parameters and load distribution in the lower limbs.
Prognostic Factors in Staged Bilateral Total Knee Arthroplasty - A Retrospective Case Series Analysis
Background: Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure. Methods: We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications. Results: All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371). Conclusions: We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size.
Gait assessment in patients with intra-articular calcaneal fractures after treatment with the Ilizarov method
Gait Analysis in Patients with Symptomatic Pes Planovalgus Following Subtalar Arthroereisis with the Talus Screw
Short-term and medium-term radiological and clinical assessment of patients with symptomatic flexible flatfoot following subtalar arthroereisis with spherus screw
Background: There have been no reports on arthroereisis screw insertion into the talus in patients with flexible flatfoot. We aimed to conduct a clinical and radiological assessment in patients with symptomatic pes planovalgus deformity treated with a talar screw. Methods: This study involved a prospective assessment of 27 patients treated surgically for symptomatic flexible flatfoot deformity in the period 2021â2022. The following parameters were assessed in this study: Mearyâs angle, the CostaâBartani angle, the calcaneal pitch angle, surgery duration, the length of hospital stay, patient satisfaction, patientsâ retrospective willingness to consent to the treatment they received, postoperative complications, and the use of analgesics. Results: The mean follow-up period was 14.76 months. Mearyâs angle decreased from 18.63° before surgery to 9.39° at follow-up (p = 0.004). The CostaâBartani angle decreased significantly from 154.66° before surgery to 144.58° after surgery (p = 0.012). The calcaneal pitch angle changed from 16.21° before to 19.74°. Complications were reported in three patients (11.11%). The mean surgery duration was 32 min. The mean hospital stay was 2.2 days. Fourteen patients (51.85%) were highly satisfied with the treatment, and 12 patients (44.44%) were quite satisfied with treatment. Twenty-five (92.59%) of the evaluated patients would choose the same type of treatment again. Six patients (22.22%) needed to use analgesics prior to surgical treatment, whereas none of the patients needed to use them by the final follow-up. Conclusion: Spherus screw arthroereisis helps improve radiological parameters in patients with flexible flatfoot. We observed good clinical outcomes after treatment with a talar screw, with a majority of patients reporting moderate-to-high levels of satisfaction with treatment. Both short- and medium-term treatment outcomes of pes planovalgus treatment with the use of Spherus screw are good.
Clinical and radiological assessment of the Polish modification of the Ilizarov external fixator for the treatment of intra-articular calcaneal fractures
Do Patient Sex and Age Affect Hemiepiphysiodesis Outcomes?
(1) Background: The purpose of this study was to assess the effects of sex and age on the outcomes of hemiepiphysiodesis performed for genu valgum and varum deformity correction. (2) Methods: We analyzed patients who had undergone O-Plate hemiepiphysiodesis due to genu valgum or varum in the period of 2020â2023. The study group comprised 22 females and 20 males aged between 3 and 14 years at the time of surgery. Age-stratification yielded a subgroup of 3â10-year-olds (16 patients, 20 treated limbs) and a subgroup of 11â14-year-olds (26 patients, 28 treated limbs). We assessed the following parameters: hospital stay duration, deformity correction time, MAD correction, amount of angular correction, correction velocity, correction rate, complete deformity correction, deformity recurrence, surgery duration, and complications. (3) Results: The mean follow-up was 19 months. The mean surgery time in the subgroup of 3â10-year-olds (25.62 min) was significantly longer than that in the subgroup of 11â14-year-olds (22.81 min, p = 0.018). The mean deformity correction time in the male subgroup (11.33 months) was significantly shorter than that in the female subgroup (15.87 months, p = 0.013). A comparison of the subgroups stratified by age yielded a mean amount of angular correction of 10.5° in the younger children, which was significantly higher than that of 7.2° achieved in the older children; p = 0.027. The difference in mean correction velocity between 3â10-year-old children (4.03 mm/month) and that in 11â14-year-old children (1.39 mm/month) was statistically significant; p = 0.031. The mean rate of correction was 0.49°/month in females and 0.89°/month in males, with the latter rate significantly greater; p = 0.023. The difference in the mean rate of correction between the younger (1.08°/month) and the older subgroup (0.59°/month) was also significant; p = 0.018. A significant difference in terms of deformity recurrence rates was observed between the younger subgroup (66.67%) and older subgroup (only 10.53%); p = 0.005. (4) Conclusions: Patient sex had no significant effect on hemiepiphysiodesis outcomes; patient age has a considerable effect on hemiepiphysiodesis outcomes.
Arthroereisis with a Talar Screw in Symptomatic Flexible Flatfoot in Children
Background: Pes planovalgus, or flexible flatfoot, deformity is a common problem in pediatric orthopedic patients. There is no consensus on using the technique of arthroereisis in the treatment of symptomatic pes planovalgus. The aim of our study was to prospectively assess the functional outcomes following symptomatic pes planovalgus treatment with the use of the Spherus talar screw. Methods: Twenty-seven patients (11 females, 16 males), at a mean age of 10.5 years (7â14 years) were included in the prospective study. We assessed the level of physical activity (including sports) based on the University of California, Los Angeles (UCLA) activity scale, a 10-point level-of-activity VAS scale, and the Grimby physical activity scale. Pain was assessed based on a VAS pain scale; foot function was assessed with the revised Foot Function Index (FFI-R); and ankle joint mobility was measured. Results: The mean follow-up period was 18 months (14â26 months). There was a significant improvement in VAS-measured physical activity scores from 5.47 to 7 at follow-up, p = 0.048. There was a significant improvement in UCLA activity scale scores from 4.78 to 6.05 at follow-up, p = 0.045. Pain levels decreased from a mean VAS score of 4.73 prior to surgery to a mean score of 2.73 at follow-up, p = 0.047. The functional FFI-R scores showed a significant improvement from 140 points prior to surgery to 97.75 points at follow-up, p = 0.017. Comparison of the preoperative and follow-up values of the range of plantar flexion, adduction, and abduction in the operated limb also showed no significant changes in those individual parameters. The mean values of dorsiflexion, plantar flexion, adduction, and abduction at the ankle joint at follow-up, compared individually between the operated and non-operated foot showed no statistically significant differences. Conclusions: The use of a talar screw in the treatment of symptomatic pes planovalgus helps reduce pain and improve functional outcomes after treatment. Foot function assessments showed diminished pain, improved levels of physical and sport activity, and no effect on the range of motion after surgery in comparison with preoperative data. Arthroereisis with a talar screw is a valid surgical technique for the treatment of symptomatic pes planovalgus.
Gait Analysis in Patients After Hemiepiphysiodesis Due to Valgus or Varus Knee Deformity
Background: Developmental knee joint deformities are a common problem in pediatric orthopedics. Children with a valgus or varus deformity of the distal femur or the proximal tibia are commonly treated with hemiepiphysiodesis. Gait analysis in patients with lower limb deformities plays an important role in clinical practice. The purpose of our study was to assess gait parameters in patients who underwent hemiepiphysiodesis procedures of the distal femur or proximal tibia due to a knee deformity and to compare them with those in healthy controls. Methods: We prospectively evaluated 35 patients (14 females and 21 males) after hemiepiphysiodesis and compared the results with a healthy control group (26 participants). Gait was analyzed with a G-Sensor device (BTS Bioengineering Corp., Quincy, MA, USA). We assessed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, and step length. We assessed these gait parameters in a group of patients before and after treatment with hemiepiphysiodesis. We compared the patientsâ results before and after treatment to those of a healthy control group. The level of significance was set at p < 0.05. Results: The mean follow-up period was 13 months. There was no difference in the results of gait assessments in patients prior to and after treatment. The median step length was 47.09% in the treated limb after treatment and 54.01% in the intact limb (p = 0.018). There were no other differences in gait parameters in the treated limbs and the healthy, intact limbs in the patient group after treatment. There were no significant differences in the patients before and after treatment compared with those in the healthy control group in all gait parameters. Conclusions: Valgus or varus knee deformity correction with the use of hemiepiphysiodesis does not significantly improve preoperative gait parameters. The biomechanical outcomes of hemiepiphysiodesis in the treatment of valgus or varus knee deformity are good. We observed no differences in gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, gait velocity, cadence, or step length between the experimental and healthy control groups.