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Clinical and radiological assessment of the Polish modification of the Ilizarov external fixator for the treatment of intra-articular calcaneal fractures
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.
Gait assessment in patients with intra-articular calcaneal fractures after treatment with the Ilizarov method
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 2021–2023. 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 ossein–hydroxyapatite complex helps reduce the number of complications and shortens the time to achieve pain relief and to resume normal activities.
The Use of Ossein–Hydroxyapatite 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 ossein–hydroxyapatite 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 (29–68 years), who were receiving osteogenon, with aseptic tibial shaft nonunion treated with the Ilizarov external fixator in the period 2019–2023, 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 parameters—duration 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 ossein–hydroxyapatite 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.
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 2021–2022. The mean patient age was 47 years (range 25–67 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 patients’ return to their earlier, pre-injury level of physical activity.