OBJECTIVE: To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. METHODS: Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. RESULTS: Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. CONCLUSION Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.
Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Tibia/surgery* ; Osteotomy/methods* ; Rickets ; External Fixators ; Retrospective Studies ; Treatment Outcome

Objective:To investigate the clinical efficacy and indications of arthrolysis plus Ilizarov technique in the treatment of traumatic fibrous stiffness of the knee.Methods:The clinical data were analyzed retrospectively of the 9 patients (10 knees) with traumatic fibrous stiffness who had been treated by arthrolysis plus Ilizarov technique from January 2012 to December 2020 at Department of Orthopaedics, Rehabilitation Hospital of National Research Center for Rehabilitation Technique Aids. There were 8 males and one female, aged from 15 to 42 years (average, 30.2 years). The left side was affected in 2 cases, the right side in 6 ones and bilateral sides in one. Their knee stiffness was all caused by injury around the knee. The time from injury to treatment ranged from 12 months to 38 years (average, 16.5 years). The admission examination revealed that the knee extension ranged from -40° to 0° and the knee flexion from -10° to 40°. Wearing time for the external fixator and incidence of complications were recorded; the ranges of knee motion were compared before and after treatment; the Qin Sihe criteria for postoperative limb deformity correction were used at the last follow-up to evaluate the curative efficacy.Results:The 9 patients were followed up for 20 to 78 months with an average of 35 months. The external fixators were worn for 14 to 200 days with an average of 78.4 days. During the traction period, pin tract reaction (3 holes) occurred in 2 patients with 3 knees, pin tract infection (2 holes) in 2 patients with 2 knees, the incision healed poorly in one patient, and no other complications occurred. The functional recovery of the knee was good at the last follow-up. The knee extension was 0°, insignificantly different from the preoperative value (-6.5°±12.9°) ( t=-1.591, P=0.146); the flexion angle was 70.0°±17.6°, significantly better than the preoperative value (15.0°±17.2°) ( t=-6.822, P< 0.001). According to the Qin Sihe postoperative criteria, the curative efficacy at the last follow-up was excellent in 7 knees and good in 3. Conclusion:In the treatment of traumatic fibrous stiffness of the knee, when the efficacy of simple arthrolysis is not good enough, a combination with Ilizarov technique can help improve the postoperative knee function and prevent severe complications.

Objective:To investigate surgical methods and clinical effects of tibial pseudarthrosis due to neurofibromatosis type I (NF1) in adult using Ilizarov technique combined with intramedullary nail.Methods:A total of 12 adult with tibial pseudarthrosis due to NF1 treated by Ilizarov technique combined with intramedullary nail from October 2009 to December 2017 were retrospectively included. There were 6 males and 6 females with an average age of 27±8.3 years (range 17-44). All cases presented severe anterior arch in varus or valgus deformity with shortening in an average of 10.8±3.7 cm (range 5.6-16.5 cm). The in-volved levels were at the middle and lower part of tibia. All cases suffered from more than one treatment with failed surgery. One male patient with 5 times of unsuccessful operations. There were 4 cases with severe limping gait and 8 cases with walking with the help of brace (or single crutch) preoperatively. Regarding the family history, seven cases were inherited by father and 5 cases by mother. During surgery, the part of tibial pseudarthrosis and thickened fibrous tissue surroundings like periosteal were removed. The contracture achilles tendon was elongated in open way, and intramedullary nailing cross the ankle joint was applied when the tibial medullary cavity opened. Further, iliac bone grafting and proximal tibial osteotomy were performed with Ilizarov fixator application finally. The tibia was lengthened at a rate of 0.5-1 mm/d at 7 days postoperatively. The healing rate of pseudarthrosis and the length and alignment of limb were evaluated by X-ray routinely. The lower limb function and complications were assessed by self-made table for lower limb deformity correction and functional reconstruction.Results:All patients were followed up for 31-80 months with an average of 47.6±14.7 months. Bone union of pseudarthrosis in all cases was eventually achieved. The tibia was lengthened 5-12 cm with an average of 8.4±2.5 cm. There were 9 cases underwent second surgeries to promote bone healing and to correct residual deformities. The external fixator was used for 25-37 months with an average of 31.5±3.7 months. There was no complication, including neurovascular injury, severe soft tissue or bone infection affecting the clinical effects. All intramedullary nails were not removed finally. The limb function and gait in full weight bearing in 12 patients recovered at the latest follow-up. The evaluation score was 2.4±0.3 (range 2.1-2.8), of which 9 cases were excellent 3 were good. Thus, the excellent and good rate was 100%.Conclusion:The satisfactory clinical effects, including angular deformity correction, pseudarthrosis healing and short limb lengthening, can be achieved in adult with tibial pseudarthrosis due to NF1 by using the combination method of Ilizarov technique and intramedullary nail. However, the treatment duration could be longer.

Lower leg lengthening has a history of more than 100 years. However, serious complications occurred in the early stage due to the immature device and technical conditions. The emergence of Ilizarov technology making limb lengthening is a kind of controlled operation. Based on the "Ilizarov effect", the results of limb regeneration and lengthening were obtained by slow, stable and continuous distraction of living tissues. The regeneration of bone and soft tissue is like limb development in children. Currently, the traditional Ilizarov external fixation is still the dominated method for leg lengthening. The Chinese Ilizarov external fixator and the lower leg Achilles tendon elastic lengthening external fixator are the representatives of domestic application. Other limb lengthening methods, including computer hexapod assisted orthopedic surgery (CHAOS), lengthening over nail (LON), lengthening and then nailing (LATN) and intramedullary nail lengthening system, have not been developed in China. Percutaneous transverse osteotomy at 5-6 cm below the tibial plateau is a common osteotomy method in China. This method can maximize the retention of periosteum and intramedullary blood circulation. Limb lengthening more than 4 cm is recommended by leg Achilles tendon elastic synchronous lengthening fixator with calcaneal wire fixation. Following the principle of tension-stress, the lengthening is carried out slowly. Further, the lengthening device is removed step by step according to the principle of dynamic adjustment of fixed stiffness.

Lower limb lengthening, especially femur lengthening and tibia lengthening, is the most commonly used and effective technique in management of limb length discrepancy and dwarfism. However, there are many complications and sequelae in clinic practice, which limits the application and development of this technique to some extent. The reasons may be related to the following two points: one is the lack of sub discipline of limb lengthening in the domestic system of health and medical education, in other word, it is difficult acquired academic and clinical guidance from specialty of "Limb Lengthening and Reconstruction" in orthopedics departments and hospitals. Secondly, limb lengthening and reconstruction with its own theoretical principles and medical model is a systematic engineering and integration discipline, which cannot be completely guided by the classical orthopedic medical paradigm. The complications of lower limb lengthening have been classified according to local and general, immediate, early and late stage, or by infection and non-infection, or by problems, obstacles, complications, etc. Regarding the nature, Qin proposed a new classification for complications, which is divided into five categories: from soft tissue, from joint, from bone, infective and complex. This classification method can reflect the characteristics of different types, reflect the progressive relationship, and is easy to record, distinguish, emphasize and avoid. Different types of complications can occur in different stages of lower limb lengthening, different kinds of complications can occur alone or simultaneous, and different degrees of complications can transform into each other. It requires that surgeon engaged in limb lengthening must have solid knowledge of orthopedics, and be able to quickly identify and effectively deal with various complications; the patients should fully understand and implement the key points of each step during the whole process of limb lengthening, doctors and patients should be friends to avoid and reduce the occurrence of complications.

Objective:To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods:A retrospective analysis of 13 patients (16 feet) who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study. 9 males and 4 females; aged 39-77 years (average 66 years); left foot 7 cases, right foot 9 cases. 5 cases were patients with diabetic foot, 1 case was diabetic foot with arteriosclerosis obliterans, 2 cases were thromboembolic vasculitis, and 5 cases were arteriosclerosis obliterans. The tibial periosteum was dissected and a distraction device was placed. In the 3 patients with foot ulcers, tibial periosteum distraction devices were placed on the severer side. The periosteal distraction began on the third day after surgery, about 0.75 mm/d, the adjustment was done usually in two weeks. Two weeks later, the stretch plate was removed surgically. The followings were evaluated: visual analogue scale (VAS) pain score, foot peripheral oxygen saturation, foot capillary filling test, lower extremity arterial CT angiography (CTA), etc.Results:All 13 patients were followed up for 2-12 weeks, with an average of 3.85 weeks. VAS pain score: the average pain score of 13 patients with preoperative foot pain was 5.31±1.84 (range, 2-9) points, and 2 weeks after surgery, the average value was 2.46±1.39 (range, 1-6) points with statistical significance ( t=6.124, P<0.001) ; peripheral foot oxygen saturation: the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83% (range, 50%-98%), 1 patient was not detected before surgery, and 2 weeks after operation, the average blood oxygen saturation was 92.33%±7.91% (range, 75%-99%). There was no significant difference between them ( t=1.124, P=0.285). The foot skin temperature of 10 patients was 35.68±0.85 ℃ (range, 34.00-36.60 ℃) before surgery and 36.23±0.46 ℃ (range, 35.50-36.90 ℃) after surgery, and the difference was statistically significant ( t=3.197, P=0.008) . Capillary filling test: 2 weeks after operation, the capillary filling response was significantly improved. All 13 patients had improved CTA of both lower extremity arteries before operation, and 11 patients had CTA taken back after two weeks of operation. Compared with preoperative CTA, new vascular network was found in the operation limb. In addition to 1 patient with thromboangiitis obliterans (mainly suffering from foot pain, no wound symptoms), 2 of 12 patients with heart failure, renal failure and other basic diseases did not heal, and the wounds of the other 10 patients had improved significantly 1 month later. Conclusion:Lateral tibia periosteum distraction can be used to treat chronic ischemic diseases of lower extremities with satisfactory postoperative results.

Ilizarov technology, which led to bone regeneration and limb lengthening, was one of the important milestones in the development of orthopedics in the 20th century. With involving in clinical of evolution, system cybernetics, regenerative medicine, artificial intelligence, 3D printing in the 21st century, the usual orthopaedic category was broken through. The skull, spine, pelvis, fingers, toes and neuropathic ulceration, ischemic gangrene almost can implement regenerate, repair and reconstruction, which further proof that the biological force can inspire the potential of the human tissue regeneration. This paper traced the history of limb lengthening for more than 100 years, expounded the original bone osteotomy, lengthening concept and important biological theory of Ilizarov technique, distraction osteogenesis and distraction histogenesis, and their development in the former Soviet Union, Europe, North America and all over the world. The strengths, weaknesses and continuous improvement of Wagner, Bastiani, Orthofix, Ilizarov fixator and lengthenable intramedullary nail were introduced, and clinical application of different tissue regeneration and reconstruction caused by distraction histogenesis were described in this paper. International Society for Limb Lengthening and Reconstruction and the academic organizations of various countries play important roles in promoting process of continuous development of limb lengthening. The origin and development of limb lengthening and reconstruction in China can be divided into four stages:the stage before Ilizarov technology, namely the independent research and development of external fixation; the stage of Ilizarov technology period of distraction osteogenesis; the stage post-Ilizarov; and the stage of limb regeneration and reconstruction under stress control and regulation, which has now entered a new era of rapid development.

The Soviet Union orthopedic doctor Ilizarov invented the ring external fixator which could be assembled into more than 800 configurations, and created a new minimally invasive external fixation technology system called Ilizarov technology which was different from the western classical orthopedic technique. The theoretical basis of this technique is to imitate nature, by controlling and transforming the stress of life movement in vitro, to cure the complex trauma fracture, bone and soft tissue defect, infection and severe deformity of limbs, and to save some endangered amputation complex trauma and limb deformity. From theoretical guidance, surgical indications, medical models and postoperative management, it differs from the modern technique of internal fixation (AO) fracture treatment theory in trauma orthopedics. It can achieve fracture reduction and fixation by the most minimally invasive or even bloodless operation, and control bone growth in vitro. It can not only complete the fixation requirements of most fractures in trauma orthopedics, but also solve complex problems such as bone nonunion, bone defect, soft tissue defect of limbs and associated malformation without bone graft and loss of bone length. Ilizarov technology was introduced into China mainland for more than 30 years, but the application of this technology in the field of orthopaedics in China is still not extensively spreaded because of many reasons, In this article, the authors review the application of Ilizarov technology in the field of trauma orthopedics in China for domestic Orthopaedic surgeon to better understand this technology.

Objective:To summarize the effect of Ilizarov technique in the treatment of limb contracture secondary to venous malformation.Methods:From January 2015 to June 2019, nine cases of limb contracture secondary to venous malformation, from Peking University Third Hospital and Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, were treated with Ilizarov technique, including four males and five females, aged 9 to 35 years, with an average age of 19.5 years. There were two cases of flexion of the hip and knee, four cases of flexion of the knee, two cases of flexion of the knee with talipes equinovarus, and one case of flexion of the wrist. Ilizarov technique was used for treatment after the evaluation of the multi-disciplinary treatment team. According to the safe zone of wire fixation and the limbs deformities character, the preassembled external fixator was connected to the relevant deformed limbs, and the tendons were released at the same time. Limbs deformities were corrected gradually by adjusting the external fixator. For patients with severe pain or rapid development of the affected area, it is appropriate to perform ultrasound-guided injection of lauromacrogol and physical therapy to promote the function of joints.Results:During the treatment, there were no neurovascular injury, peripheral blood circulation disorder, infection event of injection channel and incision, or deep vein thrombosis. The follow-up were 6 to 40 months, with an average of 30.5 months. All the contractures of the hip and knee joints, most of the deformities of the wrist and ankle joints were corrected and the pain disappeared.Conclusions:Ilizarov technique is a minimally invasive, safe and effective method for the treatment of limb contracture secondary to venous malformation.

Objective:To summarize the effect of Ilizarov technique in the treatment of limb contracture secondary to venous malformation.Methods:From January 2015 to June 2019, nine cases of limb contracture secondary to venous malformation, from Peking University Third Hospital and Rehabilitation Hospital of the National Research Center for Rehabilitation Technical Aids, were treated with Ilizarov technique, including four males and five females, aged 9 to 35 years, with an average age of 19.5 years. There were two cases of flexion of the hip and knee, four cases of flexion of the knee, two cases of flexion of the knee with talipes equinovarus, and one case of flexion of the wrist. Ilizarov technique was used for treatment after the evaluation of the multi-disciplinary treatment team. According to the safe zone of wire fixation and the limbs deformities character, the preassembled external fixator was connected to the relevant deformed limbs, and the tendons were released at the same time. Limbs deformities were corrected gradually by adjusting the external fixator. For patients with severe pain or rapid development of the affected area, it is appropriate to perform ultrasound-guided injection of lauromacrogol and physical therapy to promote the function of joints.Results:During the treatment, there were no neurovascular injury, peripheral blood circulation disorder, infection event of injection channel and incision, or deep vein thrombosis. The follow-up were 6 to 40 months, with an average of 30.5 months. All the contractures of the hip and knee joints, most of the deformities of the wrist and ankle joints were corrected and the pain disappeared.Conclusions:Ilizarov technique is a minimally invasive, safe and effective method for the treatment of limb contracture secondary to venous malformation.