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Results and biomechanical consideration of treatment of congenital lower limb shortening and deformity using the Ilizarov method

Morasiewicz P., Morasiewicz L., Stępniewski M., Orzechowski W., Morasiewicz M., Pawik Ł., Wrzosek Z., Dragan S.

Acta of Bioengineering and Biomechanics

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2014

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Vol. 16, no. 1

133--140

EN

One of the applications of the Ilizarov apparatus is the correction of congenital shortening and deformities. Ilizarov external fixator produces biomechanical structure with surrounding tissue, which is the reason why very important is correct stability of fixator. Large distraction in the case of high value of lengthening, and large deformity corection result in shear stresses that occur additionally in the regenerate, which can potentially lead to damage of the regenerating nutritive microcirculation of bone tissue and bone fragment displacements. Our objective was to assess the results of the Ilizarov method in the treatment of congenital shortening taking into account treatment strategy and the size of the axis of lengthening and correction. Our research problems include presenting the effects of biomechanics of musculoskeletal deformations on treatment results, presenting complications and their treatment. Between 1989 and 2009, 62 patients underwent surgery to correct congenital lower limb deficiencies at our Clinic; 33 patients were followed-up. In total, there were 70 surgeries (2.12/patient). Axial correction was performed in 26 patients (78.79%). Average age at the start of the treatment was 15.58 years. Mean follow-up was 8.58 years. Mean lengthening per surgery was 3.17 cm with the lengthening index of 50.7 day/cm. Results were very good for 23 patients, good for 7 patients, satisfactory for 3 patients. Complications appeared in 24 patients, problems occurred in 74.42% of the cases, obstacles in 4.65% of cases, and true complications in 20.93% of the cases. The best results were achieved in the treatment of patients with two-stage and two-segment lengthening with a total elongation of less than 7 cm, and without correction of the axis. Congenital shortening of the lower limb should be treated comprehensively because the shortening applies to all segments, and disturbs biomechanics of all lower limb. In the case of axial correction and large amount of elongation high soft tissue forces counteract the distraction forces. Hybrid construction may help to shorten treatment time, increase fixator stability and decrease rate of complications. We suggest use of hybrid Ilizarov fixator, especially when large elongation and axis corection are planned.

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The impact of the type of derotation mechanism on the stiffness of the Ilizarov fixator

Morasiewicz P., Filipiak J., Konietzko M., Dragan Sz.

Acta of Bioengineering and Biomechanics

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2012

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Vol. 14, no. 1

67-73

EN

One of the applications of the Ilizarov apparatus is the correction of rotational deformities. There are several types of designs commonly used for derotation. Different types of derotators have different mechanical properties, which affect the stability of the entire Ilizarov apparatus. The aim of this study was to determine the stiffness of the Ilizarov fixator depending on the type of derotation mechanism. We analyse three types of derotators: the type Z, the type H, and the cubicoid derotator. The tests were conducted on physical models in which the fixator analysed was fitted to polyethylene pipe segments. The reference fixator was the Ilizarov apparatus in the configuration adapted for thigh lengthening. The pipe segments intersected at a point corresponding to the osteotomy site of the distal thigh. The fixator was assembled with one proximal arch fixed with two Schanz screws, a proximal ring fixed with two Kirschner wires (K-wires), a middle free ring, and a distal ring fixed with three K-wires. There were three different types of derotation mechanisms installed between the proximal and middle rings. We determined the axial stiffness kA and the transverse stiffnesses of the compared fixators in two planes: frontal kM-L and sagittal kA-P. The results of the research lead to two basic conclusions. Firstly, the use of any of the derotators analysed has no negative impact on the stiffness of the Ilizarov apparatus. Secondly, similar stiffness values of the fixators with different derotation mechanisms suggest their equal applicability and the choice between them can be made based on practical considerations. In the case of axial stiffness, the differences do not exceed 7.5%. The highest value of stiffness kA was obtained for the type H derotator, while the lowest value was obtained for the type Z derotator. There is a greater difference in the case of transverse stiffness in the sagittal plane, which only concerns the fixator with the type Z derotators. The stiffness coefficient kA-P for that fixator is lower by approximately 19% compared to the reference fixator.

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Distribution of radiological density in bone regenerate in relation to cyclic displacements of bone fragments

Filipiak J., Krawczyk A., Morasiewicz L.

Acta of Bioengineering and Biomechanics

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2009

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Vol. 11, nr 3

3-9

EN

We asked how bone fragment displacement could influence the distribution of radiological density in bone regenerate formed during the process of bone lengthening. The metatarsi of 21 sheep were lengthened by 20 mm by the Ilizarov method. The bone fragments were externally fixed with a specially designed ring external fixator equipped with linear actuator driver system. The test sheep were divided into three experimental groups: the G1 and G2 groups (N = 8) and the GR group (N = 5) - the reference group. In the case of sheep from the G1 and G2 groups, the lengthening was supplemented with mechanical stimulation of the regenerate in the form of cyclic bone fragment displacements (CBFDs) with the amplitudes of 1 mm (G1) and 2 mm (G1). Mechanical stimulation was applied over 30 days for 1 h per day with a frequency of 1 Hz. Eight weeks after the procedure the sheep were sacrificed in accordance with the required procedures. The analysis of the degree of bone regenerate mineralization involved the studies based on the CT scanning. The analysis of the results obtained is based on the paramenter called the degree of regenerate mineralization (RMD). The analysis of radiological density was carried out in the selected measurement areas. Such an area was located in three horizontal zones, taking into account the regenerate height, i.e. in its middle part (half regenerate length); the top part, 2 mm from the edge of the proximal fragment; and the bottom part, 2 mm from the edge of the distal fragment. The value of the RMD parameter varies significantly, depending on the bone regenerate area. The results obtained show that the CBFD = 2 mm accelerates the rate of mineralization of an eight-week-old regenerate. In the case of CBFD = 1 mm, the mineralization rate is lower by more than a dozen per cent.

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The change of regenerate rigidity during its mineralization in function of the time of removal the stabilizer. Preliminary simulate tests

Kulig M.

Zeszyty Naukowe Katedry Mechaniki Stosowanej / Politechnika Śląska

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2006

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z. 26

207-212

EN

The influence of the building and mineralization of the new bone tissue in the distraction crevice, on the general decrease of strain levels in telescopic rods, due to the bone structure taking over support of some portion of weight is a very interesting issue. The change of bone rigidity (EA, EJ) from zero up to a normal healthy bone makes such evaluation or further interpretation of results virtually possible. This is possible by observation of drop of strain in telescopic rods when the new bone tissue starts to carry the main load of body mass and muscle force.