Efficacy of the “Eiffel tower” double titanium elastic nailing in combined management of congenital pseudarthrosis of the tibia: preliminary outcomes of 17 cases with review of literature

Background Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed. Methods Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the “Eiffel Tower” double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months. Results The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6–141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01). Conclusions The “Eiffel Tower” double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery. Level of evidence Level IV.

Prebent Titanium Elastic Nailing, Ilizarov Fixation and Bone Grafting for Treating Congenital Pseudarthrosis of the Tibia: Preliminary Outcomes of 15 Cases

Background: To report the preliminary outcome of treating congenital pseudarthrosis of the tibia (CPT) by using titanium elastic nails (TENs) combined with other surgical procedures including pseudarthrosis resection, autogenous iliac bone grafting and Ilizarov technique, with a mean follow-up time of 4.5 (3.3 to 6.3) years.Methods: 15 patients with CPT treated by combined surgery including pseudarthrosis resection, titanium elastic nails (TENs) technique, autogenous iliac bone grafting and Ilizarov fixation between 2013 and 2017 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle movement were used to evaluate ankle function. Results: The mean age at index surgery was 110 (24 to 285) months. 13 (86.7 %) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 4.8 (3 to 7) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (13.3%) and 5 (33.3%) patients developed pin infection. The mean limb length discrepancy at the final follow up was 14.6 (4–41) mm. 3 patients (20 %) had ankle valgus deformities with a mean LDTA of 74.3° (range, 68 to 81°). The average AOFAS score improved from 40.3 (27 to 51) pre-operatively to 76.1 (63 to 87) post-operatively. For the patients who received proximal tibial lengthening, the average healing index (HI) was 65.1 (57.3 to 77.8) days/cm.Conclusions: Titanium elastic nails (TENs) technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphyseal and early functional recovery.

Compare Between Gait Analysis of Patient with Ilizarov Leg and Prosthesis Leg

Gait analysis can be described as a field of biomechanical engineering dealing with the subject of human locomotion. This study aimed to identify the effect of Ilizarov on gait when the presence the above-knee prosthesis. The study was made on a 50-year-old male patient was underwent correction right tibia with Ilizarov fixation due to war accident in July 2012. Also, this accident led to trans-femoral amputation. Two-dimensional gait system of a synchronized 25 Hz camera with an AMTI force platform was use for measuring gait kinematics and kinetics data while walking at a self-selected speed. These data can be used as standard measures in pathology studies, as input to theoretical joint models, and as input to mechanical joint simulators treated with Ilizarov and prosthetics.