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Open Access 01-12-2022 | Research

Kinematic parameters after tibial nonunion treatment using the Ilizarov method

Authors: Łukasz Pawik, Felicja Fink-Lwow, Andżelika Pajchert Kozłowska, Łukasz Szelerski, Radosław Górski, Malwina Pawik, Paweł Reichert, Piotr Morasiewicz

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Background

Analysis of the outcomes of Ilizarov treatment of tibial nonunion shows functional deficits in the lower limbs of some patients. Biomechanical gait parameters are an important measure for assessing musculoskeletal disorder treatments that aim to restore normal gait. The purpose of our study was to compare the kinematic parameters in patients with tibial nonunion treated using the Ilizarov method and those in a control group of healthy volunteers.

Methods

The study population consisted of 23 patients (age 54.9 ± 16.4 years) who were treated for tibial nonunion using the Ilizarov method, as well as 22 healthy adult controls (age 52.7 ± 10.6 years). Kinematic parameters were measured using a Noraxon MyoMOTION System. We measured hip flexion and abduction, knee flexion, ankle dorsiflexion, inversion, and abduction during walking.

Results

Our analysis showed significant differences between the patients’ operated limbs (OLs) and the controls’ nondominant limbs (NDLs) in the ranges of hip flexion, hip abduction, and knee flexion. We observed no significant differences in knee flexion between the OL and the NOL in patients or between the dominant limb (DL) and NDL in controls. Our evaluation of the kinematic parameters of the ankle joint demonstrated significant differences between the patients’ OLs and the controls’ NDLs in the ranges of ankle dorsiflexion, ankle inversion, and ankle abduction. There were also significant differences in the range of ankle dorsiflexion and ankle abduction between the patients’ NOLs and the controls’ DLs.

Conclusion

Tibial nonunion treatment using the Ilizarov method does not ensure complete normalization of kinematic parameters assessed 24–48 months following the completion of treatment and rehabilitation.

Peng J, Min L, Xiang Z, Huang F, Tu C, Zhang H. Ilizarov bone transport combined with antibiotic cement spacer for infected tibial nonunion. Int J Clin Exp Med. 2015;8(6):10058–65.PubMedPubMedCentral

Schoenleber SJ, Hutson JJ. Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction. Foot Ankle Int. 2015;36(4):400–7. https://doi.org/10.1177/1071100714558509.CrossRefPubMed

Zhang H, Xue F, Jun XH. Ilizarov method in combination with autologous mesenchymal stem cells from iliac crest shows improved outcome in tibial non-union. Saudi J Biol Sci. 2018;25(4):819–25. https://doi.org/10.1016/j.sjbs.2016.11.001.CrossRefPubMed

Meleppuram JJ, brahim S. Experience in fixation of infected non-union tibia by Ilizarov technique – a retrospective study of 42 cases. Rev Bras Ortop. 2017;52(6):670–5. https://doi.org/10.1016/j.rboe.2016.11.008.CrossRefPubMed

Abuomira IEA, Sala F, Elbatrawy Y, Lovisetti G, Alati S, Capitani D. Distraction osteogenesis for tibial nonunion with bone loss using combined Ilizarov and Taylor spatial frames versus a conventional circular frame. Strateg Trauma Limb Reconstr. 2016;11(3):153–9. https://doi.org/10.1007/s11751-016-0264-4.CrossRef

Eralp IL, Kocaoğlu M, Dikmen G, Azam ME, Balci HI, Bilen FE. Treatment of infected nonunion of the juxta-articular region of the distal tibia. Acta Orthop Traumatol Turc. 2016;50(2):139–46. https://doi.org/10.3944/AOTT.2015.15.0147.CrossRefPubMed

Khan MS, Rashid H, Umer M, Qadir I, Hafeez K, Iqbal A. Salvage of infected non-union of the tibia with an ilizarov ring fixator. J Orthop Surg. 2015;23(1):52–5. https://doi.org/10.1177/230949901502300112.CrossRef

Madhusudhan TR, Ramesh B, Manjunath K, Shah HM, Sundaresh DC, Krishnappa N. Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions – a prospective study. J Trauma Manag Outcomes. 2008;2(1):6. https://doi.org/10.1186/1752-2897-2-6.CrossRefPubMedPubMedCentral

Sanders DW, Galpin RD, Hosseini M, MacLeod MD. Morbidity resulting from the treatment of tibial nonunion with the Ilizarov frame. Can J Surg. 2002;45(3):196–200.PubMedPubMedCentral

10.

McNally M, Ferguson J, Kugan R, Stubbs D. Ilizarov treatment protocols in the management of infected nonunion of the tibia. J Orthop Trauma. 2017;31:47–54. https://doi.org/10.1186/1752-2897-2-6.CrossRef

11.

McHale KA, Ross AE. Treatment of infected tibial nonunions with debridement, antibiotic beads, and the Ilizarov method. Mil Med. 2004;169(9):728–34. https://doi.org/10.7205/MILMED.169.9.728.CrossRefPubMed

12.

Jiao H, Xiao E, Graves DT. Diabetes and its effect on bone and fracture healing. 2015;13(5):327–35. https://doi.org/10.1007/s11914-015-0286-8.CrossRef

13.

Morasiewicz P, Konieczny G, Dejnek M, Urbański W, Dragan SŁ, Kulej M, et al. Assessment of the distribution of load on the lower limbs and balance before and after ankle arthrodesis with the Ilizarov method. Sci Rep. 2018;8(1):15693. https://doi.org/10.1038/s41598-018-34016-3.CrossRefPubMedPubMedCentral

14.

Morasiewicz P, Urbański W, Kulej M, Dragan SŁ, Dragan SF, Pawik Ł. Balance and lower limb loads distribution after Ilizarov corticotomy. Injury. 2018;49(4):860–5.CrossRef

15.

Veilleux LN, Robert M, Ballaz L, Lemay M, Rauch F. Gait analysis using a force-measuring gangway: intrasession repeatability in healthy adults. J Musculoskelet Neuronal Interact. 2011;11(1):27–33.PubMed

16.

Bhave A, Paley D, Herzenberg JE. Improvement in gait parameters after lengthening for the treatment of limb-length discrepancy. J Bone Jt Surg - Ser A. 1999;81(4):529–34. https://doi.org/10.2106/00004623-199904000-00010.CrossRef

17.

Morasiewicz M, Koprowski P, Wrzosek Z, Dragan S. Gait analysis in patients after lengthening and correction of tibia with Ilizarov technique. Physiotheraphy (Pol). 2010;18(1):9–18. https://doi.org/10.2478/v10109-010-0045-4.CrossRef

18.

Saraph V, Zwick EB, Steinwender G, Auner C, Schneider F, Linhart W. Leg lengthening as part of gait improvement surgery in cerebral palsy: an evaluation using gait analysis. Gait Posture. 2006;23(1):83–90. https://doi.org/10.1016/j.gaitpost.2004.12.003.CrossRefPubMed

19.

Manjra MA, Naude J, Birkholtz F, Glatt V, Tetsworth K, Hohmann E. The relationship between gait and functional outcomes in patients treated with circular external fixation for malunited tibial fractures. Gait Posture. 2019;68:569–74. https://doi.org/10.1016/j.gaitpost.2019.01.008.CrossRefPubMed

20.

Koczewski P, Urban F, Jóźwiak M. Analysis of some gait parameters at different stages of leg lengthening using the Ilizarov technique. Chir Narzadow Ruchu Ortop Pol. 2004;69(6):393–7.PubMed

21.

Rozbruch SR, Segal K, Ilizarov S, Fragomen AT, Ilizarov G. Does the taylor spatial frame accurately correct tibial deformities? Clin Orthop Relat Res. 2010;468(5):1352–61. https://doi.org/10.1007/s11999-009-1161-7.CrossRefPubMed

22.

Osman W, Alaya Z, Kaziz H, Hassini L, Braiki M, Naouar N. Treatment of high-energy pilon fractures using the ilizarov treatment. Pan Afr Med J. 2017;27(14):199. https://doi.org/10.11604/pamj.2017.27.199.11066.CrossRefPubMedPubMedCentral

23.

Wang XJ, Chang F, Su YX, Wei XC, Wei L. Ilizarov technique combined with limited adjunctive surgical procedures for correction of relapsed talipes equinovarus in children. J Int Med Res. 2018;46(2):802–10. https://doi.org/10.1177/0300060517724710.CrossRefPubMed

24.

Bańkosz Z, Winiarski S, Lanzoni IM. Gender differences in kinematic parameters of topspin forehand and backhand in table tennis. Int J Environ Res Public Health. 2020;17(16):1–12. https://doi.org/10.3390/ijerph17165742.CrossRef

25.

Bańkosz Z, Winiarski S. Kinematic parameters of topspin forehand in table tennis and their inter-and intra-individual variability. J Sport Sci Med. 2020;19(1):138–48.

26.

Struzik A, Konieczny G, Grzesik K, Stawarz M, Winiarski S, Rokita A. Relationship between lower limbs kinematic variables and effectiveness of sprint during maximum velocity phase. Acta Bioeng Biomech. 2015;17(4):131–8. https://doi.org/10.5277/ABB-00290-2015-02.CrossRefPubMed

27.

Struzik A, Konieczny G, Stawarz M, Grzesik K, Winiarski S, Rokita A. Relationship between lower limb angular kinematic variables and the effectiveness of sprinting during the acceleration phase. Appl Bionics Biomech. 2016;1–9; https://doi.org/10.1155/2016/7480709.

28.

Suciu O, Onofrei RR, Totorean AD, Suciu SC, Amaricai EC. Gait analysis and functional outcomes after twelve-week rehabilitation in patients with surgically treated ankle fractures. Gait Posture. 2016;49:184–9. https://doi.org/10.1016/j.gaitpost.2016.07.006.CrossRefPubMed

29.

Coren S. The lateral preference inventory for measurement of handedness, footedness, eyedness, and earedness: norms for young adults. Bull Psychon Soc. 1993;31(1):1–3. https://doi.org/10.3758/BF03334122.CrossRef

30.

Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 2016;151(11): 162775. https://doi.org/10.1001/jamasurg.2016.2775.CrossRef

31.

Wani NB, Syed B. Ilizarov ring fixator in the management of infected non-unions of tibia. Sicot-J. 2015;1(22):1–6. https://doi.org/10.1051/sicotj/2015022.CrossRef

32.

Zura R, Braid-Forbes MJ, Jeray K, Mehta S, Einhorn TA, Watson JT, et al. Bone fracture nonunion rate decreases with increasing age: a prospective inception cohort study. Bone. 2017;95:26–32. https://doi.org/10.1016/j.bone.2016.11.006.CrossRefPubMed

33.

Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, et al. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury. 2014;45(2):3–7. https://doi.org/10.1016/j.injury.2014.04.002.CrossRef

34.

Ekegren CL, Edwards ER, de Steiger R, Gabbe BJ. Incidence, costs and predictors of non-union, delayed union and mal-union following long bone fracture. Int J Environ Res Public Health. 2018;15(12):2845. https://doi.org/10.3390/ijerph15122845.CrossRefPubMedCentral

35.

Kanakaris NK, Giannoudis PV. The health economics of the treatment of long-bone non-unions. Injury. 2007;38:77–84. https://doi.org/10.1016/S0020-1383(07)80012-X.CrossRef

36.

Tian R, Zheng F, Zhao W, Zhang Y, Yuan J, Zhang B, et al. Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis. J Orthop Surg Res. 2020;15(1):377. https://doi.org/10.1186/s13018-020-01904-2.CrossRefPubMedPubMedCentral

37.

Butler RJ, Barrios JA, Royer T, Davis IS. Frontal-plane gait mechanics in people with medial knee osteoarthritis are different from those in people with lateral knee osteoarthritis. Phys Ther. 2011;91(8):1235–43. https://doi.org/10.2522/ptj.20100324.CrossRefPubMedPubMedCentral

38.

Cichy B, Wilk M. Gait analysis in osteoarthritis of the hip. Med Sci Monit. 2006;12(12):507–13.

39.

Klöpfer-Krämer I, Brand A, Wackerle H, Müßig J, Kröger I, Augat P. Gait analysis – available platforms for outcome assessment. Injury. 2020;51(2):90–6. https://doi.org/10.1016/j.injury.2019.11.011.CrossRef

40.

Shrader MW, Draganich LF, Pottenger LA, Piotrowski GA. Effects of knee pain relief in osteoarthritis on gait and stair-stepping. Clin Orthop Relat Res. 2004;(421):188–93; https://doi.org/10.1097/01.blo.0000119248.70353.a5.

41.

Brockett CL, Chapman GJ. Biomechanics of the ankle. Orthop Trauma. 2016;30(3):232–8. https://doi.org/10.1016/j.mporth.2016.04.015.CrossRefPubMedPubMedCentral

42.

Roaas A, Andersson GB. Normal range of motion of the hip, knee and ankle joints in male subjects, 30–40 years of age. Acta Orthop Scand. 1982;53(2):205–8. https://doi.org/10.3109/17453678208992202.CrossRefPubMed

43.

CS Moriguchi, TO Sato, HJC Gil Coury. Ankle movements during normal gait evaluated by flexible electrogoniometer.Braz. J. Phys. Ther. 2007 Jun; 11 (3). https://doi.org/10.1590/S1413-35552007000300006

44.

Calori GM, Albisetti W, Agus A, Iori S, Tagliabue L. Risk factors contributing to fracture non-unions. Injury. 2007;38:11–8. https://doi.org/10.1016/S0020-1383(07)80004-0.CrossRef

Title: Kinematic parameters after tibial nonunion treatment using the Ilizarov method
Authors: Łukasz Pawik
Felicja Fink-Lwow
Andżelika Pajchert Kozłowska
Łukasz Szelerski
Radosław Górski
Malwina Pawik
Paweł Reichert
Piotr Morasiewicz
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05683-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Kinematic parameters after tibial nonunion treatment using the Ilizarov method

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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