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E-raamat: Intramedullary Limb Lengthening: Principles and Practice

  • Formaat: PDF+DRM
  • Ilmumisaeg: 19-Sep-2017
  • Kirjastus: Springer International Publishing AG
  • Keel: eng
  • ISBN-13: 9783319602974
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  • Formaat: PDF+DRM
  • Ilmumisaeg: 19-Sep-2017
  • Kirjastus: Springer International Publishing AG
  • Keel: eng
  • ISBN-13: 9783319602974
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Providing a comprehensive overview of the current orthopedic uses of intramedullary devices, this practical, well-illustrated guide opens with a review of the history of limb lengthening from the early external fixator up to Ilizarov’s monumental discoveries, with a summary of the biology of new bone formation in a widening distraction gap. This is followed by post-Ilizarov developments with external fixators designed to ease application and increase patient tolerance of such devices, as well as a discussion of the intramedullary lengthening devices from the earliest mechanical distractors to the most modern implants, detailing the surgical principles, pre-operative planning and specific operative techniques for each. Concluding chapters focus on preventing and dealing with complications from the surgery and day-to-day post-operative management. A unique feature of the book is a cross-section atlas of the upper and lower limbs that will assist surgeons to avoid impaling neuro
vascular structures during the minimally invasive portions of operative insertion of the implants.

Intramedullary Limb Lengthening: Principles and Practice is an ideal, on-the-spot resource for orthopedic surgeons, residents and trainees treating pediatric and adult limb deformities and length deficiencies, as well as physical therapists and other health care providers who manage such patients post-operatively.
1 Historical Background
1(16)
Introduction
1(2)
Early Pioneers
3(3)
Parkhill
3(1)
Codivilla
4(1)
Putti
4(1)
Abbott
4(2)
Bost and Larsen
6(1)
G.A. Ilizarov
6(1)
First Patient
6(1)
Distraction Osteogenesis
7(1)
Ilizarov Apparatus
8(1)
Ilizarov Institute, Kurgan, Siberia
9(1)
Skepticism About Ilizarov's Method
9(1)
Dissemination of the Ilizarov Method
10(3)
The Cold War
10(1)
Italian Connection
10(2)
Worldwide Dissemination
12(1)
ASAMI and LLRS
12(1)
References
13(1)
Further Reading
14(3)
2 The Regenerate Bone
17(10)
Histologic Features of the Regenerate
17(4)
Histology, Early Phases
17(1)
Histology, Vascularization
17(2)
The Fibrous Interzone
19(1)
Maturation Phases
19(1)
Ossification
20(1)
The Ring of Ranvier
21(1)
Factors Influencing Regenerate Quality
21(1)
Stability
21(1)
Osteotomy/Corticotomy
22(1)
Rate and Rhythm of Distraction
22(1)
Ilizarov Terminology
22(2)
Introduction
22(1)
Location
22(1)
Sequence
23(1)
Action
23(1)
Objective
23(1)
Summary
23(1)
Conclusion
24(1)
Applications of the Ilizarov Method
24(1)
References
25(2)
3 Modifications of the Ilizarov Apparatus
27(6)
Half-Pin Mounting
27(1)
Computer-Controlled Hexapod Fixators
27(2)
Monolateral External Fixation
29(1)
Strategies to Shorten Time in Fixation
30(1)
Lengthening Over a Nail
30(1)
Lengthening and Then Nailing
30(1)
Lengthening and Then Plating
31(1)
References
31(2)
4 Intramedullary Lengthening Devices
33(18)
Background
33(1)
Elimination of the External Fixator
33(1)
Ratcheting Devices
34(3)
Bliskunov Intramedullary Nail
34(1)
Albizzia Intramedullary Nail
35(1)
Internal Skeletal Kinetic Distractor
36(1)
Rotating Spindle Devices
37(6)
Fitbone® Intramedullary Nail
37(2)
Phenix® Intramedullary Nail
39(1)
PRECICE® Intramedullary Nail
39(1)
Transferring Energy Through Soft Tissues
39(4)
Correcting Deformities with Intramedullary Lengthening Nails
43(1)
Achondroplasia and Related Conditions
43(4)
Achondroplasia
43(1)
Hypochondroplasia
44(1)
Turner's Syndrome
45(1)
Constitutional Short Stature
45(1)
Stature Surgery in Dwarfing Conditions
45(1)
Clinical Illustration: Four-Segment Intramedullary Lengthening
46(1)
Technical Considerations
46(1)
Uses of Intramedullary Lengthening Nails
47(1)
References
48(1)
Further Reading
49(2)
5 Surgical Principles of Intramedullary Lengthening
51(42)
General Principles
51(16)
Similarity to Intramedullary Trauma Nails
51(1)
Differences from Intramedullary Trauma Nails
51(1)
Guide Wire Issues
52(1)
Short or Long Nails
52(1)
Preoperative Planning
52(1)
Assessing Deformities
53(3)
Hidden Deformities
56(1)
Full-Length X-ray Studies
57(1)
Clinical Illustration: Failure to Identify Hidden Deformity
58(1)
Level of the Osteotomy
59(1)
The Osteotomy Formula
59(1)
Fixator-Assisted Nailing
60(1)
Periosteal Elevation
61(1)
Venting
62(1)
Depth Plunging
63(1)
Compartment Syndrome
63(1)
Thermal Injury While Drilling Vent Holes
64(1)
Osteotomy Technique
64(1)
Transverse Locking Screws: Proximal Guide
65(1)
Testing the Implant
66(1)
Preliminary Osteotomy Gap
66(1)
A Spare Implant
66(1)
Correcting Deformities with Intramedullary Lengthening Nails
66(1)
Considerations for Tibiofibula Lengthening
67(8)
The Fibula
67(1)
Osteotomy of the Fibula
67(2)
Fibular Fixation to the Tibia
69(1)
Blocking Equinus
69(2)
Tibial Insertion Point
71(1)
Transverse Locking Screws: Distal Targeting
71(4)
Considerations for Femoral Lengthening
75(7)
Antegrade and Retrograde Nailing
75(1)
Trochanteric or Piriformis Femoral Entry Portal
76(1)
Retrograde Femoral Nailing
77(3)
Bone Curvature
80(1)
Clinical Illustration: Cortical Penetration
80(2)
Considerations for Humeral Lengthening
82(6)
Antegrade and Retrograde Nailing
82(1)
Nail Size
83(1)
The Proximal Humeral Portal
83(2)
Clinical Illustration: Humeral Lengthening via Proximal Portal
85(1)
The Distal Humeral Portal
85(1)
Clinical Illustration: Humeral Lengthening via Distal Portal
86(2)
Forearm
88(1)
Reaming the Canal
88(2)
References
90(1)
Further Reading
91(2)
6 Preventing Complications During Limb Lengthening
93(32)
Background
93(1)
Operative Strategies to Prevent Bone Deformities During Lengthening
94(1)
Bone Deformities During Lengthening
94(1)
Tibial Deformation
94(1)
Femoral Deformation
94(1)
Forearm Deformation
95(1)
Preventing Deformities (External Fixator Principles)
95(6)
Ring Prophylaxis
95(1)
Strategic Pin Placement
96(1)
The Waypoint Method
96(1)
Biomechanical Axis Considerations
97(2)
Correction with External Fixators
99(1)
Valgus Prophylaxis with Intramedullary Lengthening Nails
100(1)
Planning the Correction
101(1)
Preventing Deformities During Lengthening (Intramedullary Lengthening Nail Principles)
101(12)
Background
101(2)
Blocking Screws
103(2)
Clinical Illustration: No Blocking Screws
105(2)
Clinical Illustration: Secondary Blocking Screws
107(1)
Clinical Illustration: One Blocking Screw
108(2)
Clinical Illustration: Many Blocking Screws
110(1)
Blocking Screws as Guidance Screws
110(1)
Drill Bits for Guidance
111(1)
Regenerate Enhancement with Blocking Screws
112(1)
Excessive Correction
113(4)
The Osteotomy Site
113(1)
Angulation
114(1)
Translation and Rotation
114(1)
Angulation, Translation, and Rotation
115(2)
Latency, Rate, and Rhythm Modifications
117(1)
Rationale
117(1)
Latency
117(1)
Rate
117(1)
Rhythm
118(1)
Surgical Soft Tissue Release
118(5)
Rationale
118(2)
Subluxations and Dislocations
120(3)
References
123(1)
Further Reading
124(1)
7 Postoperative Management Considerations
125(12)
Basic Principles
125(3)
Initial Management
125(1)
Postoperative Neurological Problems
125(1)
Postoperative Vascular and Circulatory Problems
126(1)
Compartment Syndrome
127(1)
Contractures, Subluxations, and Dislocations
127(1)
Avoiding Complications
128(7)
Physiotherapy
128(1)
Stretching
129(1)
Splinting
130(1)
Night Positioning
131(3)
Functional Use of the Limb
134(1)
Failure to Control Progressive Contractures
135(1)
Reference
135(1)
Further Reading
135(2)
8 Postoperative Care, Day by Day
137(22)
In Operating Room
137(1)
After Surgery
137(1)
Day-by-Day Management
137(5)
Postoperative Day 1
137(1)
Postoperative Days 2--4
138(1)
Postoperative Days 5, 6, and 7 or Later
138(1)
Latency
138(1)
Distraction
139(1)
Visualizing the Regenerate New Bone
139(1)
After One Week of Distraction
139(2)
Two Weeks of Distraction
141(1)
Three Weeks of Distraction
141(1)
Four Weeks of Distraction
141(1)
Visits During Distraction
141(1)
Judging the Regenerate
142(3)
Assessment
142(1)
Classification of Regenerate
143(1)
Bone Mineral Density
143(1)
Pixel Value Ratio
143(1)
Ultrasound
144(1)
The Regenerate Around a Lengthening Nail
144(1)
Patterns of Regenerate
145(1)
Biology of the Regenerate
145(2)
Gardening
145(1)
Biological Factors Retarding Regenerate
146(1)
Chemical Factors Retarding Regenerate
146(1)
Mechanical Factors Retarding Regenerate
147(1)
Maturation (Consolidation)
147(1)
Visits During Maturation
147(1)
Tardy Regenerate Ossification
147(6)
Stimulating Regenerate Ossification
148(1)
Mechanical Enhancement
149(1)
Pulsed Electromagnetic Field
149(1)
Pulsed Ultrasound
149(1)
Chemical Enhancement
150(1)
Biological Enhancement
150(1)
Bone Grafting
151(1)
Hyperplastic Regenerate
151(1)
When Length is Achieved
152(1)
Planning Implant Removal
152(1)
Post-Removal Management
153(1)
Conclusion
153(1)
References
153(2)
Further Reading
155(4)
9 Alternatives to Limb Lengthening
159(12)
Pelvic Tilting
159(1)
Shoe Lifts
159(1)
Surgery on the Normal Side
160(2)
Growth Arrest
160(1)
Shortening the Normal Limb
161(1)
Intramedullary Segmental Shortening
161(1)
Amputation
162(1)
Major Limb Deficiencies
162(1)
Assessing the Medical Literature
163(2)
The Limb Lengthening and Reconstruction Society-North America
163(1)
Problems with Publications
163(1)
The LLRS-AIM Complexity Score
164(1)
Judging Patient Wishes
165(1)
Patient-Reported Outcomes
165(1)
The Limb Deformity Modified SRS (LD-SRS) Score
165(4)
Section 1 All patients
166(2)
Section 2 After Completion of Treatment
168(1)
References
169(1)
Further Reading
170(1)
10 The Future of Intramedullary Limb Lengthening
171(14)
Device Modifications
171(9)
Lengthening Plates
171(1)
Trauma Nail
171(1)
High Tibial Osteotomy
172(2)
Residual Limb Elongation
174(1)
Smart Remote Controllers
175(1)
Bone Transport
176(3)
Bifocal Treatment
179(1)
Expanded Indications
180(1)
Cosmetic Stature Surgery
180(1)
Conclusion
181(1)
References
182(1)
Further Reading
183(2)
11 Cross-Section Atlas
185(20)
Development of the Atlas
185(1)
Background
185(1)
Derivation of the Atlas
186(1)
The Need for a Cross-Section Atlas for Intramedullary Lengthening
186(1)
Plunge Depth
186(1)
The Atlas
186(17)
Principles of the Atlas
186(17)
References
203(2)
Index 205
Stuart A. Green, MD, Professor, Department of Orthopedic Surgery, University of California - Irvine, Orange, CA, USA Mark T. Dahl, MD, Gillette Children's Specialty Healthcare, University of Minnesota, Minneapolis, MN, USA