The clinical significance of posttraumatic malunions of lower extremities long bones

Authors

  • Kostiantyn Romanenko
  • Yaroslav Doluda
  • Dmytro Prozorovskiy
  • Vasyl Pariy

DOI:

https://doi.org/10.15674/0030-59872020472-79

Keywords:

Posttraumatic deformity, malunion, malalignment, lower extremity, secondary changes, compensation

Abstract

The treatment of patients with long bones fractures, despite the development and improvement of treatment methods and fixing devices in certain cases can lead to unwanted results such as a formation of posttraumatic deformity — malunion. Objrctive. To provide modern approach regarding clinical significance and necessity of correction of secondary changes in moving segment that appeared as a result of formation of lower extremity malu­nion. Methods. The results of treatment of 196 patients were analyzed (89 men, 107 women; age from 19 to 76 years). All the patients had the malunion of the long bones of lower extremities and have been treated from 2004 to 2019 years. Analysis of special literature and own experience was performed to identify the effects of malunions. Results. It was shown that formed malunion lead to tangible shortening of injured extremity, joints overloading and muscle function violation. Malunions are compensated by the means of changing in movement arch and gait pattern. While it is noted that unphysiological load on joints, that predispose the development of degenerative changes, and muscle fatigue and pain are the results of muscle work to support inadequate position of the joints. Malunions on the level of femur and tibia became clinically significant on condition of severe restriction of extremi­ty function, thus its restoration is the goal of treatment. Diffe­rent cases of malunion development were considered: varus, valgus, antecurvatio, recurvatio, translation, torsion malalignment. Clinical examples are given. Conclusions. Clinical significance of different malunions depend upon their localization, presence and severity of secondary changes, status of injured extremity and physical condition of the patient, his or her individual demands. Secondary changes can play the role of compensation and spread on injured extremity, sacro-iliac joints, lumbar spine, contralate­ral extremity. The assessment of secondary changes of musculoskeletal system is mandatory for the patients with malunions during the planning of treatments measures. The indication for surgical correction should be defined with taking into considera­tion possible development of malunion complications in future.

Author Biographies

Kostiantyn Romanenko

 Kharkiv Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine

PhD in Traumatology and Orthopaedics:

Yaroslav Doluda

PhD in Traumatology and Orthopaedics

Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

Dmytro Prozorovskiy

PhD in Traumatology and Orthopaedics

Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

 

Vasyl Pariy

PhD in Traumatology and Orthopaedics

Bogomolets National Medical University, Kyiv. Ukraine

References

Fayaz, H. C., Giannoudis, P. V., Vrahas, M. S., Smith, R. M., Moran, C., Pape, H. C., Krettek, C., & Jupiter, J. B. (2011). The role of stem cells in fracture healing and nonunion. International Orthopaedics, 35(11), 1587-1597. https://doi.org/10.1007/s00264-011-1338-z

Korzh, N. A., Gerasimenko, S. I., Klimovitsky, V. G., Loskutov, A. E., Romanenko, K. K., Gerasimenko, A. S., & Kolomiets, E. N. (2010). The prevalence of bone fractures and the results of their treatment in Ukraine (clinical and epidemiological study). Orthopedics, traumatology and prosthetics, 3, 5-14. https://doi.org/10.15674/0030-5987201035-14. [in Russian]

Popsuishapka, A. K., Uzhegova, O. E., & Lytvyshko, V. A. (2013). Frequency of non-union of fragments in isolated diaphyseal fractures of long bones of the extremities. Orthopedics, traumatology and prosthetics, 1, 39-43. https://doi.org/10.15674/0030-59872013139-43. [in Russian]

Popsuishapka, O. K., Lytvyshko, V. O., Uzhegova, O. E., & Pidgaiska, O. O. (2020). Frequency of complications of treatment of diaphyseal fractures of extremities according to Kharkiv traumatological MSEC. Orthopedics, traumatology and prosthetics, 1, 20-26. https://doi.org/10.15674/0030-59872020120-25. [in Ukrainian]

Marti, R. K., & van Heerwaarden, R. J. (2008). Osteotomies for posttraumatic deformities. Georg Thieme Verlag

Paley, D. (2002). Principles of deformity correction. https://doi.org/10.1007/978-3-642-59373-4

Engsberg, J., Leduc, S., Ricci, W., & Borrelli J. Jr. (2014). Improved function and joint kinematics after correction of tibial malalignment. American Journal of Orthopedics, 43(12), E313–E318

Fan, C. H. (2014). One-stage femoral osteotomy and computer-assisted navigation total knee arthroplasty for osteoarthritis in a patient with femoral Subtrochanteric fracture Malunion. Case Reports in Orthopedics, 2014, 1-4. https://doi.org/10.1155/2014/645927

Lonner, J. H., Siliski, J. M., & Lotke, P. A. (2000). Simultaneous femoral osteotomy and total knee arthroplasty for treatment of osteoarthritis associated with severe extra-articular deformity. The Journal of Bone and Joint Surgery-American Volume, 82(3), 342-348. https://doi.org/10.2106/00004623-200003000-00005

Heirholzer, G., & Hax, P. M. (1985). Corrective osteotomies of the lower extremities after trauma. Springer-Verlag Berlin Heidelberg

Probe, R. A. (2003). Lower extremity angular Malunion: Evaluation and surgical correction. Journal of the American Academy of Orthopaedic Surgeons, 11(5), 302-311. https://doi.org/10.5435/00124635-200309000-00003

McKellop, H. A., Sigholm, G., Redfern, F. C., Doyle, B., Sarmiento, A., & Luck, J. V. (1991). The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint. The Journal of Bone & Joint Surgery, 73(9), 1382-1391. https://doi.org/10.2106/00004623-199173090-00014

Tarr, R. R., Resnick, C. T., Wagner, K. S., & Sarmiento, A. (1985). Changes in Tibiotalar joint contact areas following experimentally induced tibial angular deformities. Clinical Orthopaedics and Related Research, (199), 72–80. https://doi.org/10.1097/00003086-198510000-00011

Ting, A. J., Tarr, R. R., Sarmiento, A., Wagner, K., & Resnick, C. (1987). The role of Subtalar motion and ankle contact pressure changes from angular deformities of the tibia. Foot & Ankle, 7(5), 290-299. https://doi.org/10.1177/107110078700700505

Korzh, M. O., Romanenko, K. K., Karpinsky, M. Yu., Prozorovsky, D. V., & Yaresko, O. V. (2015). Mathematical modeling of the influence of femoral deformation on the load of the joints of the lower extremity. Orthopedics, traumatology and prosthetics, 4, 25-30, https://doi.org/10.15674/0030-59872015425-30. [in Ukrainian]

Romanenko, K. K., Ashukina, N. O., Batura, I. O., & Prozorovsky, D. V. (2017). Mornenhology of articular cartilage of the knee joint of rats under conditions of extra-articular deformation of the femur. Orthopedics, traumatology and prosthetics, 1, 63-71. https://doi.org/10.15674/0030-59872017163-71. [in Ukrainian]

Butcher, C., & Atkins, R. (2003). (II) principles of deformity correction. Current Orthopaedics, 17(6), 418-435. https://doi.org/10.1016/j.cuor.2003.10.001

Tscherne, H., & Gotzen, L. (1979). Posttraumatische Fehlstellungen. Chirurgie der Gegenwart. Bd IVa. Unfallchirurgie. Urban & Schwarzenberg, München Wien Baltimore

Winquist, R. A., Hansen, S. T., & Clawson, D. K. (1984). Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. The Journal of Bone & Joint Surgery, 66(4), 529-539. https://doi.org/10.2106/00004623-198466040-00006

McKellop, H. A., Llinas, A., & Sarmiento, A. (1994). Effects of tibial malalignment on the knee and ankle. The Orthopedic Clinics of North America, 25(3). 415-423

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ORIGINAL ARTICLES