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.
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Introduction
The Ilizarov method is commonly used in the treatment of tibial nonunion [40].
Previous reports demonstrated a high prevalence of range-of-motion limitations, particularly at the ankle and knee, in patients with tibial nonunion [40]. The observed range-of-motion differences may have also been due to compensatory mechanisms [24]. A change in the range of motion at one joint results in compensatory changes in the range of motion of other joints [24]. Moreover, increasing gait speed increases the joint range of motion [26]. Another factor contributing to joint stiffness may have been the long immobilization with an external fixator [19].
Limitations
One of the limitations of our study is its retrospective character, which was due to the impossibility of assessing kinematic parameters in patients prior to surgery, since they were either unable to walk or their walking ability was considerably impaired, due to pain and pathological mobility at the tibial nonunion site. Nonetheless, range-of-motion studies carried out by other authors were also retrospective [19, 22, 23]. Due to the small number of patients after tibial nonunion treatment, it was not possible to select a uniform group of patients in terms of the number of previous surgeries and the exact site of tibial nonunion (in the same sections of the bone). Another limitation was the small sample size; however, most other authors who assessed kinematic parameters also used study groups of similar or smaller sizes [19, 22,23,24,25,26,27], as it is difficult to accrue a large population of patients who consent to undergo additional evaluations. Moreover, we had no data on either patients’ or volunteers’ unhealthy habits, such as systematic smoking, unhealthy diets [44], or comorbid metabolic conditions, which may potentially affect functional recovery, based on laboratory test results such as fasting blood glucose or insulin levels; instead, the only type of comorbidity-associated data we collected was limited to that elicited at history-taking. Our study volunteers were deemed healthy based on a general history-taking negative for metabolic conditions, including diabetes. However, individual lifestyle choices, such as smoking, were considered in the analysis, since we assumed that such parameters have no impact on kinematic gait parameters in the control group.
Another limitation of our work is the lack of assessing the residual pain and its correlation with range of motion; however, other authors also did not assess the correlation between residual pain and range of motion [21,22,23, 37].
The strengths of our study include the uniform postoperative management and rehabilitation regimen, the long follow-up, the carefully selected control group, and the reproducible assessment of kinematic parameters using the objective and accurate Noraxon MyoMOTION System [24,25,26,27].
The statistically significant differences between the OLs and NOLs in patients demonstrated by the measurement method employed in our study are significant from the clinical point of view and indicate that the accuracy of measurements may help optimize and personalize treatment and rehabilitation for subsequent patients treated with the Ilizarov method.
Our retrospective study assessed kinematic parameters after treatment. The observed range-of-motion abnormalities may have been a product of the initial injury that led to tibial nonunion and other surgical procedures that the patients underwent before the Ilizarov treatment. Abnormal joint mobility may also have been due to the Ilizarov treatment itself.
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.
The kinematic parameter values in the NOLs of patients after Ilizarov treatment and in the DLs of healthy individuals.
Availability of data and material
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to privacy.
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ŁP, FFL, and PM designed the study. ŁP, APK, ŁS, RG, MP, and PM collected, analyzed and interpreted the data. ŁP, FFL, MP, PR, and PM drafted the manuscript. ŁP, FFL, and PM revised it critically for important intellectual content. ŁP, FFL, PR, MP, and PM conducted the final revision of the manuscript. All authors read and approved the final manuscript.
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Pawik, Ł., Fink-Lwow, F., Kozłowska, A.P. et al. Kinematic parameters after tibial nonunion treatment using the Ilizarov method. BMC Musculoskelet Disord 23, 723 (2022). https://doi.org/10.1186/s12891-022-05683-1
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DOI: https://doi.org/10.1186/s12891-022-05683-1