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OBJECTIVE: Post-operative patients are at increased risk of becoming chronic users of opioids, and overprescribing can lead to abuse and diversion. Though data have shown a decrease in opioid prescriptions nationally, limited studies have specifically evaluated the influence of state legislation on this trend. This study aimed to assess the impact of legislation in the state of Tennessee on opioid prescribing amongst orthopedic surgeons. DESIGN: This retrospective cohort analysis evaluated patients who received opioids post-orthopedic surgery before and after the state legislation was passed. SETTING: A community teaching hospital. PATIENTS AND PARTICIPANTS: Two hundred and three post-orthopedic surgery patients were included, with 101 in the preleg-islation and 102 in the post-legislation groups. INTERVENTIONS: State legislation in Tennessee limiting amounts of prescribed opioids went into effect in July 2018. MAIN OUTCOME MEASURE(S): The primary outcome was total morphine milligram equivalents (MMEs) prescribed, with secondary outcomes of days' supply, dosage units, and MME per day. RESULTS: Orthopedic surgery patients in the post-legislation arm were prescribed significantly fewer MME than those in the prelegislation arm (median MME 375 vs. 562.5; p < 0.001). Prescription days' supply, number of dosage units, and MME per day were also significant lower in the post-legislation group. CONCLUSIONS: After orthopedic surgery, patients in the post-legislation arm were prescribed a median 187.5 MME less than those in the prelegislation arm. Our findings suggest that state opioid legislation is associated with a reduction in the amount of opioids prescribed in certain orthopedic surgery patients, though further studies evaluating adequacy of pain control are warranted.

The increasing demand for healthcare services, coupled with the challenges of managing budgets and navigating complex regulations, has underscored the need for sustainable and efficient healthcare delivery. In response to this pressing issue, this thesis aims to optimize hospital efficiency using Artificial Intelligence (AI) techniques. The focus extends beyond improving surgical intraoperative time to encompass preoperative and postoperative periods as well. The research presents a novel Prescriptive Analytics System (PAS) designed to enhance the Surgical Success Rate (SSR) in surgeries and specifically in high volume arthroplasty. The SSR is a critical metric that reflects the successful completion of 4-surgeries during an 8-hour timeframe. By leveraging AI, the developed PAS has the potential to significantly improve the SSR from its current rate of 39% at The Ottawa Hospital to a remarkable 100%. The research is structured around five peer-reviewed journal papers, each addressing a specific aspect of the optimization of surgical efficiency. The first paper employs descriptive analytics to examine the factors influencing delays and overtime pay during surgeries. By identifying and analyzing these factors, insights are gained into the underlying causes of surgery inefficiencies. The second paper proposes three frameworks aimed at improving Operating Room (OR) throughput. These frameworks provide structured guidelines and strategies to enhance the overall efficiency of surgeries, encompassing preoperative, intraoperative, and postoperative stages. By streamlining the workflow and minimizing bottlenecks, the proposed frameworks have the potential to significantly optimize surgical operations. The third paper outlines a set of actions required to transform a selected predictive system into a prescriptive one. By integrating AI algorithms with decision support mechanisms, the system can offer actionable recommendations to surgeons during surgeries. This transformative step holds tremendous potential in enhancing surgical outcomes while reducing time. The fourth paper introduces a benchmarking and monitoring system for the selected framework that predicts SSR. Leveraging historical data, this system utilizes supervised machine learning algorithms to forecast the likelihood of successful outcomes based on various surgical team and procedural parameters. By providing real-time monitoring and predictive insights, surgeons can proactively address potential risks and improve decision-making during surgeries. Lastly, an application paper demonstrates the practical implementation of the prescriptive analytics system. The case study highlights how the system optimizes the allocation of resources and enables the scheduling of additional surgeries on days with a high predicted SSR. By leveraging the system's capabilities, hospitals can maximize their surgical capacity and improve overall patient care.

В настоящее время актуальной проблемой в сфере маркетинга является выбор экономически обоснованных инструментов оценки бренда и повышения его узнаваемости. В рамках данной работы была проведена оценка капитала бренда и выявлено, что узнаваемость компании находится на низком уровне.В связи с этим,были предложены и апробированы маркетинговые инструменты в сети интернет, а также рассчитана их эффективность. / The current issue in marketing is economically feasible tools for assessment and increase brand awareness. Within this work, the brand equity was evaluated and it was revealed that the company's recognition is low. In connection with this, marketing tools in the Internet have been proposed and tested and their effectiveness has been calculated.

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Bakgrund   Muskuloskeletala systemet, även benämnt som rörelseapparaten, kräver alltid postoperativ omvårdnad efter operation i de nedre extremiteterna. En viktig aspekt av vårdprocessen är personcentrerad omvårdnad, som betonar vikten av preoperativ information, postoperativ rehabilitering och aktiv patientmedverkan. Tidig mobilisering efter operation är avgörande för att minska risken för komplikationer och förkorta sjukhusvistelsen, samtidigt som det finns en strävan att förbättra patientens livskvalitet och återställa funktion. Denna studie fokuserar på att analysera den postoperativa vården efter ortopedisk kirurgi. Syfte  Syftet var att belysa postoperativ vård efter ortopedisk kirurgi. Metod  En icke-systematisk litteraturöversikt baserad på 15 vetenskapliga originalartiklar med kvalitativa, kvantitativa eller mixad design. Artiklarna valdes ut från databaserna PubMed och CINAHL. Samtliga artiklar har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Integrerad dataanalys användes för att sammanställa resultatet. Resultat Resultatet sammanställdes med hjälp av två huvudkategorier: Tidig mobilisering och Vårdandets perspektiv. Resultatet visade att tidig mobilisering är fördelaktigt i det tidiga stadiet av postoperativ omvårdnad då det påskyndar rehabiliteringen, förbättrar behandlingsprocessen och sänker vårdkostnaderna. Dessutom framhölls vikten av väl anpassad patientinformation för att stärka den personcentrerade vården. Det är avgörande att vårdgivarna anpassar informationen för att optimera varje patients behandlingsupplevelse och resultat. Slutsats Denna litteraturöversikt understryker vikten av tidig mobilisering efter ortopedisk kirurgi för att påskynda patientens återhämtning, förkorta sjukhusvistelser samt minska smärta, vilket förbättrar både fysiska och psykiska utfall. Genom att implementera ett personcentrerat förhållningssätt som anpassade smärtbehandlingsprotokoll och grundlig preoperativ utbildning kan vårdgivare övervinna hinder som åldersfaktorer och rörelserädsla. Tidig mobilisering, som en del av ERAS-program, visar även ekonomiska fördelar genom minskade vårdkostnader och effektivare resursanvändning, vilket gör det till en kritisk komponent i postoperativ vård. / Background The musculoskeletal system always requires postoperative care after surgery in the lower extremities. An important aspect of the care process is person-centered nursing, which emphasizes the importance of preoperative information, postoperative rehabilitation, and active patient participation. Early mobilization after surgery is essential to reduce risk of complications and shorten the hospital stay, while striving to improve the patient's quality of life and restore function. This study focuses on analyzing the postoperative care after orthopedic surgery. Aim The aim was to shed light on postoperative care after orthopedic surgery. Method A non-systematic literature review based on 15 original scientific articles with a qualitative, quantitative or mixed design. The articles were selected from the databases PubMed and CINAHL. The articles have been quality checked based on Sophiahemmet University's assessment document for scientific classification and quality. Integrated data analysis was used to compile the results. Results The results were compiled with the help of two main categories: Early Mobilization and the Nursing perspective. The result showed that early mobilization is beneficial in the early stage of postoperative care that accelerates rehabilitation, improves the treatment process and lowers costs. Additionally, the importance of well-adapted patient information to strengthen person-centered care was highlighted. It's critical that caregivers adapt the information to optimize each patient's treatment experience and outcomes. Conclusions This literature review highlights the importance of early mobilization after orthopedic surgery to accelerate recovery, shorten hospital stays, and reduce pain, improving both physical and psychological outcomes. Implementing person-centered approaches such as customized pain management protocols and thorough preoperative education, caregivers can overcome barriers like age factors and movement fear. Early mobilization, as part of ERAS, also demonstrates economic benefits through reduced healthcare costs and more efficient resource usage, making it a critical component of postoperative care.

Il existe différents facteurs pouvant altérer la récupération fonctionnelle de patients souffrant de traumatismes orthopédiques (TO), dont le fait de subir un traumatisme craniocérébral (TCC) concomitant. Le profil de traumatismes combinés (TCC et TO) a principalement été étudié en contexte de blessures jugées sévères (TCC modéré/sévère et multiples fractures), notamment dans un souci de maximiser la récupération de ces patients et le déploiement des ressources médicales. Par ailleurs, la littérature demeure limitée en ce qui a trait à l’impact de subir un TCC en contexte de blessures jugées moins sévères, soit un TCC léger (TCCL) et une fracture isolée (un seul os fracturé), bien qu’il s’agisse de deux blessures à très forte incidence et qu’elles partagent diverses similarités (p.ex. : mécanismes d’accidents et physiologiques communs). Ainsi, la présente thèse s’est spécifiquement intéressée à cette population aux prises avec une fracture isolée avec, ou sans, TCCL concomitant. Dans un premier temps, les travaux de la thèse ont permis d’investiguer la fréquence de TCCL concomitant en contexte de fracture isolée (article 1) ainsi que son impact sur la récupération post-fracture selon diverses mesures cliniques (articles 2, 3, 4). Les résultats ont démontré que le TCCL était fréquent, quoique fortement sous-diagnostiqué, chez des patients vus au département d’urgence (DU) pour une fracture isolée et que sa présence avait un impact significatif sur le niveau de douleur perçu, le délai pour retourner au travail et le risque de développer de l’ossification hétérotopique (forme de complications orthopédiques). Dans un deuxième temps, la présente thèse a utilisé une approche théorique (article 5) et clinique (article 6) afin d’étudier les mécanismes physiologiques sous-tendant la perception de douleur, symptôme clé suite à une fracture, dans un souci de limiter les risques de chronicisation de la douleur et de proposer des méthodes d’intervention ciblées selon la population étudiée. Les travaux ont notamment mis en lumière une association entre l’intensité de douleur rapportée par des patients en phase aiguë post-fracture et le degré d’atteintes des mécanismes d’excitabilité corticale du cortex moteur primaire mesurées par l’entremise de la stimulation magnétique transcranienne (SMT). Enfin, sur la base d’évidences théoriques soulevées dans un article de revue de la présente thèse, il semble y avoir une pertinence dans l’utilisation de la SMT auprès de la population orthopédique comme méthode d’investigation et d’intervention, considérant sa capacité à cibler les mécanismes physiologiques impliqués dans la transition de la douleur aiguë à la douleur chronique. / A variety of factors can affect the functional recovery of patients with an orthopedic trauma (OT), including concomitant traumatic brain injuries (TBI). The recovery profile of patients with combined traumas (OT and TBI) has been studied primarily in the context of severe injuries (moderate/severe TBI and multiple fractures), in order to maximize recovery and medical resources. On the other hand, there is limited evidence on the impact of concomitant TBI in the context of milder injuries, such as in patients sustaining a mild TBI combined with an isolated limb fracture, despite both injuries being highly prevalent and sharing various similarities (e.g., overlapping injury mechanisms and physiological mechanisms). The current thesis sought to bridge this knowledge gap via a multifaceted approach. We first investigated the risk of sustaining a concomitant mild TBI in patients with an isolated limb fracture (article 1) as well as its impact on post-fracture recovery according to various clinical measures (articles 2, 3, 4). The results showed that mild TBI was frequent, although highly underdiagnosed, in patients seeking care for an isolated limb fracture in the emergency department. Moreover, the presence of a concomitant mild TBI had a significant detrimental impact on the level of perceived pain, on return to work delays, and on the risks of developing heterotopic ossification (a type of orthopedic complication). Secondly, this thesis used a theoretical (article 5) and a clinical (article 6) approach to study the physiological mechanisms underlying pain perception, a key symptom following a fracture, in order to limit the risks for pain chronification and to propose intervention methods tailored to the studied population. In particular, results highlighted an association between pain intensity as perceived by patients in the acute phase post-fracture and the degree of cortical excitability impairments of the primary motor cortex, as measured by transcranial magnetic stimulation (TMS). Finally, based on theoretical evidence highlighted in a review article included in this thesis, there are evidence supporting the use of TMS in a traumatically injured population as a method to investigate and intervene given its ability to target key physiological mechanisms involved in the transition from acute to chronic pain.

隨著全球人口結構高齡化和醫療技術的日新月異，使得全球醫療器材市場，正以前所未有的速度，快速地蓬勃發展，預估2006年全球醫療器材市場的總值約為1,643.57億美元，相對於2006年我國醫療器材產業的營業額新台幣690億元，我國目前大概只佔全球醫療器材市場總值的1.4%，相較於半導體、以及電子業稱霸國際，全球醫療器材市場，不啻是我國廠商的一片藍海! 2004年全球骨科市場的價值達190億美元，預期未來十年的年平均成長率將高達10~13%，聯合骨科在人工關節的設計與製造，具有亞洲第一的水準，非常具有競爭優勢，然而，由於歐美知名品牌的公司規模及在中國人工關節市場先驅者的地位，聯合骨科如何在激烈的競爭環境中脫穎而出，考驗著聯合骨科經理人的智慧；目前，聯合骨科在台灣及大陸，分別擁有約20% 以及10% 的市場佔有率，並在西安與新竹建立生產基地。 透過實際參與中國人工關節市場操作的台灣及大陸的聯合骨科經理人、競爭廠商經理人、以及學術界的專家的角度，利用策略行銷4C成本理論，分析聯合骨科在中國人工關節市場的發展現況的優缺點與可能的成因之後，本研究建議聯合骨科在運用有限資源的有效性及時效性的考量之下，可以考慮優先解決買者的外顯單位效益成本以及買者的專屬陷入成本，進而取得市場上的優勢，除此之外，如果他們能夠持續地提升技術層面的優勢之外，更進一步的創造行銷與服務方面的效能，必能在中國的人工關節市場上，取得優勢，創造出更亮麗的成績；深耕中國、佈局世界，以期與世界級的品牌大廠，能夠在全球的人工關節市場競爭上，有更卓越的表現！ / Along with global aging population and rapid advancement of medical technology, global medical devices market is increasing at the fastest speed ever and is reaching US$ 164B in 2006. 2006 Taiwan medical devices market is US$ 2.3B which is only 1.4% of overall global medical devices market. Comparing with dominant positions of Taiwan semiconducting and electronic industries, global medical devices market is a great “Blue Ocean” opportunity! Global orthopedic market will reach US$ 19B in 2004 and is expected to grow at 10-13% annually for the coming 10 years. United Orthopedic Corporation （UOC） is very competitive and is in a leading position in orthopedic joint design and manufacturing in Asia. Due to relative large company size and market pioneer position of well-known US & European brands in China, management team of UOC is facing a tremendous challenge to win this game；So far, UOC is holding 20% and 10% of market share in Taiwan and China, respectively. UOC has set-up manufacturing bases in both Xian and Hsin-Chu. After consolidating individual assessment of UOC management team, competitors’ management team as well as experts from academic society who are personally involving in orthopedic joint market in China and applying the strategic marketing analysis of 4C theory, we have concluded the strength/weakness and their possible causes of UOC current market status in China. Based on our findings, we suggest UOC could consider utilize its limited resources effectively and efficiently, as priorities, to build up its competitiveness on Cost/Utility ratio and Asset Specificity. If UOC can create effectiveness on both marketing and service furthermore, it can achieve competitive advantage and better performance in China orthopedic joint market；Establishing a strong foundation in China and structuring its market position in the world. UOC will be able to tackle face-to-face competition with world-class orthopedic companies in global market!

<p>Kompleksnost visokoenergetskih preloma platoa i pilona tibije i njihova udruženost sa značajnim povredama mekog tkiva oko pripadajućeg zgloba veoma je dobro opisana. Lečenje ima za cilj da multifragmentarni prelomi platoa i pilona tibije postanu stabilni, artikularno poravnani, bezbolni, da koleno i skočni zglob budu pokretni i da se minimizira rizik do nastanka posttraumatskog osteoartritisa. Aparat po Ilizarovu sa nategnutim iglama, koristi opterećenje da stvori jedinstvenu podr&scaron;ku za zglob i stabilnu imobilizacju preloma da se postigne njegovo srastanje. Ovo omogućuje ranu pokretljivost zgloba bez rizika od gubitka redukcije. Cilj istraživanja je procena i poređenje rezultata lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju proksimalnog i distalnog okrajka potkolenice tretiranih spoljnjim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu primenom ASAMI ko&scaron;tanog skoring sistema i funkcionalnog skoring sistema po Karlstrom &ndash; Olerudu.Takođe je jedan od ciljeva istraživanja bio da se uoče faktori koji utiču na različite rezultate lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju gornjeg i donjeg okrajka potkolenice tretiranih spoljnim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu. Istraživanje je dizajnirano kao kontrolisana komparativna klinička studija a podaci su se prikupljali retrospektivno i delom prospektivno na osnovu medicinske dokumentacije od 2008. do 2013. godine. Studija je u potpunosti izvedena na Klinici za ortopediju i traumatologiju Kliničkog centra Vojvodina u Novom Sadu. Studija je obuhvatila ukupno 103 ispitanika kod kojih je u toku 2008 do 2013. godine postavljena dijagnoza unutarzglobnog vi&scaron;ekomadnog preloma gornjeg ili donjeg okrajka tibije. Ispitanici koji su obuhvaćeni ovim kliničkim istraživanjem razvrstani su u tri grupe: Prvu grupu od 53 ispitanika činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo spoljnjim unilateralnim rigidnim fiksatorom. Drugu grupu ispitanika, njih 31, činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo aparatom po Ilizarovu. Treću grupu činila su 19 ispitanika sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice koji su lečenje započeli spoljnjim unilateralnim rigidnim fiksatorom, a u kasnijem periodu zbog nastalih komplikacija (lo&scaron;e srastanje, produženo srastanje, nesrastanje, infekcija, pseudoartroza) lečenje nastavili konverzijom spoljnjeg unilateralnog rigidnog fiksatora u aparat po Ilizarovu. Osnovni izvor podataka za prikazano istraživanje bio je protokol formiran za svakog bolesnika pojedinačno, istorije bolesti i poliklinička evidencija. Za potrebe istraživanja dizajniran je protokol istraživanja gde su se prikupljeni podaci analizirali hronolo&scaron;ki : podaci o pacijentu, klinički nalaz na prijemu, postoperativni tok, monitoring aparata, klinički nalaz na otpustu i klinički nalaz na kontrolama od 6, 12 i 18 meseci. Kliničke nalaze na kontrolama na 6, 12 i 18 meseci beležili smo upotrebom skoring sistema ASAMI ( Udruženja za istraživanje i primenu metoda po Ilizarovu) &ndash; za ko&scaron;tane rezultate, i Karlstrom &ndash; Oleruda za procenu funkcionalnih rezultata. Neki do najvažnih rezultata dobijenih prilikom ovog istraživanja jesu da je najbrže vreme srastanja imala grupa Ilizarov, nakon 16&plusmn;2 nedelja. Grupa konverzija zabeležila je prosečno vreme srastanja u 17&plusmn;2 nedelji, dok je kod ispitanika u grupi fiksator zabeženo srastanje u 21&plusmn;4 nedelji. Pojava povr&scaron;nih i dubokih infekcija značajno je veća kod grupe tretiranih spoljnim unilateralnim fiksatorom nego kod grupa tretiranih aparatom po Ilizarovu. Vreme postizanje ranog, punog oslonca na operisani ekstremitet je značajno kraće kod grupe Ilizarov i konverzija nego kod grupe fiksator. Procena ko&scaron;tanih rezultata kori&scaron;ćenjem ASAMI bodovnog sistema ko&scaron;tanog srastanja ukazuje na statistički značajno bolje rezultate kod grupa Ilizarov i konverzija u odnosu na grupu spoljnji fiksator u periodu praćenja i analize na 6,12 i 18 meseci. Funkcionalni rezultati primenom sistema funkcionalne evaluacije po Karlstrom &ndash; Olerudu govore u prilog značajno statistički boljim rezultatima kod grupe Ilizarov i konverzija u odnosu na grupu spoljni fiksator u periodima praćenja i analize na 6,12 i 18 meseci. Na osnovu dobijenih rezultata dolazimo do zaključka da je tretman ispitanika sa multifragmentarnim, intraarikularnim prelomima gornjeg i donjeg okrajka kostiju potkolenice znatno efikasniji aparatom po Ilizarovu &scaron;to sveukupno daje smernice za brži i kvalitetniji oporavak ispitanika i njihov povratak svakodnevnim aktivnostima sa &scaron;to manjim posttraumatskim sekvelama.</p> / <p>The complexity of high-energy fractures of the tibia plateau and pilons and their association with significant violations of the soft tissue around the corresponding joint is well described in the literature. Main aim of the treatment is to multiple fractures of the tibia plateau and pilon become stable, articularly aligned, without pain, and with full motion in the knee and ankle joint with minimum risk for post-traumatic osteoarthritis. Ilizarov apparatus with taut needles is used to create a unique load support for the ankle and create conditions for good healing. This strong stability allows early joint movement, without risk of loss position of fracture parts. The aim of this research is assessment and comparation of the results of treatment, for intraarticular multiple fractures of the proximal and distal part of lower leg tretaed with unilateral external rigid fixator and Ilizarov apparatus, with ASAMI bone scoring system and functional scoring sistem by Karlstrom &ndash; Olerud. One of the goals of the study was to detect factors which affecting different treatment results of the intraarticular multiple fractures of the proximal and distal part of lower leg, tretaed with unilateral external rigid fixator and Ilizarov apparatus. The study was designed as a controlled comparative clinical study and data were collected retrospectively and prospectively form medical records from 2008 to 2013. The study has been fully implemented at the Department for orthopedic surgery and traumatology in the Clinical Center of Vojvodina in Novi Sad and included 103 patients who had intraarticular multiple fractures of the proximal and distal part of tibia. Subjects covered in this clinical study were classified into three groups: The first group of 53 patients were with intraartiulary multifragmentary open or closed fractures of the upper or distal part of lower leg, treated exclusively with unilateral external rigid fixator. The second group included 31 patients with intraarticular open or closed fractures of the upper or distal lower leg, treated exclusively with Ilizarov apparatus. 19 patients made the third group with intraarticulary open or closed fractures of the upper or distal lower leg, which were treated at the begining with unilateral external rigid fixator and later because of the complications (poor or prolonged healing, nonunion, infection and pseudoarthrosis) tretment was continued by Ilizarov apparatus. The main source of data for this study was protocol wich was established for each patient individually. In this protocol collected data analyzed by date: patient data, clinical findings at admission, postoperative course, monitoring apparatus, clinical findings at discharge and clinical findings at the controls which were at 6, 12 and 18 months after surgery. Clinical findings at control examinations (6, 12 and 18 months after surgery), we recorded by scoring system ASAMI (Association for the Study and Application of the Methods of Ilizarov) - that represent the results of the bone healing, and Karlstrom - Olerud for assessment functional outcomes. The most important results were: the fastest time of bone union was in the group of Ilizarov, and it was after 16 &plusmn; 2 weeks and the third group (conversion group) recorded an average time after 17 &plusmn; 2 weeks, while the patients in the first group (external fixator) had average time of union after 21 &plusmn; 4 week. The appearance of superficial and deep infection was significantly higher in the group treated with unilateral external fixator than in the group treated by the Ilizarov apparatus. Fastest full weight bearing on the injured leg, had patients in the group treated with Ilizarov apparatus. Evaluation of results using bone ASAMI fusion scoring system indicating a statistically significantly better results in the conversion and Ilizarov group compared to the group of external fixator in the period of monitoring at 6,12 and 18 months after surgery. Functional results by Karlstrom - Olerud scoring system show statistically significantly better results in the Ilizarov and conversion group contrary to the external fixator group in periods of monitoring at 6,12 and 18 months. Based on these results we conclude that the treatment of subjects with intraarticulary, multifragmentary fractures of the upper and lower part of the lower leg are more efficient after Ilizarov apparatus which provides overall guidance for faster and better recovery of patients and their return to their daily activities with minimal post-traumatic sequelae.</p>