Effectiveness of Treatment for Distal Tibial Nonunions With Associated Complex Deformities Using a Hexapod External Fixator

Arvesen, John; Watson, J. Tracy; Israel, Heidi

doi:10.1097/bot.0000000000000726

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…The measured length differences between each LLR can lead to inaccurate bone transports. A residual deformity occurs in approximately one third of the patients after the initial correction [11][12][13][14]. The advantage of TSF treatment is that new protocols can be calculated to adjust for these measurement errors.…”

Section: Discussionmentioning

confidence: 99%

“…3 months) (mFA-mTA mechanical tibiofemoral angle, MPTA medial proximal tibia angle, mLDFA mechanical lateral distal femur angle, mLDTA mechanical lateral distal tibia angle, mLPFA mechanical lateral proximal femur angle, JLCA joint line convergence angle, AMA anatomical and mechanical femoral angle) deformities can occur after the initially planned deformity or length correction [11][12][13][14]. Iterative adjustment of the bone transport and the deformity correction based on the control radiographs are often necessary until the desired mechanical axis alignment is achieved [11,15]. These adjustments are time-consuming, result in higher radiation exposure for the patient, increase treatment time of bone lengthening procedures with increasing risk of pin infections and finally lead to patient's and doctor's dissatisfaction.…”

Section: Introductionmentioning

confidence: 99%

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Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

Ahrend

Rühle

Springer³

et al. 2021

Arch Orthop Trauma Surg

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Introduction In absence of deformity or injury of the contralateral leg, the contralateral leg length is used to plan limb lengthening. Length variability on long-leg weight-bearing radiographs (LLR) can lead to inaccurate deformity correction. The aim of the study was to (1) examine the variability of the measured limb length on LLR and (2) to examine the influence of the position of the magnification device. Materials and methods The limb lengths of 38 patients during deformity correction with a taylor-spatial-frame were measured retrospectively on 7.3 ± 2.6 (4–13) LLR per patient. The measured length of the untreated limb between LLR were used to determine length variability between LLR in each patient. To answer the secondary aim, we took LLR from a 90 cm validation distance. A magnification device was placed in different positions: at the middle of the 90 cm distance (z-position), 5 cm anterior and 5 cm posterior from the z-position, at the bottom and top of the validation distance as well as 5 cm medial and 15 cm lateral from the z-position. Results The measured length variability ranged within a patient from 10 to 50 mm. 76% of patients had a measured limb length difference of ≥ 2 cm between taken LLR. Compared to length measurement of the 90 cm test object with the magnification device in the z-position (90.1 cm), positioning the device 5 cm anterior led to smaller (88.6 cm) and 5 cm posterior led to larger measurements (91.7 cm). The measured length with the magnification device at the bottom, top, medial or lateral (90.4; 89.9; 90.2; 89.8 cm) to the object differed not relevantly. Conclusions High variability of limb length between different LLR within one patient was observed. This can result from different positions of the magnification device in the sagittal plane. These small changes in positioning the device should be avoided to achieve accurate deformity correction and bone lengthening. This should be considered for all length and size measurements on radiographs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

Ahrend

Rühle

Springer³

et al. 2021

Arch Orthop Trauma Surg

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“…Arvesen et al assessed the efficacy of hexapod external fixation for the treatment of distal tibial nonunions with associated complex deformities [33]. They reported a 94% union rate, and reduced a mean 18 degree pre-operative deformity to less than 5 degrees after.…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

Molepo

Barnard²,

Birkholtz

et al. 2018

Eur J Orthop Surg Traumatol

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“…The angular deformity correction of lower limb can be achieved using hinges set on center of rotation of angulation (CORA) of the connecting rods by Ilizarov technique [14]. Currently used hexapod external fixator system can correct multi-directional extra-articular deformity accurately within the rage of measurement in units of 1 mm and 1° [17, 18] (Figures 4 and 5).…”

Section: Extra-articular Deformity and Lower Limb Alignmentmentioning

confidence: 99%

Intra- and Extra-Articular Deformity of Lower Limb: Tibial Condylar Valgus Osteotomy (TCVO) and Distal Tibial Oblique Osteotomy (DTOO) for Reconstruction of Joint Congruency

Watanabe

Takenaka

Kinugasa

et al. 2019

Advances in Orthopedics

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Osteotomies are the established surgical procedure for the deformity of the lower limb induced by osteoarthritis (OA) of the knee and ankle. Closed-wedge (CW) and open-wedge (OW) high tibial osteotomy (HTO) are extra-articular surgery, which aim to shift the mechanical axis from medial to slightly lateral and reduce the overload in the medial compartment of the varus deformed knee by extra-articular correction. However, varus deformity of the knee with the teeter effect, which could be accompanied with subluxation and thrust due to the medial-lateral soft tissue imbalance, is not resolved only by the shift of mechanical axis. The depression of the medial tibia plateau, so-called pagoda deformity, is the intra-articular deformity, which could potentially cause the teeter effect and involves intra-articular incongruency. In such case, the osteotomy with novel concept should be developed to overcome the issues, both the imbalance of soft tissue and intra-articular deformity. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy, which improves the joint congruency of the medial-compartment knee OA with subluxation and/or intra-articular deformity and also provides better joint stability. A similar argument is raised in the treatment of the ankle OA. Low tibial osteotomy (LTO) is an extra-articular surgery to correct malalignment of lower leg. Distal tibial oblique osteotomy (DTOO) is a novel surgery to improve the bony congruency of the ankle OA. In DTOO, the distal tibia is cut obliquely from the proximal medial to the distal lateral in the coronal plane and towards the center of the tibiofibular joint to improve the bony congruency of the ankle joint. Tibial condylar valgus osteotomy (TCVO) and distal tibial oblique osteotomy (DTOO) can correct intra-articular deformity of knee and ankle, respectively. The rationale and indication of TCVO and DTOO for the treatment of the lower limb by reconstructing the joint congruency are discussed.

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Effectiveness of Treatment for Distal Tibial Nonunions With Associated Complex Deformities Using a Hexapod External Fixator

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 18 publications

References 12 publications

Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

Functional outcomes of the failed plate fixation in distal tibial fractures salvaged by hexapod external fixator

Intra- and Extra-Articular Deformity of Lower Limb: Tibial Condylar Valgus Osteotomy (TCVO) and Distal Tibial Oblique Osteotomy (DTOO) for Reconstruction of Joint Congruency

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