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  • 2022-02-17Principles of multiplanar deformity analysis and correction in long bone

  • 2022-02-17Calculation of the True Plane of the Deformity

  • 2022-01-17Tips for timely diagnosis of Charcot foot and ankle

  • 2021-12-21Magnetic Resonance for Charcot Foot and Ankle Diagnosis

  • Tags complex_foot_deformity, correction_of_deformity, correction_of_deformity_following_lengthening, correction_of_deformity_with_lengthening, fusion_with_concomitant_femoral_lengthening, lengthening
Acute or gradual correction of a deformity?
2022-01-17

Although several studies have reported good results of the treatment of the lower extremity deformity combined with shortening – a condition that often means disabling impairment in the daily life activities – to date there are still very few studies that review the evidence by comparing the outcomes of acute versus gradual correction.

A lower extremity deformity is usually caused by congenital or acquired anomaly, arthritis, trauma, tumor or infection.

Several methods have been described to surgically treat deformities, which can be synthesized as either acute or gradual correction, although to this day there is little evidence to recommend one form of correction over the other. Various studies consider accuracy of reduction as the primary outcome measure to compare the two different methods. (1) (2) For some experts, acute correction has the benefit of shorter time to healing and is more comfortable for the patients. Gradual correction needs more compliance by the patient, but is more forgiving. (3)

Both monolateral and circular external frames can be used for either acute or gradual correction.

In the gradual correction by using a monolateral external fixator to treat a deformity, some key points should be considered: 1) when the device is positioned on the convex side of the deformity, angular correction through the micrometric clamp will distract the osteotomy; 2) By contrast, if the device is placed on the concave side of the deformity, a compression will occur at the osteotomy. If there is not a sufficient gap at the osteotomy site, the bone ends will jam and prevent any further correction.

In the acute correction by using a monolateral external fixator, templates are designed to permit the accurate placement of the two sets of bone screws. They are not designed to be left in place while the correction is performed. They are instead designed to be replaced by two standard straight LRS (the Limb Reconstruction System designed by Orthofix) clamps. If the bone screws have been positioned correctly, once osteotomy has been performed, the manipulation to place the screws into standard straight LRS clamps should conclude the required correction.

References

  1. Gilbody J, Thomas G et al. 2009. Acute Versus Gradual Correction of Idiopathic Tibia Vara in Children. J Ped Orthop; 29(2):110-4.
  2. Matsubara H, Tsuchiya H et al. Deformity correction and lengthening of lower legs with an external fixator. Int Orthop; 30(6):550-4.
  3. Mogeeb Radwan M AE 2020. Correction of Adolescent Blount’s Disease Deformity Using Hinged Ilizarov Frame. Ortho Res Online J; 6(4). OPROJ.000643.2020.
< Magnetic Resonance for Charcot Foot and Ankle Diagnosis > Tips for timely diagnosis of Charcot foot and ankle

MORE POSTS

Principles of multiplanar deformity analysis and correction in long bone2022-02-17

A multiplanar deformity analysis can be both simple and complex: a correct determination of angular and metric deformity apex and plane is a fundamental task. This is true in both the preoperative surgery planning and the postoperative management phases, in order to obtain the most accurate correction and promote the quickest recovery for the patient’s well-being.

Calculation of the True Plane of the Deformity2022-02-17

The initial assessment of any lower extremity deformity is fundamental to plan a successful surgical program of correction, as well as an effective post-operative management of the healing process. The assessment should include the X-rays of full length weight bearing of both legs, with a complete axis evaluation to fix the position of the deformities, which is “the true plane of the deformity”.

CORA (Center Of Rotation of Angulation)2021-12-17

The term CORA (Center of Rotation of Angulation) means a method of mechanical and anatomical axis planning based on joint orientation, which has gained international recognition and acceptance. Many surgeons from all over the world apply this method to limb lengthening and deformity correction, and the CORA principles and concepts have clearly shaped both design and functionality of the last generation of external devices.

Basic considerations of deformity correction: Anatomical and Mechanical Axis2021-05-15

Bone deformity is a three-dimensional issue, considering the three-dimensional shape of bones and joints. All basic considerations of deformity correction by using an external device should include the fundamental concepts of Anatomical and Mechanical Axis. These concepts allow a better understanding of the effects of adjustments or modifications in one plane when managing a three-dimensional problem such as bone deformity.

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