Diaphyseal osteotomy after post-traumatic malalignment

Abstract

Tibia and femur shaft fractures can sometimes lead to post-traumatic deformities. Correction by means of circular external frames is a valuable option. The aim of this article is to give an overview of the problem and to focus on some important technical issues of the preoperative planning, the surgical procedures, and the postsurgical management of circular external fixators.

Fig. 1

Female, 20 years, malunion distal left femur (Salter Harris fracture 8 years earlier): (1) 7° valgus, 22 mm shortening, no axial deformity. (2) The CORA is in close proximity to the intercondylar notch. (3) Teleradiography 38 days since surgery, 31 days after the beginning of the correction. The osteotomy was performed necessarily proximal to the CORA (see point 2), a certain amount of lateral shift was expected. Some degrees of anatomic varus, limb mechanical axis, and lengthening restoration

Fig. 2

The CORAgin method

Fig. 3

Male, 43 years. Malunion right tibia after open Gustilo-Anderson III A fracture (2 years earlier), 18° valgus, 35 mm shortening. (1) Preoperative teleradiography. (2) The chisel for the De Bastiani osteotomy (corticotomy) under fluoroscopy. (3) Postoperative X-ray control. (4) Teleradiography at the end of the correction (35 days after the operation, 28 days after the beginning of the correction)