Fixator-assisted tibial lengthening over a plate in a patient with sequelae of poliomyelitis

Abstract

There are many techniques for limb lengthening. Lengthening over a plate is an alternative choice of fixation in children or when nailing is difficult. We present a new technique for tibial lengthening with using a monolateral external fixator over a lengthening plate.Lengthening over an intramedullary nail is a commonly used method in patients with short stature or limb-length discrepancy. However, in patients with a narrow and excessively sclerotic intramedullary cavity in the pediatric age group where the skeletal system has not yet fully developed, difficulties have been observed in lengthening methods with nailing.Therefore, in these cases, the use of lengthening techniques over a plate is an alternative treatment option. Nevertheless, in lengthening techniques over a plate, if one side of the osteotomy area cannot be fixed, associated mechanical axis problems have been reported.We applied tibia lengthening with external fixator assistance over a custom-made lengthening plate in a patient with sequelae of poliomyelitis. This new lengthening technique applied over a plate could be the solution to the problems observed in other lengthening techniques over a plate.

Figure 1

Lateral (A) and anteroposterior (B) images of the custom-made anatomic lateral proximal tibia lengthening plate. Screw fixation in the “Lengthening Hole” from the distal of the osteotomy area allows lengthening by sliding over the plate during lengthening.

Figure 2

The anatomic lateral proximal tibial lengthening plate designed to be compatible with the minimally invasive plate osteosynthesis technique was placed subcutaneously. Anterior (A) and lateral (B) view of the lengthening plate and insertion guide. Using a small incision and the guide, the lengthening plate was placed subcutaneously on the tibial lateral surface (C).

Figure 3

Anteroposterior (A) and lateral (B) fluoroscopy images after fixation of the lengthening plate.

Figure 4

Anteroposterior (A) and lateral (B) fluoroscopy images after osteotomy.

Figure 5

Visual image (A) and fluoroscopic image (B) of the monolateral external fixator placement on the tibial medial surface.

Figure 6

Postoperative anteroposterior (A) and lateral (B) radiographic images before lengthening.

Figure 7

Anteroposterior (A) and lateral (B) radiographic images after lengthening.

Figure 8

Anteroposterior (A) and lateral (B) radiographic images after fixation of the most distal screws of the lengthening plate after removal of the external fixator.

Figure 9

Anteroposterior (A) and lateral (B) radiographic images document healing of the lengthening area and well consolidated osteotomy site.