Correction of post-traumatic deformities by osteotomy and external fixation

Introduction In post-traumatic deviations, the operative realignement of the joint axis is mandatory to prevent an early joint degeneration. Moreover, the angular deformity may cause a reduction in the normal R.O.M when it lies close to the joint. Post-traumatic deformities are usually multiplanar and deviations on the frontal, sagittal or horizontal plane can be mutually associated. The aim of this paper is to report on the results of surgical treatment of these deformities by osteotomy and unilateral external fixation (EF). Patients and Methods We reviewed the files of all patients affected by long bones post-traumatic deformities treated in the 2000–2006 period. We selected only patients in whom the correction was obtained by osteotomy and EF. A total of 16 patients fulfilled these inclusion criteria. In all cases a MMF or Orthofix device was used. Fourteen deformities occurred in tibia and two in humerus. The osteotomy level was set preoperatively according to Paley et al. The postoperative angular correction, the mechanical axis, as well as the development of osteoarthritic changes were clinically and radiographicallyradiographically evaluated on follow-up controls. Results No patient had undergone total arthroplasty or reported disabling pain in the joints nearby the operated bone segment. A nearly normal ROM was detected in these joints in all patients but one, affected by preoperative knee osteoarthritis. The mean time until consolidation of the osteotomy was 3.8 months (2.2– 4.8). Complete normalisation of the frontal axis of the involved bone was observed in 12 tibial and in the 2 humeral cases. In two tibial deformities we were forced to carry out the osteotomy far away from the centre of rotational angulation (C.O.R.A.), because of a skin dystrophy. In these cases a clinically silent translational deformity developed. Discussion and Conclusions The results of surgical correction of posttraumatic deformities with osteotomy and EF were satisfactory. The main advantage of EF is represented by its flexibility which enables the surgeon to correct even complex deformities, allowing postoperative adjustments of the bone axis. Moreover, no iterative surgery is required to remove the hardware.