Biomechanical Considerations in Foot and Ankle Circular External Fixation: Maintenance of Wire Tension.

Initial tensioning of the forefoot wires to 130 kg followed by simultaneous tensioning of the calcaneal wires to 90 kg and using the rigid double-row foot plate closed anteriorly via threaded rods produce maximum preservation of the initial wire tension during foot circular external fixation.

Treatment Strategies and Frame Configurations in the Management of Foot and Ankle Deformities.

To provide standardized nomenclature for various hexapod frame configurations for foot and ankle deformity correction, a unique classification of the hexapod external fixators was proposed. This classification is based on number of correction levels, secured anatomic blocks, and direction of the strut attachment. It allows the combination of all different foot and ankle frame assemblies into a few standard hexapod configurations, irrespective of which external fixator is used.

Lengthening in Congenital Femoral Deficiency: A Comparison of Circular External Fixation and a Motorized Intramedullary Nail.

Background: Circular external fixation for limb-lengthening is associated with frequent and numerous complications. Intramedullary lengthening devices represent a potential advance in limb-lengthening. The purpose of this study was to compare the outcomes of femoral lengthening in pediatric patients treated by either circular external fixation or a motorized intramedullary nail.

Evaluation of complications of treatment of severe Blount's disease by circular external fixation using a novel classification scheme.

Corrective osteotomy for recalcitrant varus deformity secondary to adolescent and infantile Blount's disease can be challenging because of a combination of severity of deformity, complexity of deformity, and frequent association with patient obesity. We present here the outcome of treatment by osteotomy and gradual deformity correction by circular external fixation in 31 patients with either infantile or adolescent Blount's disease. We used a unique classification scheme to quantify and qualify complications in this patient group: category I, complications not requiring an alteration in the treatment plan, not involving unplanned return to surgery, and not influencing outcome; category II, complications requiring an alteration in the treatment plan, including unplanned returns to surgery, but that did not influence outcome; category IIIA, complications that resulted in a failure to achieve treatment goals; and category IIIB, complications that resulted in a failure to achieve treatment goals and the development of a new pathology or worsening of patient condition.

Deformity correction in pediatric skeletal dysplasia: treatment challenges and solutions.

We reviewed our experience with limb-deformity correction in 54 children with skeletal dysplasias. Our goal was to outline common treatment strategies developed in our hospital to overcome the challenges associated with the management of these conditions. Utilization of computer-assisted preoperative planning, intraoperative monitoring of peripheral nerve function, individualized bone segment stabilization using a modular circular external fixation system, and a flexible distraction protocol improved the precision of angular deformity correction in our practice, simplified external fixator assembly, diminished postoperative frame modifications, enhanced the stability of fixation, and reduced the rate of complications.

Treatment of femoral lengthening-related knee stiffness with a novel quadricepsplasty.

Background: Knee stiffness is common after femoral lengthening. Certain patients require a quadricepsplasty when therapy does not improve flexion. A small subset of such patients may also have obligate patellar dislocation with knee flexion due to contracture of the extensor mechanism.

The effect of the amount of limb lengthening on skeletal muscle.

The adaptation of tibialis anterior muscles after 20% and 30% gradual limb lengthening was evaluated. Eight skeletally mature neutered male goats had 20% (n = 4) or 30% (n = 4) tibial distraction at a rate of 0.25 mm three times per day.