Correction of lower limb deformities with fixator assisted nailing.

Hussain Wahab,Masood Umer,Talal Aqueel Noor-Us-Sabah,Shah Fahad,Haroon Ur Rashid,Yasir Mohib

doi:10.1016/j.amsu.2019.07.006

Hussain Wahab, Masood Umer + Show 4 more

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https://doi.org/10.1016/j.amsu.2019.07.006

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Abstract

IntroductionDeformities of the lower extremities can be congenital or acquired. Various surgical treatments have been employed for such disorders including osteotomy followed by either external fixation, internal fixation or external fixator assisted internal fixation. The aim of surgery is correction of deformity and restoration of mechanical axis and joint line. External fixator assisted internal fixation with intramedullary (IM) nail insertion is considered the gold standard, however, it is less commonly practiced as expertise required are usually not available at most centers. This study was conducted to assess the radiological and functional outcomes after fixator assisted IM nailing for correction of lower limbs deformity.MethodsIt was a retrospective study at a tertiary care hospital. All cases of lower limb deformity whose correction was done with fixator assisted IM nailing from 2010 till 2017 were analyzed. Pre Op x-rays and post op x rays were analyzed for Mechanical Axis Deviation (MAD), anatomical Lateral Distal Femoral Angle (aLDFA), mechanical Lateral Distal Femoral Angle (mLDFA) and Medial Proximal Tibial Angle (MPTA), post-operative activity and functional status of the patients. Data was analyzed using SPSS.ResultsThirteen patients were included in the study. Fixator assisted IM nailing was performed on 29 long bones of these patients including 16 femur and 13 tibial deformities. Pre Op and Post Op comparison was done for MAD, aLDFA, mLDFA, MPTA. Pre op mean MAD was 38.87 ± 25.58 post op mean MAD 17.54 ± 12.25 mm. Only 2 of our patients developed knee stiffness for which manipulation under anesthesia was done. One of our patients developed weakness in toe extension, which recovered after 6 months. On follow up evaluation patients had normal range of motion and no functional limitation.ConclusionFixator assisted IM nailing for deformity correction is a better option, because it has advantages of both external fixator and internal fixator. Knee stiffness associated with external fixator can be prevented. It is more convenient for patient.

Highlights

Deformities of the lower extremities can be congenital or acquired
First described by Paley in 1997, the internal fixation (i.e.; intramedullary nail) gives stability, patient convenience and prevents recurrence of the deformity; the temporary external fixator helps in accuracy and adjustability [4]
In this study we present our experience of deformity correction of lower limb with fixator assisted intramedullary nailing, its radiological outcome and complications

Summary

Introduction

Deformities of the lower extremities can be congenital or acquired. Various surgical treatments have been employed for such disorders including osteotomy followed by either external fixation, internal fixation or external fixator assisted internal fixation. This study was conducted to assess the radiological and functional outcomes after fixator assisted IM nailing for correction of lower limbs deformity. All cases of lower limb deformity whose correction was done with fixator assisted IM nailing from 2010 till 2017 were analyzed. Conclusion: Fixator assisted IM nailing for deformity correction is a better option, because it has advantages of both external fixator and internal fixator. Knee stiffness associated with external fixator can be prevented The Fixator assisted nailing is considered the gold standard, because it has advantages of both methods of deformity correction [3]. First described by Paley in 1997, the internal fixation (i.e.; intramedullary nail) gives stability, patient convenience and prevents recurrence of the deformity; the temporary external fixator helps in accuracy and adjustability [4]

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