Nonunion of Vascularized Fibula With Shortening and Multiplanar Deformity in a 6 Years Old Managed Simultaneously With Hexapod Circular External Fixator

Abstract

The hexapod circular external fixator is considered a major upgrade to the classic Ilizarov ring fixators, which made it easier to manage complex deformities. Surgeons now, using it, can manage deformities in all three planes simultaneously without the need for frame modifications. We present a case report that shows the versatile nature of the hexapod circular fixator in a 6-year-old female patient who presented with multiple problems seen in a single bone, namely, two types nonunion at two different sites of a vascularized fibula graft of the leg (hypertrophic nonunion at the proximal site and atrophic nonunion at the distal site) with varus, procurvatum, and internal rotation deformities as well as 3-cm shortening. She underwent vascularized fibular graft surgery to treat osteomyelitis of the tibia 2 years prior. A hexapod circular fixator was applied which would statically stabilize the lower nonunion site (augmented with bone marrow injection at that site) and corrected the deformities and shortening through distraction at the proximal hypertrophic nonunion site in one surgical procedure. The case demonstrates the versatility of the hexapod circular fixator in treating complex orthopaedic situations, maintaining a minimally invasive approach while allowing full weight-bearing.