Dataset Information

A retrospective comparative study of corrective osteotomy for tibial deformities with the multiaxial correction fixator and the circular fixator.

ABSTRACT:

Purpose

A multiaxial correction (MAC) fixator is a monolateral type of fixator that can correct multi-planer deformities. The purpose of this study is to compare the clinical outcome of correction for tibial deformities with the MAC fixator and the circular external fixators.

Methods

We retrospectively reviewed consecutive patients reconstructed with the MAC fixator (MAC group) or circular external fixators (Ring group) due to the congenital diseases or residual conditions after treatment of trauma, infection, tumor, or limb lengthening between 2003 and 2016.

Results

The 30 patients who had angular tibial deformity were included. In patients with tibia vara or lateral bowing, the average pre-operative mechanical medial proximal tibial angle (mMPTA) of the MAC group and the Ring group was significantly increased to 86.9 ± 3.5° in the MAC group and 88.0 ± 3.6° in the Ring group postoperatively. Medial bowing was also successfully corrected in both groups. Regarding the sagittal alignment, post-operative anatomical posterior proximal tibial angle (aPPTA) of the MAC group was deteriorated after coronal correction. The operative time was significantly shorter in the MAC group than the Ring group (p < 0.05).

Conclusion

The MAC fixator successfully corrected coronal deformities of the tibia with shorter operative time, but it has a risk of occurrence of the procurvatum deformity compared with circular external fixators. Paying attention to the sagittal alignment, the MAC fixator can be one of the treatment options for correction of the coronal tibial deformities.

SUBMITTER: Matsushita M

PROVIDER: S-EPMC7394807 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description: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.