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Bone elongation using monolateral external fixation: a practical guide.

Salcedo Cánovas C - Strategies Trauma Limb Reconstr (2015)

Bottom Line: In the literature, we can find many articles that describe in detail specific complex procedures related to the limb reconstruction.These articles also come from a period in which the callotasis technique was being developed and, therefore, incur in discrepancies depending on the year they were written or the school of the author.This paper provides a general and summarised overview of the theoretical and practical aspects interesting to a surgeon that needs clear information on the bone elongations performed with the help of a monolateral external fixator.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, Unit of Paediatric Orthopaedic Surgery and Traumatology, CSUR - Spanish Reference Unit of the Spanish Health System, University Hospital "Virgen de la Arrixaca", University of Murcia, Plaza de Fontes, 4. 3º C, Murcia, Spain. cesalcan@yahoo.es.

ABSTRACT
In the literature, we can find many articles that describe in detail specific complex procedures related to the limb reconstruction. However, the general information on the biological and mechanical bases of callotasis is out of date, and the surgeons must relate to works dating from the early 1980s. These articles also come from a period in which the callotasis technique was being developed and, therefore, incur in discrepancies depending on the year they were written or the school of the author. This paper provides a general and summarised overview of the theoretical and practical aspects interesting to a surgeon that needs clear information on the bone elongations performed with the help of a monolateral external fixator.

No MeSH data available.


Related in: MedlinePlus

Lengthening along the mechanical axis (left) and the anatomical axis (right)
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Fig7: Lengthening along the mechanical axis (left) and the anatomical axis (right)

Mentions: The decision to place the body of the fixator with respect to the anatomical or mechanical axis of the bone to be lengthened is important, and it will depend on the situation of the first screw (unless articulated clamps are used). For some authors, it is important that the longitudinal axis of the fixator is parallel to the femoral diaphysis, following the anatomical axis of the femoral bone [1, 2]. However, when the femoral lengthenings exceed 7–9 cm, we can see an increase in femoral valgus above 7°. If the elongation axis is not parallel to the mechanical axis, a minor deformity will occur during the gradual increase in length. An axis of elongation parallel to the anatomical axis of the femur shall move the knee medially and force the mechanical axis in the lateral direction, resulting in a valgus deformity of the knee. Per each centimetre of elongation along the anatomical axis, the mechanical axis is laterally displaced 1 mm. For this reason, other authors consider that the body of the fixator has to be placed in parallel with the mechanical axis, preventing the valgus and the medial translation during the lengthening, [6] as shown in Fig. 6. Nevertheless, we also have to take into consideration that placing the body of the fixator parallel to the mechanical axis will result in having more stress on the pin bone interface since the screws will not be inserted at right angles into the bone. Also, the frame will not be parallel to the limb (Fig. 7).Fig. 6


Bone elongation using monolateral external fixation: a practical guide.

Salcedo Cánovas C - Strategies Trauma Limb Reconstr (2015)

Lengthening along the mechanical axis (left) and the anatomical axis (right)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666227&req=5

Fig7: Lengthening along the mechanical axis (left) and the anatomical axis (right)
Mentions: The decision to place the body of the fixator with respect to the anatomical or mechanical axis of the bone to be lengthened is important, and it will depend on the situation of the first screw (unless articulated clamps are used). For some authors, it is important that the longitudinal axis of the fixator is parallel to the femoral diaphysis, following the anatomical axis of the femoral bone [1, 2]. However, when the femoral lengthenings exceed 7–9 cm, we can see an increase in femoral valgus above 7°. If the elongation axis is not parallel to the mechanical axis, a minor deformity will occur during the gradual increase in length. An axis of elongation parallel to the anatomical axis of the femur shall move the knee medially and force the mechanical axis in the lateral direction, resulting in a valgus deformity of the knee. Per each centimetre of elongation along the anatomical axis, the mechanical axis is laterally displaced 1 mm. For this reason, other authors consider that the body of the fixator has to be placed in parallel with the mechanical axis, preventing the valgus and the medial translation during the lengthening, [6] as shown in Fig. 6. Nevertheless, we also have to take into consideration that placing the body of the fixator parallel to the mechanical axis will result in having more stress on the pin bone interface since the screws will not be inserted at right angles into the bone. Also, the frame will not be parallel to the limb (Fig. 7).Fig. 6

Bottom Line: In the literature, we can find many articles that describe in detail specific complex procedures related to the limb reconstruction.These articles also come from a period in which the callotasis technique was being developed and, therefore, incur in discrepancies depending on the year they were written or the school of the author.This paper provides a general and summarised overview of the theoretical and practical aspects interesting to a surgeon that needs clear information on the bone elongations performed with the help of a monolateral external fixator.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, Unit of Paediatric Orthopaedic Surgery and Traumatology, CSUR - Spanish Reference Unit of the Spanish Health System, University Hospital "Virgen de la Arrixaca", University of Murcia, Plaza de Fontes, 4. 3º C, Murcia, Spain. cesalcan@yahoo.es.

ABSTRACT
In the literature, we can find many articles that describe in detail specific complex procedures related to the limb reconstruction. However, the general information on the biological and mechanical bases of callotasis is out of date, and the surgeons must relate to works dating from the early 1980s. These articles also come from a period in which the callotasis technique was being developed and, therefore, incur in discrepancies depending on the year they were written or the school of the author. This paper provides a general and summarised overview of the theoretical and practical aspects interesting to a surgeon that needs clear information on the bone elongations performed with the help of a monolateral external fixator.

No MeSH data available.


Related in: MedlinePlus