PubMed · 8784691
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J A Fixsen. Problems in the lower extremity.. https://pubmed.ncbi.nlm.nih.gov/8784691/
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Basically, four post-traumatic conditions of the proximal femur can be improved by corrective osteotomies: recurring luxations and subluxations of the hip joint; necrosis of the femoral head; non-unions; deformities. Dependent on the individual situation, the following procedure can be recommended, including diagnosis of deformities and indication and therapy of corrective osteotomies: analysis of the problem from the viewpoint of history, clinical findings and imaging techniques; indication for corrective osteotomy; graphic planning; operation technique. Particularities of post-traumatic conditions with regard to diagnosis, indication and surgical technique are indicated. Only with perfectly tailored concepts can we respond to the individual situation of an individual patient and reflect the variety and complexity of post-traumatic conditions of the proximal femur.
Although the simplest way to correct bone deformity is one-stage correction, the problem associated with that method is overstretching of the soft tissues, which limits the correction and leads to complications such as compartment syndrome or peripheral nerve palsy. If an adequate amount of tissue necessary for correction is formed in advance, the deformity can be corrected safely at one stage without overstretching of the tissues. A leg lengthening technique was employed to form the necessary tissues. After leg lengthening with an unilateral external fixator (Hifixator), deformities were corrected manually at one stage without anesthesia, and the corrected positions were again secured with the fixator. To correct rotational deformity, two sets of pins were inserted into the proximal bone fragment of the tibia at the time of the operation, and after lengthening the proximal pin clamp of the fixator was disconnected from one pin set and reconnected to the other set. We applied this method to four tibias of three patients without any complications. The tension of the tissues was monitored using a pressure sensor built into a Hifixator to prevent the tissues from overstretching. During and after the correction, the tension of the tissue was maintained at less than before the correction.
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