Introduction Closed distraction of stiff tibial nonunions with a hexapod external fixator can predictably lead to union without the need for additional surgery or bone graft.
Indications & Contraindications
Step 1: Fibular Osteotomy Resect 5 to 10 mm of the fibula, from its distal half or at the level of the fibular deformity if present.
Step 2: Application of Hexapod Proximal Ring Using “Rings First” Method Apply the proximal ring orthogonal to the proximal bone segment.
Step 3: Application of Hexapod Distal Ring Using “Rings First” Method Apply the distal ring orthogonal to the distal bone segment.
Step 4: Connection of Struts and Application of Sterile Dressing Connect the proximal and distal rings with 6 oblique struts.
Step 5: Postoperative Planning, Deformity Correction, and Distraction Perform gradual deformity correction and distraction at a rate of 1 mm per day.
Step 6: Postoperative Care Until Union Perform pin-site care and functional rehabilitation.
Step 7: “Trial of Union” and Frame Removal Ensure adequate union prior to removal of the circular fixator.
Results Hexapod closed distraction has been successfully used for the management of stiff hypertrophic tibial nonunions in our practice over the last 6 years.
Pitfalls & Challenges
Closed distraction of stiff tibial nonunions with a hexapod external fixator can predictably lead to union without the need for additional surgery or bone graft.
Tibial nonunions are challenging to treat despite the frequency with which these complications are encountered. The associated morbidities include disuse osteopenia and joint contractures that complicate the management further and necessitate a treatment strategy that will allow early functional rehabilitation. Closed distraction with a hexapod external fixator for treatment of stiff hypertrophic tibial nonunion has the advantages of gradual correction of concomitant deformities, restoration of limb length, stability that allows early functional rehabilitation, and predictable union rates.
Preoperatively, all …
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