Precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with circular external fixator_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MIAO Qiuju ^1,2 ,  DING Huanwen ¹ , WANG Hong ¹ , TU Qiang ¹ , CHEN Jiarong ¹ , LIU Huiliang ¹

1. Department of Bone and Joint Disease, Guangzhou General Hospital of Guangzhou Military, Guangzhou Guangdong, 510010, P.R.China;
2. Graduate College, Traditional Chinese Medicine University of Guangzhou, Guangzhou Guangdong, 510405, P.R.China;

Corresponding author：

DING Huanwen, Email: dhuanwen123@aliyun.com

Keywords：

Ilizarov circular external fixator; tibial deformity; bone lengthening; digital technology; precisely orthormorphia

DOI：

10.7507/1002-1892.201710066

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Objective To evaluate the effectiveness of precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with external fixator. Methods Twenty-six cases of tibial angulation deformity combined with shortening deformity were treated between June 2012 and August 2016, including 12 males and 14 females aged from 1 to 19 years with an average age of 16.5 years. There were 6 cases of congenital patella pseudoarthrosis, 1 case of fibrous dysplasia of femur and tibia, 3 cases of limb shortening deformity caused by infantile paralysis, 16 cases of fracture malunion. Limb shortening was 1.5-9.5 cm (mean, 6.2 cm) before operation. The deformity from three-dimensional perspective was analysed by digital technology, the surgical procedures of lengthening and osteotomy was simulated, the navigation templates were completed with computer aided design (CAD) and three-dimensional printing, and the external fixator was used to assist the lengthening of the tibia. X-ray films were regularly reviewed after operation to observe the new bone remolding, limb lengthening, load bearing line of lower limb, and recurrences of angulation. Results All the patients were followed up 14-48 months (mean, 18.8 months). There was only 1 case of superficial pin site infection which was cured with oral antibiotics and pin site care with mild disinfectants, and no complication such as bone nonunion, equines deformity, or vascular nerve injury occurred. The deformity of tibia and load bearing line of lower limb had been completely recovered according to postoperative X-ray films at 1 week. All the cases achieved perfect limb length as with preoperative design. The bone mineralization time was 12-20 weeks (mean, 11.6 weeks), the external fixator removal time was 18-26 weeks (mean, 14.9 weeks), and the healing index was 21-78 d/cm (mean, 63.4 d/cm). The postoperative flexion range of the injured limb was 15° less than the unaffected extremity in 1 case, and the situation was improved significantly after some physical manipulation and exercise, who completed the limb lengthening and achieved the expected effectiveness finally. Conclusion Precise orthormorphia of tibial deformity by using digital technology, and limb lengthening with the aid of external fixator can achieve good effectiveness with good reliability, invasiveness, and precision.

Citation： MIAO Qiuju, DING Huanwen, WANG Hong, TU Qiang, CHEN Jiarong, LIU Huiliang. Precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with circular external fixator. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 1018-1025. doi: 10.7507/1002-1892.201710066 Copy

1.	Ilizarov GA. The Apparatus: Components and Biomechanical Principles of Application. Berlin Heidelberg: Springer, 1992: 63-136.
2.	Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res, 1990, (250): 8-26.
3.	Lam A, Garrison G, Rozbruch SR. Lengthening of tibia after transtibial amputation: use of a weight bearing external fixator-prosthesis composite. HSS J, 2016, 12(1): 85-90.
4.	Kovoor CC, George VV, Jayakumar R, et al. Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation-a retrospective study. Injury, 2015, 46(10): 1964-1968.
5.	Bukva B, Vrgoc G, Brdar R, et al. Treatment of congenital leg length discrepancies in children using an Ilizarov external fixator: a comparative study. Coll Antropol, 2014, 38(4): 1171-1174.
6.	Gan Y, Ding J, Xu Y, et al. Accuracy and efficacy of osteotomy in total knee arthroplasty with patient specific navigational template. Int J Clin Exp Med, 2015, 8(8): 12192-12201.
7.	Kaneyama S, Sugawara T, Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient specific screw guide template system. Spine (Phila Pa 1976), 2015, 40(6): E341-348.
8.	Griffet J, Leroux J, El Hayek T. Lumbopelvic stabilization with external fixator in a patient with lumbosacral agenesis. Eur Spine J, 2011, 20 Suppl 2: S161-165.
9.	Bilen FE, Kocaoglu M, Eralp L, et al. Fixator-assisted nailing and consecutive lengthening over an intramedullary nail for the correction of tibial deformity. J Bone Joint Surg (Br), 2010, 92(1): 146-152.
10.	Sun XT, Easwar TR, Manesh S, et al. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail. J Bone Joint Surg (Br), 2011, 93(6): 782-787.
11.	Fernandes HP, Barronovo DG, Rodrigues FL, et al. Femur lengthening with monoplanar external fixator associated with locked intramedullary nail. Rev Bras Ortop, 2016, 52(1): 82-86.
12.	Shyam AK, Song HR, An H, et al. The effect of distraction-resisting forces on the tibia during distraction osteogenesis. J Bone Joint Surg (Am), 2009, 91(7): 1671-1682.
13.	Wagner H. Operative lengthening of the femur. Clin Orthop Relat Res, 1978, (136): 125-142.
14.	Iacobellis C, Berizzi A, Aldegheri R. Bone transport using the Ilizarov method: a review of complications in 100 consecutive cases. Strateg Trauma Limb Reconstr, 2010, 5(1): 17-22.
15.	Yin P, Zhang Q, Mao Z, et al. The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods. Acta Orthop Belg, 2014, 80(3): 426-435.
16.	De Bastiani G, Aldegheri R, Renzi-Brivio L, et al. Limb lengthening by callus distraction (callostasis). J Pediatr Orthop, 1987, 7(2): 129-134.
17.	Kocaoğlu M, Bilen FE, Dikmen G, et al. Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthop Traumatol Turc, 2014, 48(2): 157-163.
18.	Giebel G. Infected non-unions with soft tissue loss: the shortening-lengthening technique. London: Springer, 2000: 563-567.
19.	Fu M, Lin L, Kong X, et al. Construction and accuracy assessment of patient- specific biocompatible drill template for cervical anterior transpedicular screw (ATPS) insertion: an in vitro study. PLoS One, 2013, 8(1): e53580.
20.	Harshwal RK, Sankhala SS, Jalan D. Management of nonunion of lower-extremity long bones using mono-lateral external fixator--report of 37 cases. Injury, 2014, 45(3): 560-567.
21.	Heller M, Bauer HK, Goetze E, et al. Applications of patient-specific 3D printing in medicine. Int J Comput Dent, 2016, 19(4): 323-339.
22.	Upex P, Jouffroy P, Riouallon G. Application of 3D printing for treating fractures of both columns of the acetabulum: benefit of pre-contouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res, 2017, 103(3): 331-334.
23.	Peters-Strickland T, Pestreich L, et al. Usability of a novel digital medicine system in adults with schizophrenia treated with sensor-embedded tablets of aripiprazole. Neuropsychiatr Dis Treat, 2016, 12: 2587-2594.
24.	Neyaz Z, Phadke RV, Singh V, et al. Three-dimensional visualization of intracranial tumors with cortical surface and vasculature from routine MR sequences. Neurol India, 2017, 65(2): 333-340.

1. Ilizarov GA. The Apparatus: Components and Biomechanical Principles of Application. Berlin Heidelberg: Springer, 1992: 63-136.
2. Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res, 1990, (250): 8-26.
3. Lam A, Garrison G, Rozbruch SR. Lengthening of tibia after transtibial amputation: use of a weight bearing external fixator-prosthesis composite. HSS J, 2016, 12(1): 85-90.
4. Kovoor CC, George VV, Jayakumar R, et al. Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation-a retrospective study. Injury, 2015, 46(10): 1964-1968.
5. Bukva B, Vrgoc G, Brdar R, et al. Treatment of congenital leg length discrepancies in children using an Ilizarov external fixator: a comparative study. Coll Antropol, 2014, 38(4): 1171-1174.
6. Gan Y, Ding J, Xu Y, et al. Accuracy and efficacy of osteotomy in total knee arthroplasty with patient specific navigational template. Int J Clin Exp Med, 2015, 8(8): 12192-12201.
7. Kaneyama S, Sugawara T, Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient specific screw guide template system. Spine (Phila Pa 1976), 2015, 40(6): E341-348.
8. Griffet J, Leroux J, El Hayek T. Lumbopelvic stabilization with external fixator in a patient with lumbosacral agenesis. Eur Spine J, 2011, 20 Suppl 2: S161-165.
9. Bilen FE, Kocaoglu M, Eralp L, et al. Fixator-assisted nailing and consecutive lengthening over an intramedullary nail for the correction of tibial deformity. J Bone Joint Surg (Br), 2010, 92(1): 146-152.
10. Sun XT, Easwar TR, Manesh S, et al. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail. J Bone Joint Surg (Br), 2011, 93(6): 782-787.
11. Fernandes HP, Barronovo DG, Rodrigues FL, et al. Femur lengthening with monoplanar external fixator associated with locked intramedullary nail. Rev Bras Ortop, 2016, 52(1): 82-86.
12. Shyam AK, Song HR, An H, et al. The effect of distraction-resisting forces on the tibia during distraction osteogenesis. J Bone Joint Surg (Am), 2009, 91(7): 1671-1682.
13. Wagner H. Operative lengthening of the femur. Clin Orthop Relat Res, 1978, (136): 125-142.
14. Iacobellis C, Berizzi A, Aldegheri R. Bone transport using the Ilizarov method: a review of complications in 100 consecutive cases. Strateg Trauma Limb Reconstr, 2010, 5(1): 17-22.
15. Yin P, Zhang Q, Mao Z, et al. The treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator and a systematic review of infected tibial nonunion treated by Ilizarov methods. Acta Orthop Belg, 2014, 80(3): 426-435.
16. De Bastiani G, Aldegheri R, Renzi-Brivio L, et al. Limb lengthening by callus distraction (callostasis). J Pediatr Orthop, 1987, 7(2): 129-134.
17. Kocaoğlu M, Bilen FE, Dikmen G, et al. Simultaneous bilateral lengthening of femora and tibiae in achondroplastic patients. Acta Orthop Traumatol Turc, 2014, 48(2): 157-163.
18. Giebel G. Infected non-unions with soft tissue loss: the shortening-lengthening technique. London: Springer, 2000: 563-567.
19. Fu M, Lin L, Kong X, et al. Construction and accuracy assessment of patient- specific biocompatible drill template for cervical anterior transpedicular screw (ATPS) insertion: an in vitro study. PLoS One, 2013, 8(1): e53580.
20. Harshwal RK, Sankhala SS, Jalan D. Management of nonunion of lower-extremity long bones using mono-lateral external fixator--report of 37 cases. Injury, 2014, 45(3): 560-567.
21. Heller M, Bauer HK, Goetze E, et al. Applications of patient-specific 3D printing in medicine. Int J Comput Dent, 2016, 19(4): 323-339.
22. Upex P, Jouffroy P, Riouallon G. Application of 3D printing for treating fractures of both columns of the acetabulum: benefit of pre-contouring plates on the mirrored healthy pelvis. Orthop Traumatol Surg Res, 2017, 103(3): 331-334.
23. Peters-Strickland T, Pestreich L, et al. Usability of a novel digital medicine system in adults with schizophrenia treated with sensor-embedded tablets of aripiprazole. Neuropsychiatr Dis Treat, 2016, 12: 2587-2594.
24. Neyaz Z, Phadke RV, Singh V, et al. Three-dimensional visualization of intracranial tumors with cortical surface and vasculature from routine MR sequences. Neurol India, 2017, 65(2): 333-340.

Chinese Journal of Reparative and Reconstructive Surgery

Precise orthormorphia of tibial angulation deformity and shortening deformity by using digital technology combined with circular external fixator

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