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External Fixators for Deformity Correction

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Essential Biomechanics for Orthopedic Trauma

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Abstract

External fixators have reinvented the art of deformity correction by incorporating the 4D technology of gradual correction over time into the operative strategy. Computer navigation through the use of hexapod technology has further advanced the surgeon’s ability to realign malunited fractures and nonunions safely and reproducibly. Frame stability is paramount to successfully controlling the fixated bone fragments and performing accurate deformity correction with reliable healing. The biomechanics begin with a thorough evaluation of the patient and the radiographs to generate a comprehensive preoperative plan. A stable frame is applied in the operating room, and a minimally invasive surgery is performed when possible. Careful follow-up is done to check the frame integrity including strut markings, the adjacent soft tissues, and the radiographs. Problems and obstacles are addressed. Frame removal is determined by assessing many factors.

The success of this method is proven and is the result of the hard work and courage of many surgeons and patients. Several studies have been cited in this chapter but only represent a fraction of the work that has been done in this field, particularly at the Ilizarov Scientific Center in Kurgan, Russia, where extensive research has taken place for decades. The field of deformity correction continues to evolve as we better understand which deformities can be corrected acutely and which require gradual approach. While internal lengthening technology has dominated femur limb reconstruction in recent years, there will always be a role for circular frames in this field.

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Authors and Affiliations

  1. Weill Medical College of Cornell University, New York, NY, USA

    Austin T. Fragomen

  2. Limb Lengthening and Complex Reconstruction Service, The Hospital for Special Surgery, New York, NY, USA

    Austin T. Fragomen

  3. Department of Orthopaedic Surgery, Benioff Children’s Hospital at Mission Bay, University of California at San Francisco, San Francisco, CA, USA

    Kristin S. Livingston

  4. Department of Orthopedics, Benioff Children’s Hospital of Oakland, University of California–San Francisco, Oakland, CA, USA

    Sanjeev Sabharwal

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  1. Austin T. Fragomen
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  2. Kristin S. Livingston
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  3. Sanjeev Sabharwal
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Correspondence to Austin T. Fragomen .

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Editors and Affiliations

  1. Orthopaedic Trauma Service, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    Brett D. Crist

  2. BayCare Health System, Lutz, FL, USA

    Joseph Borrelli Jr.

  3. Injury Repair and Recovery Program, McGill University Health Center Research Institute, Montreal, QC, Canada

    Edward J. Harvey

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Fragomen, A.T., Livingston, K.S., Sabharwal, S. (2020). External Fixators for Deformity Correction. In: Crist, B., Borrelli Jr., J., Harvey, E. (eds) Essential Biomechanics for Orthopedic Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-36990-3_8

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