Progressive Correction in Bone and Soft Tissue Deformity Using Monolateral Fixation or the Sheffield Hybrid System
Progressive deformity correction is indicated where acute correction might lead to nerve or vessel injury or to compartment syndrome. In the thigh, acute corrections are well tolerated, but in the lower leg such corrections are associated with an increased risk. This is due in part to the fact that the muscle compartments are tighter, predisposing to compartment syndrome, and in part to the sensitivity of the peroneal nerve to acute stretching. Progressive deformity correction relies on the use of hinges around which the bone rotates. Specially adapted monolateral fixators such as the ProCallus fixator in conjunction with the self-aligning articulated body, or the Limb Reconstruction System in conjunction with the OF-Garches, have a hinge whose position is fixed in relation to the adjacent screws. Such devices may be used for progressive deformity correction provided that the osteotomy is sited at the same level and is in the same plane as the hinge. Unwanted translational effects may occur if the osteotomy is either too high or too low (see Ch. 36).
KeywordsCompartment Syndrome Varus Deformity Osteotomy Site Oblique Plane Mechanical Axis Deviation
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