Correction of Tibial Deformity with Use of the Ilizarov- Taylor Spatial Frame by S. Robert Rozbruch, Austin T. Fragomen, and Svetlana Ilizarov J Bone Joint.

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Presentation transcript:

Correction of Tibial Deformity with Use of the Ilizarov- Taylor Spatial Frame by S. Robert Rozbruch, Austin T. Fragomen, and Svetlana Ilizarov J Bone Joint Surg Am Volume 88(suppl 4): December 1, 2006 ©2006 by The Journal of Bone and Joint Surgery, Inc.

This varus deformity is associated with tibial shortening. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

This image shows the majority of a 51-in (130-cm) standing bipedal radiograph of the patient in Figure 1. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The mechanical axis of the femur is drawn (solid line), and the lateral distal femoral angle is measured at 87°. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

This image is a magnification of the image in Figure 3. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

A new line of identical length (L') is drawn perpendicular to the distal tibial axis and is slid down this axis until it intersects with the origin line (L). S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

When line L' intersects with line L (or an extension of line L), a point on the distal mechanical axis (the nonreference axis) is defined. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

A virtual grid is established in line with the proximal (reference) axis to measure the distance between the origin and the corresponding point. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The corresponding point is 7 mm lateral to the origin. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The corresponding point is 10 mm proximal to the origin. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The deformity parameters are entered into the computer, and anteroposterior, lateral, and axial stick images are generated. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

A soft bump is placed under the ipsilateral buttock and lower back to rotate the patella forward. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The fibula is exposed between the lateral and posterior compartments and is cut with an oscillating saw or is predrilled and cut with an osteotome. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The reference ring is placed carefully to mimic the alignment of the proximal fragment. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The ring in this example was placed perpendicular to the desired proximal tibial mechanical axis. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The lateral radiograph confirms a desirable sagittal ring orientation. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

If one chooses to use a fibular wire, then the wire is placed by hand onto the fibular head while the foot is observed for signs of movement indicative of nerve irritation. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The half-pins are predrilled bicortically. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Live fluoroscopy is used briefly to overlap the anterior and posterior markers (connecting rod and nut, respectively). S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The image on the left shows that the markers are not aligned. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The distance from the overlapped markers to the origin is then recorded in millimeters by measuring the rancho cube. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

This patient has one ring (a one-ring ring-block) stabilizing the proximal bone segment and two rings (a two-ring ring-block) stabilizing the distal segment. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The strut lengths are entered into the top line, and a stick image with a virtual frame in place is produced. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

This maximal dorsiflexion radiograph demonstrates a patient with a recurvatum deformity of the distal aspect of the tibia and a concomitant equinus contracture of the ankle. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Final radiographs show correction of both deformities. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

A narrow osteotome is used to create a percutaneous osteotomy. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Rotational osteoclasis is used to ensure a complete osteotomy. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

Figs. 20-A through 20-E Images pertaining to the case of the patient presented in Figures 1, 2, 3, 4-A, 4-B, 4-C, 4-D, 4-E, 4-F, 5-A, 5-B, 6. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

The structure-at-risk information is entered into the program. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

A daily schedule that is easy for the patient to follow is produced. S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.

S. Robert Rozbruch et al. J Bone Joint Surg Am 2006;88: ©2006 by The Journal of Bone and Joint Surgery, Inc.