Abstract
Introduction
Lower limb mal-alignment as a result of fracture malunion can result in knee degenerative arthritis or predispose to early arthroplasty failure due to the altered mechanical axis. The choice of corrective osteotomy is often determined by potential complications. Opening wedge osteotomy is associated with poor bone healing especially in adult diaphyseal bone. Distraction osteogenesis enables gradual deformity correction with the gap filled by regenerate bone. Bone formation however is formed less favourably in the diaphysis and metaphyseal osteotomy is advised. We present a consecutive series of adult tibial diaphyseal correction using the Taylor Spatial Frame utilising the method of distraction osteogenesis.
Method
15 adults, 11 male and 3 female, underwent tibial deformity correction. A mid diaphyseal osteotomy was made using minimal soft tissue dissection and an osteotome. The site was determined by the centre of rotation of angulation (CORA). After a 6 day latency period distraction was undertaken by the Taylor Spatial Frame. Patients were encouraged to fully weight bear throughout the treatment process. Following regenerate consolidation the frame was removed and a below knee weight bearing cast applied for 4 weeks.
Result
A mean correction of 11 degrees (4∼19) was undertaken. Correction time was a mean 13.5 days (6∼22). All osteotomies consolidated and frame removal was after a mean 136 days (92–192). All patients had at least one superficial pin site infection which responded to oral antibiotics. There were no deep infections or significant complications.
Conclusion
Deformity correction at the CORA produces realignment without translation. The Taylor Spatial Frame allows accurate virtual hinge placement and stable correction of adult bone. Concern over diaphyseal osteotomy in adult bone has been previously raised but our study confirms that tibial diaphyseal correction using distraction osteogenesis is successful with minimal morbidity and rapid return to function. We believe that this should be considered as the optimal technique when undertaking tibial diaphyseal deformity correction.
