Introduction: The UMEX system of external skeletal fixation has been widely used on the Indian subcontinent since its development by Dr. B.B. Joshi of Mumbai. The system employs a method of gradual distraction with manual correction of deformity. It has applications to both the upper and lower limbs, both in Orthopaedic and Traumatic conditions.

This paper aims to introduce the system to members of B.S.C.O.S. as an alternative method of correction of the relapsed clubfoot. It has a use in other Paediatric and Adult foot deformities.

The system is light and easy to apply, and unlike some other methods of external fixation is cheap and well tolerated by patients and their parents.

Results: This paper will describe the use of the device in the first 3 patients with club foot and with 2 others, one with deformity secondary to neurological abnormality, one patient with congenital abnormality of the forefoot.

The assessment of deformity in club foot is controversial and difficult to apply to many cases. The goal of treatment is a plantigrade and supple foot, that functions well in locomotion. To date, admittedly in a small number of cases, this has been achieved following relapse from earlier surgery.

Discussion: The management of relapsed club foot and other complex foot deformities is often far from easy, and results in a stiff foot, with some residual deformity evident after repeated surgery. The UMEX system, by combining distraction with gentle manual correction, has, in our hands, been effective in restoring shape and function to the foot without the need for invasive surgery.

Introduction: Instrumental Distraction has opened a new window for management of resistant clubfoot. Classical Ilizarov assembly is typically used in patients over the age of two years. We applied the differential distraction technique using the UMEX fixator for ages varying from 6 months to 18 years. This method follows the Ilizarov principle of soft tissue response to tension stress.

Materials and Methods: A retrospective review included 120 patients, treated between 1990 – 2001. The majority of the cases were “idiopathic” with 36 feet after failed surgery, 60 feet after failed manipulation and casting, and 11-neglected clubfeet. The non-idiopathic group included 5 feet in patients with arthrogryposis, 5 feet in patients with myelomeningocele, and 3 feet in patients with Streeter’s dysplasia. The UMEX frame spans three segments. The tibial segment consists of two wires trans-fixing the tibia in its proximal third and an axial pin to prevent rocking of the frame. The metatarsal segment incorporates a transfixing pin and two half pins to maintain the transverse arch of the foot. The calcaneal segment includes two transfixing wires and and an axial pin. The three segments are then linked together by a system of clamps, rods and distractors to create the UMEX clubfoot frame. Treatment extends through three stages: Reduction, Retention and Remodeling. The distractors apply differential distraction, and the various deformities are corrected simultaneously. After r eduction is completed the frame is left in a “holding” mode for six more weeks. Thereafter, the assembly is removed and a well-molded below-knee cast is applied for a period of 8 – 12 weeks with monthly cast changes. During the remodeling phase, night splints and walking boots are used for a period of one year.

Results: Results were assessed on the basis of the HJD functional rating system. Results were measured at 6-month intervals for 2 years and then yearly. We obtained excellent results in 34.4%; good, in 38.3%; fair, in 16.7% and poor, in 10.8% of the cases.

Discussion: The classical Ilizarov method of deformity correction is a constrained assembly applying distraction – compression forces across a predefined hinge. The unconstrined UMEX assembly makes no such demands and correction is achieved at the natural joints. The technique of differential distraction avoids any compression and, as seen in the long-term follow-up, has no ill effects on the growing foot. There is no age limit for use of the system; in older patients, however, incomplete remodeling leaves residual bone deformities. If there is residual foot deformity with completion of the treatment, only limited open surgery is required. In our hands, the use of differential distraction produced functionally serviceable and cosmetically acceptable correction of clubfoot.

Conclusion: Our experience demonstrates the effectiveness of differential distraction using the UMEX mini external fixator. This is an excellent technique for correction of complex deformities of the foot and ankle at any age and in the future may replace, to a large degree, the need for open clubfoot surgery.

Seventy-nine open tibial fractures were treated with unilateral uniplanar tubular external fixators. Excellent stability allowed early weight-bearing. All comminuted fractures, with or without bone loss, and some transverse or short oblique fractures with intermediate fragments were treated by early bone grafting through a posterolateral approach. The external fixator was dynamised as soon as periosteal callus was seen on the radiograph. Bone healing times ranged from 11 to 40 weeks (mean 20). Significant ankle stiffness occurred in 10.9% and leg shortening in 2.8%. Pin track infection was seen in 45.2% but was easily controlled with standard management. The external fixation frame allowed excellent functional freedom for Oriental patients to sit cross-legged and squat. Combined with early bone grafting, external fixation is an excellent method for the management of open tibial fractures.