Closed Distraction and Gradual Deformity Correction of Stiff Hypertrophic Tibial Nonunions with Hexapod External Fixation.

Abstract

Closed distraction of stiff tibial nonunions with a hexapod external fixator can predictably lead to union without the need for additional surgery or bone graft. Resect 5 to 10 mm of the fibula, from its distal half or at the level of the fibular deformity if present. Apply the proximal ring orthogonal to the proximal bone segment. Apply the distal ring orthogonal to the distal bone segment. Connect the proximal and distal rings with 6 oblique struts. Perform gradual deformity correction and distraction at a rate of 1 mm per day. Perform pin-site care and functional rehabilitation. Ensure adequate union prior to removal of the circular fixator. Hexapod closed distraction has been successfully used for the management of stiff hypertrophic tibial nonunions in our practice over the last 6 years.