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Re: Деформация голеней
послал Mangal Parihar 11 Сентябрь 2005, 11:28
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Alex,
I do upper tibial osteotomies with either an ilizarov fixator and acute correction of the deformity or with an orthofix with gradual correction.
Sending you pics of the steps of the osteotomy and the frame.
You can do the osteotomy in a "focal dome" or in a transverse fashion. The dome has the advantage of having a good contact, allowing weight bearing as tolerated early on.
The level is below the tibial tuberosity.
The frame I use is pretty simple, with one wire each in the proximal and distal ring, two schanz pins in the proximal ring, and one each in the middle and distal ring.
I preconstruct a frame with the proximal ring in varus by the use of coupled washers in the threaded rods in the front and back. These are used as hinges, and after the correction, a medial and lateral threaded rod is also added.
Since the center of rotation of these deformities is usually near the knee joint line, lateral translation of the distal fragment is necessary to normalise all the axes.
You can also do the osteotomy in a transverse fashion.
When I use an orthofix fixator, the osteotomy is oblique, starting below the tuberosity and ending 1 cm away from the lateral cortex at the level of the head of the fibula. No fibular osteotomy is needed there. The deformity is gradually corrected over 2 or three weeks.
You could also do the same with an ilizarov fixator
Regards
Mangal Parihar
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