Treatment of severe juxta-articular deformities using Ilizarov technique

ABSTRACT

Proper alignment of the mechanical axis and joint orientation lines in juxta-articular deformities requires a combination of angulation and translation of a metaphyseal osteotomy. In severe deformities, the translation required decreases bone contact at the osteotomy site to a great extent. In addition, this translation may cause a bony prominence and a bad cosmetic effect. This study was carried out to evaluate the results of treatment of severe juxta articular deformities using an Ilizarov external fixator with hinges at the center of rotation of angulation of the deformity to produce angulation and translation at a metaphyseal osteotomy to correct the mechanical axis. In addition we aimed at assessment of the effect of bone displacement on the cosmetic appearance of the patients. The material of this work consisted of 14 severe juxta- articular lower limb deformities that were treated using llizarov technique and a metaphyseal angulation displacement osteotomy. Ten cases had unilateral deformities and two cases had bilateral deformities. The study included 9 males and 3 females. Their age ranged from 11 to 35 years [mean 19.75 +/- 8.37]. The mean preoperative deformity was 30 +/- 7.81. The mean preoperative limb length discrepancy in unilateral cases was 4.3 +/- 2.2 cm. All osteotomies healed. The mean external fixation time was 22 +/- 9 weeks. All deformities were successfully corrected to within the normal range except one patient who had 10 mm of lateral mechanical axis deviation after treatment for a varus deformity with 10 cm of limb length discrepancy. The amount of lengthening ranged from 2 to 8 cm [mean 3.37 +/- 2]. All patients were satisfied with the cosmetic appearance after correction of their deformities. Severe juxta-articular deformities can be corrected most accurately with metaphyseal angulation displacement osteotomy using Ilizarov external fixator