Post-Traumatic Conditions

Intro

Treatment Options

Complications

Orthofix Solutions

Post-Traumatic Conditions

Post-traumatic bone deformities may happen after an injury, accident, or diseases like Paget’s disease, cancer and severe bone infections.^{1, 2}

The bone deformity can result from a fracture or the treatment to cure the disease. The deformity forms when the bone does not heal properly, or does not heal at all.
Since the bone does not have its proper anatomical form, this has three main effects: ¹

The walking pattern is affected, causing some joints to be under additional pressure.
These joints that receive extra pressure start to wear down, increasing the chance of developing osteoarthritis.
There is muscle pain and fatigue due to the abnormal walking pattern.

Agile Nail™

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The Agile Nail™ is a rigid implant made of titanium alloy, designed for femoral fracture treatment and deformity correction procedures. It is inserted in the intramedullary canal of the bone from the tip or slightly lateral to the tip of the greater trochanter and fixed to the bone with locking screws. The implants are available in several sizes to fit the bone anatomy of the patient.

Ankle Hindfoot Nailing System™

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The Orthofix Ankle Hindfoot Nailing System (AHN) is designed to be used for the fusing and fixation of bones in the ankle.

Fitbone™

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The Fitbone^TM Intramedullary Limb-Lengthening System was developed in partnership with Professor Baumgart. The product was launched in 1997. Since then, this innovative treatment concept has grown into a global success story. The Fitbone TAA Intramedullary Lengthening system is intended for limb lengthening of the femur and tibia. With appropriate pre-operative planning, it is possible to ensure good limb alignment so that the limb is correct at the end of lengthening.

JuniOrtho™ Plating System

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The JuniOrtho™ Plating System (JPS) is a pediatric range of stainless steel plates designed for surgical treatment of deformities and trauma reconstruction in lower limb. The JPS plates can be used for correction of congenital deformities in femur and tibia (varus, valgus, rotational and/or shortening of the lower limb) and for the treatment of articular fractures.

LRS ADVanced™

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The Orthofix Limb Reconstruction System™ (LRS) is a series of modular monolateral external fixators used in reconstructive procedures for treatment of short stature, bone loss, open fractures, non-union, and angular deformities.

MiniRail

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The MiniRail External Fixation System consists of small rails and screws for fixation of small bones when a condition does not allow for implanting internal devices. The MiniRail is designed to help with a variety of deformity corrections and lengthening procedures of small bones and joints in the foot and upper limb.

TL-HEX TrueLok Hexapod System™

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TL-HEX is a dynamic, 3D external fixation system that combines hardware and software to correct bone deformities. This hexapod-based system functions as a 3D bone segment-repositioning module. In essence, the system consists of circular and semi-circular external supports secured to the bones by wires and half-pins, interconnected by six struts.

TrueLok™

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The Ilizarov System has experienced many modifications over the last fifty years. The TrueLok™ Ring Fixation System, developed at Texas Scottish Rite Hospital for Children (TSRHC) in Dallas, Texas, is one of the modern variants of the original fixator, but preserves many of the original principles of Professor Ilizarov. It consists of aluminum rings available in different sizes, connected to the bone through metal wires or/and bone screws. The relative movements of the rings allow the correction of almost all the bone deformities in upper and lower limbs and in the foot.

Treatment Options

The main goal of the treatment is to improve the function of the affected limb and promote a better quality of life for the patient. The aim of surgery is to achieve a bone that is in a correct position, support bone union, and ultimately achieve a functional walking pattern, in which there are no muscle imbalances or extra pressure on some joints. ^1,²

Performing an osteotomy (the surgical cutting or removal of a piece of bone to alter alignment) and applying external fixation in post-traumatic deformity allows for gradual correction and has been shown to improve functional outcomes, including cases complicated by leg length discrepancy and soft tissue compromise.^3-⁵ The development of motorized intramedullary (IM) lengthening nails introduced an alternative to external fixators.
However, each case is unique, there is no universal surgery that can treat a post-traumatic bone deformity. The treatment plan for each patient must consider the characteristics of the deformity and its causes, but also the individual aspects the patients (especially their treatment expectations), and the experience of the surgeon. ¹

Complications

If left untreated, a bone that has not healed correctly or refuses to heal will lead to discomfort, pain and a lack of mobility. A fracture that is infected and not healing is a serious complication that requires treatment by a specialist limb reconstruction surgeon. Modern techniques can usually achieve healing and cure of the infection; however, the treatment may be very prolonged, and necessitate long periods off work. In severe cases, amputation may be a preferred solution, especially if the patient has no insurance and is self-employed. The various possibilities should all be discussed, considering the whole person and their expectations for the future. ^1,^{4, 5}

References

1. Butcher CC, Atkins RM. (Ii) Principles of deformity correction. Current Orthopaedics. 2003;17(6):418-435. doi:10.1016/j.cuor.2003.10.001
2. Jones MS, Waterson B. Principles of management of long bone fractures and fracture healing. Surgery (Oxford). 2020;38(2):91-99. doi:10.1016/j.mpsur.2019.12.010
3. Ganger R, Radler C, Speigner B, Grill F. Correction of post-traumatic lower limb deformities using the Taylor spatial frame. Int Orthop. 2010;34(5):723–30.
4. Guidelines for Open Fractures of the Lower Limb, to be found at http://www.bapras.org.uk/professionals/clinical-guidance