The deformity that has occurred in the leg — whether you were born with it or it happened later — requires correcting. It could be that the deformity is too severe for non-surgical treatments to work, or that non-surgical treatments have failed. The advantage of external fixation, whether with circular fixation or a rail, is that the treatment can be changed as needed over time. Using it is easier on the muscles and other soft tissues than internal fixation. It gives the surgeon the ability to change the angle of the leg, rotate the leg, and also to make the bone longer if needed, in a way that is not possible with other treatments.
An operation is performed to create an osteotomy (see below) in the affected limb. Then the fixator is put on the limb with wires or pins above and below the osteotomy, with other wires to support the limb. Changes to the frame over time lengthen the bone and also correct the deformity. As a general rule, lengthening is carried out at about 1mm per day, in three or four steps. It tends to be faster in younger patients and slower in older ones.
An osteotomy is when a bone is cut by the surgeon to adjust or correct the deformity or to create fresh bone ends in order to form new bone growth as the healing process re-starts. The new bone growth can be guided to fix the limb in many ways, such as making it longer or changing the angle.
These are stainless steel wires that go through the bone and soft tissues (such as muscle) of the limb. These wires are attached on each side of the external rings of the TL-HEX system and held in place.
These are special pins that are put into one side of the bone. These pins are thicker than the wire pins and are attached only on one side of the frame, and are used only when stronger fixation is required.
TL-HEX is a 3D external fixation system that combines hardware and software to correct bone deformities. In essence, the system consists of circular and semi-circular external supports secured to the bones by wires and half-pins, and interconnected by six struts. Successful application and correction of the deformity or injury also relies on the use of associated software, which incorporates imaging to determine the precise measurements and positioning of TL-HEX. This combination of hardware and software allows for simultaneous adjustment of the external supports at multiple angles.
TL-HEX is simple for the surgeon to use, and provides fixation that is comfortable and reliable because it is stable. Because it is circular, the angle of the bone can be altered in any direction.
The design of the system is simple and is based on six adjustable struts. When used with a computer program, it allows for precise acute (fast) and/or gradual (over time) changes that help fix the deformity based on your special needs.
Potential complications include pin-site infection, joint stiffness or muscle contractures, and wire or pin breakage. Your surgeon will give you information on these occurrences, including the symptoms that should prompt you to seek treatment, as well as the appropriate healthcare professional to contact.
Some pain is normal, and pain may increase a little after frame adjustments. Methods for managing pain after surgery include pills, suppositories, capsules, nerve blocks and pain pumps. Pain pumps let you control the amount of pain-killer you receive, as you need it. These methods will be discussed with and explained to you before your operation. If pain does not go away or becomes acute, contact your surgeon or family doctor.
The amount of time the external fixator will be in place depends on the severity of the deformity, and how much correction will be required, as well as your/your loved one’s general health and medical history. Factors such as age, smoking status, nutrition status, mobility levels and more can influence healing. Your surgeon will provide expected time frames according to your/your loved one’s specific situation.
You may need to buy clothing a few sizes bigger than usual or track pants with buttons or zips on the outside of the leg, to accommodate the external fixation device. Long skirts may be useful. To help keep warm, you may want to purchase or make a tube of material (for example, from an old sweatshirt or sweatpants) as a “leg-warmer.” For ankle frames, there are special “boots” that are adjusted to fit the frame and allow walking. You may also use material to create foot-warmers in these cases.
Your surgeon or physical therapist will be able to answer this question for you, based on your specific situation.
You may need to make adjustments to your/your loved one’s sleeping position while the fixator is in place. Ask your surgeon’s office or your physical therapist for advice on accommodating the fixator in bed.
Follow the instructions that your surgeon or hospital staff gives you.
Your surgeon will be able to guide you on medications. Be sure to disclose all prescription and over-the-counter medications that you take.
This will depend on several factors: the type of work you do, the severity of your condition, how you get to work and the treatment plan after surgery. You should discuss returning to work with both your surgeon and your employer.
Children should mobilize as much as possible and should return to school as soon as safely possible, depending on the severity of the child’s condition and the treatment plan after surgery. Discuss a timeline with your child’s surgeon. In addition, it will be helpful to discuss the child’s after-surgery needs with the school, so that any necessary arrangements can be made. Pictures of the external fixator may be useful to bring along to this meeting.
This depends on the type of treatment you are having and whether you will be flying. Speak to your surgeon’s office for advice, and to get a letter from your surgeon in order to pass through security at the airport with the fixator in place, or with medicines related to the surgery.
Speak to your surgeon’s office for advice and to get a letter from your surgeon in order to pass through a metal detector with the fixator in place.