Fixator-Assisted Plating of Limb Deformities

Fixator-assisted plating of the distal femur and proximal tibia can be used for accurate and effective correction of acute deformity. The advantage of this hybrid technique is that one can use the best of both internal and external fixation. The external fixator is applied in a fashion that does not impede insertion of the plate. The neutral wedge osteotomy is then performed in a minimally invasive fashion. The fixator is used to incrementally correct the deformity over several minutes in a controlled and gradual fashion in the operating room. Complex deformity correction, including angulation and translation in the coronal, sagittal, and axial planes, can be gradually adjusted. The surgeon maintains control of the osteotomy, and the position can be checked with x-ray and/or computer navigation. The fixator may be further adjusted to tweak the position as needed. Once alignment is optimal, a locked plate is inserted through a minimal incision technique to maintain the position, allowing removal of the fixator.