Sample Report: Orthofix External Fixator Application
Ilizarov Frame Removal/Occupational Therapy Discharge Summary/Open Reduction and Internal Fixation of Hip Fracture/Orthofix External Fixator Application
Preoperative Diagnoses
1. Achondroplasia.
2. Genu varum.
3. Internal tibial torsion.
4. Short stature.
5. Coxa vara.
Postoperative Diagnoses
1. Achondroplasia.
2. Genu varum.
3. Internal tibial torsion.
4. Short stature.
5. Coxa vara.
Operative Procedures
1. Osteoplasty, left femur, with coxa vara correction.
2. Osteotomy, distal femur, with deformity correction.
3. Application of multiplanar external fixator, left thigh.
4. Osteotomy/osteoplasty, left tibia and fibula with correction of rotation and planned lengthening.
5. Application of multiplanar external fixator, left tibia.
6. Anterior compartment fasciotomy.
7. Botox injection, left calf.
Indications: The patient has achondroplasia and has decided to have deformity correction and stature lengthening for her severe short stature of 4 feet 3 inches in height. We decided on an ipsilateral strategy to lengthen the left femur and tibia at the same time in order to get complete realignment. We plan to correct her slight knee flexion deformity and severe varus distal femur, thus correcting her genu varum, as well as her slight coxa vara and her flexion deformity of the left hip by a subtrochanteric osteotomy of the left proximal femur. The lateral osteotomy will also be used for lengthening. Multiplanar external fixator of the Orthofix variety will be used.
Description of Procedure: Under general anesthesia, the left lower limb was prepped and draped free with the patient lying on a bump under her buttocks. She was given prophylactic antibiotics and had both an epidural catheter and urinary catheter.
I inserted a half pin by the cannulated drill technique through the quadriceps mechanism into the center of rotation angulation of the distal femur, 2 cm proximal to the knee joint, just proximal to the patella. I then used the focal dome side and marked out the trajectory of the focal dome osteotomy with a radius of 3.5 cm. I then made a small transverse incision, longitudinally split through the quadriceps mechanism, and then made multiple drill holes in the controlled center of patient angulation focal dome guide technique, and osteotomized the femur by connecting the drill holes. We then did an acute angular correction for translating medially and then angulating from varus to valgus. Lastly, we slightly posteriorly translated and extended the distal femur. To stabilize this, I applied an Orthofix device between the proximal and distal pins. Because the proximal pins were at a special angle to correct flexion of the hip, I only used one of the proximal pins and two of the distal pins. Having achieved the correction, I then used the fixator to insert two pins in the mid segment of the femur. I was now able to disconnect the fixator from the proximal two pins. I removed the proximal pin clamps, did multiple drill holes just below the proximal two pins, and did an acute correction into extension and slight valgus. I then connected the proximal pin clamp and these pins to the pin clamp, thus correcting the deformity acutely at the proximal femur. Having achieved this correction, I added one more pin in the proximal femur. With the distal femur, because of tenting of the skin, I temporarily removed one pin and then the other, letting the skin equilibrate, and inserted them through new skin holes. Because of the excellent bone contact and the plan to length proximally and not distally, I did not add a third pin distally.
Having completed this femur fixation and correction with two levels of osteotomy, the proximal one planned for lengthening of the femur, I now proceeded to do the tibial correction. I used the medial size fixator for this. Before applying the fixator, I did a fibular osteotomy through a small lateral incision. Multiple drill holes and an osteotome were used to cut the fibula after careful inspection between the lateral and posterior compartments. I did a fasciotomy of the anterior compartment, used our fasciotome to extend it proximally and distally the full length of the leg. All incisions were closed. I then applied a fixator from the medial side. I put in two pins, one proximal and one distal, at an angle about 30 degrees to each other, in order to correct the rotational deformity of the tibia. These were in different planes. When they were brought into the same plane, this deformity was corrected.
I made a small incision over the mid tibia, made multiple drill holes, and then completed an osteotomy with an osteotome. I then acutely rotated the pins to each other. After doing so, I applied the external fixator. This allowed me to insert a second proximal and second distal pin and ultimately a third proximal and third distal pin.
With the tibial fixation completed and all incisions in the leg closed, the last step of the procedure was to inject Botox into the calf muscle. I used a total of 5 cc into each head of the gastrocnemius muscle, injecting 100 units of Botox into each head of the gastrocnemius.
The procedure was tolerated well. Radiographs were obtained, confirming excellent alignment of the lower limb. I was present and performed the entire surgery. The patient was taken to the operating room with vital signs stable and neurovascularly intact.