monolateral bifocal exfix for correction of angular deformities. julio de pablos

8/6/2019 Monolateral Bifocal ExFix for Correction of Angular Deformities. Julio de Pablos

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Julio de PablosJulio de PablosHospital de Navarra yHospital de Navarra yHospital San Juan de DiosHospital San Juan de DiosPamplonaPamplona

RECOA, Evora, 2009

MonolateralMonolateralBifocal ExFixBifocal ExFix

in Angular Deformitiesin Angular Deformities

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F.E Bifocal

Multifocal ExFix (Applications)Multifocal ExFix (Applications)

v Segmental defects

- Bone Transportv Angular correctionMultiapical deformities

Uni/multiapical def. + shortening



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F.E Bifocal

PatientsPatients

vv Multiapical Def.Multiapical Def.

vv AD +shorteningAD +shortening

vv EtiologyEtiology PostraumaPostrauma InfectionInfection

CongenitalCongenital Surgical comp.Surgical comp.



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F.E Bifocal

PatientsPatients

vv Multiapical Def.Multiapical Def.

vv AD +shorteningAD +shortening

vv EtiologyEtiology PostraumaPostrauma InfectionInfection

CongenitalCongenital Surgical comp.Surgical comp.



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F.E Bifocal

Distractors

vLRS Orthofix

vWagner modified

Always Monolateral ExFix



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F.E Bifocal

Stra teg ies

vvLenthening Acute Ang. CorrectionLenthening Acute Ang. Correction

(circular exfix preferable)(circular exfix preferable)

vv Acute Ang. Correction Lengthening Acute Ang. Correction Lengthening(Lengthening Over Nail: LON)

vAcute angular correction

vvOtherOther (Progressive+acute correction)



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Progressive Lengthening

+

AcuteAngular Correction



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F.E Bifocal



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+40 d.+40 d.



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+180 d.



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+180 d.+180 d.



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+

Progressive Lengthening



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Pre-op



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Pre-op



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1 32

Ac ute Correc tion & Progressive LengtheningAc ute Correc tion & Progressive LengtheningPDF created with pdfFactory Pro trial version www.pdffactory.com


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11 22

33 44



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S.A.S

.326/98

0 das postop. 14 116 33541



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Post-op (das)Pre-op

0 335



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S.A.SS.A.S

..326/98326/98

PostPost--opop(1 y.)(1 y.)

Pre-op



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PrePre--opop PostPost--opop (1 y.)(1 y.)



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F.E Bifocal

LLengtheningengthening

OOver aver a

NNailailPDF created with pdfFactory Pro trial version www.pdffactory.com


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F.E Bifocal3 cm3 cm

JRCJRC

HN 365255HN 365255

VarVarn 29 an 29 aososVL+ acortamientoVL+ acortamientopostraumpostraumticotico



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3cm3cm



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21 m postop.21 m postop.



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+3,5 cm+3,5 cm



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8,5 m po8,5 m po



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PREOPPREOP

7 M POSTOP7 M POSTOP


F.E Bifocal


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F.E Bifocal

Other StrategiesOther Strategies

Of CorrectionOf Correction



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+21 m.



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+ 8m

+ 18m



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!!

37 m postop

Ost. VR tib ia l

Genu va lgo , 65 a .



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20 d. postop.

OsteotomOsteotom a de Ap ertura Progresivaa de Ap ertura Progresiva

Preop.

1818VLVL

2020 VRVR

60 m. postop.

44 VLVL

22 VRVR

Inm. Postop.



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F.E Bifocal


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Recomendations


F.E Bifocal


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Recomendations

PlanningPlanning ExFix Stable & VersatileExFix Stable & Versatile

3 independent pin sets3 independent pin sets Orthogonal ConfigurationOrthogonal Configuration Progressive Angular CorrectionProgressive Angular Correction

Avoid too agressive correctionsAvoid too agressive corrections((NoNo problem with initial loss of lengthproblem with initial loss of length))


monolateral bifocal exfix for correction of angular deformities. julio de pablos

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