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Limb Lengthening Fixators

- Discussion of Limb Lengthening:

- Distraction Histiogenesis: (osteoclasis):
    - whether a ring or unilateral fixator is used, there is some evidence that a better regenerate is formed with the use of titanium half pins 
           rather than transfixation wires;
           - ref: Limb lengthening by callus distraction (callotasis).

- Uniplanar Fixators:
    - see: EBI fixator
    - osteotomy can be percutaneous using a Gigli saw which is passed percutaneously around the tibia (or femur), or can consist of a dome 
           shaped osteotomy for deformities greater than 20 deg;
    - angular deformities are completely corrected in the OR;
    - distraction is delayed in the usual manner (7-14 days), unless a sigificant angulatory deformity has been corrected, in which case a longer delay may be reqired (21 days);
    - for tibia lengthening, a segment of the distal fibula must be removed;
    - technical pearls:
           - it is essential that the lengthening procede down the correct axis (mechanical or anatomic);
           - place the most proximal and most distal pin first, and then place the middle pins;
           - tethering effect of skin:
                 - when the fixator has been placed for limb lengthening, consider incising the skin in front of the path that the pin will take during the lengthening;
                        - make a larger incision for the pins closer to the osteotomy site;
                        - the incision will create a weak spot (even after the incision has healed) which will allow the half pins to cut through the skin without creating excessive skin tension;
    - reference:
           - Limb Lengthening and Correction of Angulation Deformity: Immediate Correction by Using a Unilateral Fixator.

- Ring Fixator Technique (see: Ilizarov Menu)

Complications of limb lengthening. A learning curve.

Mechanical evaluation of external fixators used in limb lengthening.

Current Techniques of Limb Lengthening.