Acute Correction of Tibial Deformity and Plate Fixation, with Subsequent Lengthening Over Plate

The use of circular external fixator for gradual correction of distal tibial deformity associated with hypertrophic nonunion has been a successful technique (Saleh and Royston, J Bone Joint Surg Br 78(1):105–109, 1996). Due to inconvenience of the external fixator, a more convenient fixation method could be used in carefully selected cases (McKee et al., J Bone Joint Surg Br 80:360–364, 1998). Provided that the resultant leg length discrepancy after treatment is less than one inch and is acceptable by the patient, then acute correction of the deformity and fixation by a locked compression plate has been successful with gratifying results to both the patient and surgeon (Helfet et al., J Bone Joint Surg Am 74(9):1286–1297, 1992; El-Rosasy and El-Sallakh, Strateg Trauma Limb Reconstr 8(1):31–35, 2013). In this case fixator-assisted correction of a hypertrophic nonunion with deformity was done followed by plate insertion. Staged lengthening over the plate was performed with a monolateral frame. Two examples of integrated fixation techniques (fixator-assisted plating and lengthening over a plate) were combined in the treatment of this patient.