Multisegment (Femur, Lower Leg, Foot) Multilevel Staged Deformity Correction

When correcting poly-segmental deformities, the methods of combined and sequential use of external and internal fixation can reduce the treatment period, reduce the number of complications, and increase the comfort of treatment for the patient (Kocaoğlu et al., Combined and consecutive use of external and internal fixation. In: LN Solomin (ed) The basic principles of external skeletal fixation using the Ilizarov and other devices (2nd edn). Springer-Verlag, 2012, pp. 1309–1378). A clinical case of staged femur, lower leg, ankle, and foot deformity correction in a patient with hypoplasia of the right lower extremity, accompanied with 19 cm shortening, is presented. At the first stage, acute correction of the distal tibial deformity and tibial-calcaneal fusion were performed. In 4 months, as the second stage of treatment, orthopedic hexapod Ortho-SUV Frame (OSF)-based femur deformity correction and lengthening were done. The period of lengthening and deformity correction was 60 days. Upon completion of the deformity correction, the transition to internal fixation with intramedullary locking nail was done using the lengthening and then nailing (LATN) approach (Rozbruch et al., Clin Orthop Relat Res 466(12):2923–2932, 2008). The femur, ankle, and foot frames were removed. Five months later, the third stage of treatment was performed: two-level osteotomy of the right tibia with lengthening 10 cm and deformity correction with the OSF over 112 days. Then, transition to the locked nail was performed using the lengthening and then nailing (LATN) approach (Rozbruch et al., Clin Orthop Relat Res 466(12):2923–2932, 2008). The restructuring of the distraction regenerates was ascertained 5 months after the frame was dismantled. Full weight bearing was allowed. Residual shortening of 2.5 cm and shortening of the foot are compensated by an orthopedic shoe lift.