Posttraumatische Fehlstellung der unteren Extremität - Korrekturen im Bereich der langen Röhrenknochen

PURPOSE: As part of a retrospective analysis of posttraumatic malunions of the lower extremity, the causes for deformity, as well as indications and methods for corrective osteotomies are reviewed. METHODS: From January 1992 until December 1996, a total of 115 patients underwent corrective osteotomies of the lower extremity secondary to posttraumatic deformities. The 89 adult patients with tibial (n = 54) or femoral (n = 35) malunion were analyzed as part of this study. RESULTS: The primary fracture treatment consisted of an intramedullary stabilization in 19 instances, a plate osteosynthesis in 22 and an external fixateur in 14 cases. Other forms of treatment were choosen in the remaining (n = 34) instances. Torsional deformities were seen after primary intramedullary nailings, while plate osteosynthesis lead to angulation in the frontal plane in the majority of the treated patients. In 43 instances uniplanar and in 46 cases multiplanar deformities had to be corrected. The correction was carried out with the help of an Ilisarow-ring fixator in 37 instances. As an internal stabilizer, 9 nails, 2 dynamic compression screws and 38 AO-plates were used. A bone graft was carried out primarily 33 times. CONCLUSIONS: The review of the literature, as well as of our own results, shows that deformities in the frontal plane should be corrected if they exceed 10 degrees of varus or 15 degrees of valgus. Malunions of more than 15 degrees in the sagittal and 15-20 degrees in the transverse plane should also be considered for correction, while a shortening of more than 3 cm represents an indication for corrective osteotomy. Callus distraction techniques have proven valuable in the correction of posttraumatic malunions of the lower leg, especially when soft tissue compromise is evident.