Operative Technique Monofocal Distraction Osteosynthesis

The monofocal distraction osteosynthesis technique, developed in cooperation between the Department of Orthopaedics and Traumatology of the University of Pavia (at the Citta di Pavia Institute) and the Central Institute of Traumatology and Orthopaedics (CITO) of Moscow, is particularly simple. In fact, this method merely provides adequate mechanical conditions to produce distraction osteogenesis.

The mechanical conditions consist of stable fixation with a circular external fixator and gradual distraction at a rate of 1.0 mm per day until the shortening has been corrected. Distraction is not administered in divided doses several times daily but as a single daily dose. Subsequently, a further distraction of 0.5 mm every 10 days is performed in order to maintain the tension effect on the nonunion during the whole period of treatment (Figs. 2-4).

In cases without shortening only periodic distraction is carried out in order to produce and maintain the tension effect during the treatment. Where angular deformity or other deformities are associated with dysmetria, treatment is modified in order to correct them.

Fig.2a, b. X-rays of a hypertrophic nonunion of the right tibia with leg length discrepancy of 2 cm in a 28-year-old man previously treated with three open surgical procedures
Fig. 3a-d. Same case as in Fig. 2. a, b X-rays at the beginning of treatment with distraction osteosynthesis. c, d X-rays at the end of the distraction phase
Fig. 4a, b. Same case as in Fig. 2. Healing of the nonunion with correction of leg length discrepancy after 4 months

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