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Casestudies  >  Malunions  >   Rule 3   >   Rule 3/Correction with Lengthening


Rule 3


                                      Malunited  upper tibial fracture with an Intramedullary nail which is broken just above the site of malunion. To remove this nail would entail destructive surgery.                   varus malunion along with shortening of 2 cm. Already developed 	symptoms  of pain in the knee joint and the low back.

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35 yr old engineer developed a malunion of an upper tibial fracture with shortening of 2 cm and varus deformty after the nail broke.The nail broke about 1 cm above the site of the maximum deformity. Hence it would have been very destructive and damaging to remvoe the nail.The task was to straighten the bone and lengthen it and we chose to do it without removing the nail.

                          scanogram taken with 3 exposures showing the shortening                                          ilizarov fixator applied  without removing the Intramedullary nail. pins and wires inserted around the nail without touching it.

The xray during treatment shows how the rule 3 of deformity correction has been applied here in the lengthening mode. Here the osteotomy as well as the hinges were placed away from site of maximum deformity and hence resulted in correction of  varus with a lateral translation which was desirable.

                      full correction of the deformity and length. the pain has reduced.                                          tibial scanogram also showing the corticotomy performed at the very small interval of the broken nail.Excellent regenerate. Here  rule 3 was performed intentionally in order to create a valgus more than anatomic correction. The corticotomy was above the site of the deformity and so were the hinges.

xray shows full correction of the deformity along with the scanogram showing equal leg lengths.
His limbs are straight an completely equal now.

Bibliography & References:


1)      Treatment of Malunions & MalNonunions of the Femur & Tibia by detailed

pre-     op planning & Ilizarov Techniques

Paley, D., Chaudhary, M., Pirone, A.M., Lentz,P., Kautz, D.

Orthop. Clin. North Am. 21: 667, 1990


2)      TransOsseous Osteosynthesis: Theoretical  & Practical aspects of growth

& regeneration of Tissues

Ilizarov G.A.

Springer Verlag, Berlin 1992


3)      Principles of Deformity Correction

Springer Verlag, New York, 2002