Vol. 21, No. 6June 199920TH ANNIVERSARY
Refereed Peer Review
FOCAL POINTKEY FACTS
Circular external fixation usingthe Ilizarov method is a novelsurgical option for correctingangular limb deformities andlengthening deformed bonesof companion animals.
Treating BoneDeformities withCircular ExternalSkeletal Fixation
North Carolina State University
Denis J. Marcellin-Little, DEDV
The Ilizarov method of circular external fixation has remarkable benefits in treat-ing bone deformities. It relies on unique external fixation devices and distraction osteogenesis.Rings placed around the limbs are interconnected with threaded rods and fixed to the boneusing small-diameter wires under tension. The angle and distance between rings can bechanged, leading to change in the shape of the bone. With distraction osteogenesis, new boneforms at the osteotomy site when it is slowly distracted after surgery.
imb deformities in dogs are most frequently caused by abnormal bonegrowth but can also be a consequence of fracture malunion, joint contrac-ture, or polyarthritis. Abnormal bone growth may be secondary to physealinjuries, dwarfism, hypertrophic osteodystrophy, multiple cartilaginous exos-toses, or hyperparathyroidism.
The most common angular limb deformitiesare antebrachial, representing 0.74% of all bone problems.
Limb deformities incats are rare. Tarsal hyperextension and torsion have been reported in kittens,
but the prevalence, cause, and pathogenesis of these problems are unknown.Bone deformities of the tarsus, carpus, and extremities also occur in Scottish-foldcats with osteodystrophy.
Conventional treatment options for limb deformities include conservativemanagement
; physeal resection with fat grafting
; physeal stapling
; transverse,oblique, cuneiform, or dome osteotomies (transsection of bone)
; ostectomies(removal of a fragment of bone) with or without fat grafting
; and stabiliza-tion with external coaptation,
or conventional external fixa-tors.
The major drawback of all of these methods is that the shape of thebone cannot be changed after surgery. Limb alignment is determined while thepatient is anesthetized and not bearing weight, making the cosmetic and func-tional results of surgery less predictable. Because bone shape and length are set atthe time of surgery, additional surgeries may be necessary to treat incomplete de-formity corrections and recurrent deformities in growing dogs. To address thisissue, adjustable fixation techniques have been attempted, with bone movementmade possible by the use of rubber bands or adjustable connecting bars on exter-nal fixators.
The results of these methods have been unpredictable.
The Ilizarov circular externalfixation method involves placingrings around the limbs; the ringsare fixed to the bone with wiresthat are 1- to 1.5-mm in diameterand under 0 to 90 kg of tension.
Joint malformations (except jointsubluxations) and degenerativejoint disease secondary to growthdeformities cannot be correctedwith circular external fixators(CEFs); growth deformitiesshould be treated before irrevers-ible joint damage occurs.
Mild angular deformities withlength deficits can be treatedwith CEFs; severe angulardeformities are ideally treatedwith hinged CEFs.
Following a delay of 2 to 7days after osteotomy, the siteis distracted 0.5 to 2 mm daily,in two to four steps, until thedeformity is corrected 2 to 8weeks later.