Deformity Correction
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Deformity Correction
What is Deformity Correction?
Deformity Correction is a procedure to straighten a bone that is bent or twisted in a way that is not normal. After the bone is straightened, the arm, leg, or foot has normal alignment and function. Deformities can be corrected in two different ways:
- All at once during a surgical procedure (called acute correction).
- Slowly over the course of several weeks or months (called gradual correction).
- Treatment depends on cause and location.
How does acute deformity correction work?
During surgery, the doctor makes a cut across the bone to create two separate bone segments. This surgical procedure to cut a bone is called an osteotomy. Then the doctor will straighten the bone.
After the bone is positioned correctly, the doctor inserts an internal device to keep the bone in the corrected position while it heals. The internal device may be an internal nail/rod or a metal plate. Sometimes additional soft-tissue procedures are done at the same time to allow the muscles and nerves to accommodate the correction. After the bone heals, the internal device may be removed during a second surgery.
In some situations, the doctor may use fixator-assisted nailing or fixator-assisted plating to straighten the bone. These two procedures involve temporary application of an external fixator during surgery to hold the bone segments in perfect alignment while an internal nail, rod or plate is applied. The external fixator is then removed at the completion of the surgery, but the internal fixation remains.
How Does Gradual Deformity Correction Work?
During surgery, an external fixator is applied to the bone. The doctor then cuts the bone (osteotomy) into two separate bone segments and may perform soft-tissue procedures to prepare the muscles and nerves.
After surgery, the patient will be given specific instructions and a schedule for how to adjust the external fixator so that it slowly straightens the bone. This gradual process of slowly separating and straightening the bone segments is called distraction, which means “pulling apart.” As the two bone segments are slowly pulled apart and straightened, new bone forms in the space between them. The new bone is called regenerate bone.
During the distraction phase, the orthopedic device is adjusted daily or even several times a day so that the bone segments are pulled apart and straightened at a slow rate of approximately 1 mm (0.04 inches) per day. This forces the body to constantly grow new bone and soft tissues such as skin, muscles, nerves, and blood vessels. The distraction phase lasts until the bone is straight or corrected. The patient will need to see the doctor every 10 to 14 days during the distraction phase and will start an intensive physical therapy schedule.
The distraction phase is followed by the consolidation phase, where the regenerate bone slowly hardens. The bone is consolidated (“healed”) when the regenerate bone has completely hardened and calcified. The consolidation phase typically takes twice as long as the distraction phase. For example, if distraction is completed in 1 month, then consolidation will take 2 months. This means that in this example, the external fixator would remain on the patient for a total of 3 months through both the distraction and consolidation phases.
To help the bone heal, patients should avoid nicotine in any form, make sure that their diet includes lots of protein, and take vitamin and mineral supplements. During this stage, your doctor may tell you to start putting some weight on the arm/leg, which will also encourage the bone to harden and heal. After the regenerate bone has fully solidified, the external fixator is removed during an outpatient surgical procedure (the patient does not stay in the hospital overnight after the removal procedure).
What happens if the bone is straightened too slowly during gradual correction?
If the bone is straightened too slowly, the bone may heal before it has been fully straightened. The doctor will want to see the patient often (every 1 to 2 weeks) during the distraction phase to prevent premature consolidation.
Even though the typical rate of correction is 1 mm per day, each person responds differently to bone lengthening. Some people’s bones heal very quickly, and the regenerate bone may harden before treatment is completed. This is called premature consolidation. When the regenerate bone hardens too quickly, the bone may heal before it is completely straight or fully aligned.
The early stages of premature consolidation can be detected on X-rays. When this starts to happen, one option is to increase the rate that the bone segments are pulled apart. For example, the patient may be told to increase the rate of distraction from 1 mm per day up to 2 mm per day. If the regenerate bone has entirely consolidated, the bone may need to be surgically cut again so that lengthening can continue.