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[Philosopher]

On this forum I've seen many people talking about malalignment and especially tibial malalignment or fibular nonunion. But in the case it happens, how do you actually treat it?

[Charizard]

On this forum I've seen many people talking about malalignment and especially tibial malalignment or fibular nonunion. But in the case it happens, how do you actually treat it?

I have seen a patient who had LON surgery from a turkish doctor (probably dr halil) endup noneunion. After about a year he got bone trasporation surgery. No idea what happened to him later tho.

[Marie_Bard]

On this forum I've seen many people talking about malalignment and especially tibial malalignment or fibular nonunion. But in the case it happens, how do you actually treat it?

It probably needsanother big surgery with new nails from a doctor who really know what to do!

[DanishViking]

Thats why you should avoid doing Tibias at all, unless you do it for: maximum height gain or femurs are unaturealy long compared to femurs (very rare).

See this: http://www.limblengtheningforum.com/index.php?topic=83916.0

[Maison]

On this forum I've seen many people talking about malalignment and especially tibial malalignment or fibular nonunion. But in the case it happens, how do you actually treat it?

Basic Treatment Strategy:

For Tibial Malalignment:
If a nail is present, remove it. Then cut the bone, correct the alignment, and fix it with a new nail. If necessary, blocking screws can be used to aid in fixation.

For Non-unions:
(1)In some cases, simply replacing the existing nail with a thicker one can resolve the issue.
(2)For large bone defects, bone grafting is frequently performed.
(3)Treating non-unions with infection is particularly challenging. Generally, if a nail is present, it is removed, the infected tissue is cleared, and external fixation is performed.
After the infection has healed, the defect is filled with a bone graft.
Additionally, a specific technique called the Masquelet Technique is available. I believe the LLT victim underwent this treatment in the US.

[Philosopher]

Basic Treatment Strategy:

For Tibial Malalignment:
If a nail is present, remove it. Then cut the bone, correct the alignment, and fix it with a new nail. If necessary, blocking screws can be used to aid in fixation.

For Non-unions:
(1)In some cases, simply replacing the existing nail with a thicker one can resolve the issue.
(2)For large bone defects, bone grafting is frequently performed.
(3)Treating non-unions with infection is particularly challenging. Generally, if a nail is present, it is removed, the infected tissue is cleared, and external fixation is performed.
After the infection has healed, the defect is filled with a bone graft.
Additionally, a specific technique called the Masquelet Technique is available. I believe the LLT victim underwent this treatment in the US.

It might seem a naive question, but what if malalignment happens while lenghtening, what do you mean by cutting the bone? How do you deal with the reduce in size and do you lenghten afterwards as usual?

[Maison]

It might seem a naive question, but what if malalignment happens while lenghtening, what do you mean by cutting the bone? How do you deal with the reduce in size and do you lenghten afterwards as usual?

My previous explanation implied that the corrective surgery would be performed after the completion of bone lengthening.

If you want to correct the deformity while lengthening, there is no need for osteotomy(cutting the bone) .
For patients using Ilizarov or Taylor Spatial Frame, deformities can be corrected by adjusting the frame.
In the case of PRECICE, the bone fragments are corrected to the right position during an additional surgery, and blocking screw is inserted to maintain that position.
However, I believe that doctors who cause significant deformity in PRECICE surgery do not have this technical skill.
If such a deformity correction is performed during the lengthening phase, the bone lengthening can continue afterwards.

The explanation of osteotomy is complex, and for more details, I recommend referring to the following slides.
https://www.slideshare.net/Abdulla1986/principles-of-deformity-correction-73166924