Plating after tibial lengthening: unilateral monoaxial external fixator and locking plate.

UNLABELLED: Several studies recently reported the usefulness of plating methods following limb lengthening with external fixators. This study describes modification at the time of plate insertion, selection of a locking plate, and the direction of plating. From April 2006 to July 2009, 12 consecutive patients, mean age 17.8 years, were enrolled in the study. The mean follow-up period was 36.5 months. All lengthening procedures were performed at the tibia. After proximal tibial osteotomy, a monoaxial external fixator was maintained on the lateral side of the tibia. At the end of distraction, a manually bent locking plate was inserted on the anteromedial side of the tibia, and the external fixator was removed. The mean final lengthening amount was 4.23 cm (range, 3.6-5.0 cm). The mean duration of the external fixator was 54.9 days (range, 47-67 days) and the mean external fixator index was 13.0 days/cm (range, 12.3-14.4 days/cm). The mean time to bony consolidation was 195.7 days (range, 150-264 days) and the mean healing index was 46.1 days/cm (range, 38.4-55 days). There were only minor complications in four patients. This case series showed that, especially with tibia lengthening, our method allows for successful early removal of the external fixator as compared with other methods (plating after lengthening), is associated with fewer complications, and is an effective alternative. LEVEL OF EVIDENCE: Therapeutic Level IV.