RECOA, Evora, 2009

Monolateral
Bifocal ExFix
in Angular Deformities

Julio de Pablos
Hospital de Navarra y
Hospital San Juan de Dios
Pamplona

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 F.E Bifocal

Multifocal ExFix (Applications)

v Segmental defects
- Bone Transport
v Angular correction
§ Multiapical deformities
§ Uni/multiapical def. + shortening

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Patients
v Multiapical Def.
v AD +shortening
v Etiology
§ Postrauma
§ Infection
§ Congenital
§ Surgical comp.

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Patients
v Multiapical Def.
v AD +shortening
v Etiology
§ Postrauma
§ Infection
§ Congenital
§ Surgical comp.

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 F.E Bifocal

Distractors

Always Monolateral ExFix

vLRS Orthofix®
vWagner® modified

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Strategies

v Lenthening Acute Ang. Correction

(circular exfix preferable)
v Acute Ang. Correction Lengthening
(Lengthening Over Nail: LON)
v Acute angular correction
v Other (Progressive+acute correction)

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 Progressive Lengthening
+
Acute Angular Correction

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 +40 d.
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 +180 d.

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 +180 d.
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 Acute Angular Correction
+
Progressive Lengthening

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 Pre-op

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 Pre-op

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 1 2 3

Acute Correction & Progressive Lengthening

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 1 2

3 4
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 S.A.S
.
326/98

0 días postop. 14 41 116 335

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 Pre-op Post-op (días)

0 335

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 S.A.S
Pre-op Post-op .
(1 y.) 326/98

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 Pre-op Post-op (1 y.)

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 F.E Bifocal

Lengthening
Over a
Nail
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 3 cm F.E Bifocal

JRC
HN 365255

Varón 29 años
VL+ acortamiento
postraumático

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 3 cm

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 21 m postop.

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 Acute Angular Correction

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 +3,5 cm

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 8,5 m po

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 7 M POSTOP

PREOP

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 F.E Bifocal

Other Strategies
Of Correction

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 +21 m.

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 + 18m

+ 8m

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 Ost. VR tibial
Genu valgo, 65 a.
!

37 m postop

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 18ºVL
4º VL

20º VR
2º VR

Preop. Inm. Postop. 20 d. postop. 60 m. postop.

Osteotomía de Apertura Progresiva

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 F.E Bifocal

Final remaks

• Useful Technique
• Specific Indications
• ExFix experience
• systems
• possibilities
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Recomendations

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Recomendations
• Planning
• ExFix Stable & Versatile
• 3 independent pin sets
• Orthogonal Configuration
• Progressive Angular Correction
• Avoid too agressive corrections
(No problem with initial loss of length)

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