Lengthening/Nailing of 4 Month Old Tibia/Fibula Fracture in 35 Year-Old Female

Posted by on Nov 20, 2017 | Comments Off on Lengthening/Nailing of 4 Month Old Tibia/Fibula Fracture in 35 Year-Old Female

1) Proximal pin placed from lateral immediately anterior to the fibular head, free hand, but pretty much perpendicular to the axis of the tibia. Drill all the way across, exiting medially, balancing pin lengths medially and laterally, since this is going to be a “full frame” distraction.

2) Apply PAHS Distractor to the proximal pin on the lateral side of the leg.

3) Insert distal pin using the distal PAHS pin clamp as a drill guide, since this distractor does not have a multi-planar adjustment. We chose a calcaneal attachment distally, since this is a fairly distal tibial fracture, going 2 cm distal and 2 cm posterior to the tip of the lateral malleolus, again exiting medially.

4) Applied a medial half frame and manually pulled the medial side out to length as much as we could by hand, with the lateral side undistracted, just following passively.

5) Activated the screw jack mechanism of the PAHS distractor laterally until it started to create varus of the subtalar joint.

6) Loosened the bar nut of the bar/pin clamp of the distal, medial half frame, while a simple bone clamp was applied to the end of the bar and one side of the bar/pin clamp. Applied as much distraction force as possible, then tightened the bar nut of the bar/pin clamp. The subtalar joint should be back in slight valgus and the medial side a bit longer.

7) Activated the PAHS distractor again laterally, and repeated going from lateral screw jack to medial, bone clamp distraction as needed to achieve the tibial length/alignment  required. This approach worked like a charm, and really didn’t take much time.




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