Fixator-Assisted Plating and Nailing for Multiplanar Lower Limb Deformities in Adolescents: Indications, Technical Considerations, and Radiographic Outcomes.

BACKGROUND

Uncorrected lower limb deformities in adolescents, particularly those with severe multiplanar deviations, can lead to early joint degeneration and functional impairment. When growth modulation is no longer feasible, corrective osteotomy becomes necessary. This study aims to demonstrate the efficacy of fixator-assisted techniques-fixator-assisted locked plating (FALP) and fixator-assisted nailing (FAN)-in achieving accurate correction of complex femoral and tibial deformities across the frontal, sagittal, and torsional planes.

METHODS

A prospective study was conducted involving 27 adolescent patients (31 surgeries) treated with FALP or FAN techniques between 2021 and 2024. Patients were divided into 3 groups: group A (FALP-distal femur), group B (FALP-tibia), and group C (FAN). Data collected included demographics, surgical parameters, preoperative and postoperative deformity measurements, time to weight-bearing, bone consolidation, return to daily activities, and complications. Statistical analysis was performed using IBM SPSS Statistics 29.0. The mean follow-up was 20.9 months.

RESULTS

Radiographic union was achieved in all cases, with a mean time to consolidation of 4 months. Mean mechanical axis deviation corrections reached 36.7 mm in valgus and 36.4 mm in varus deformities, achieving near-neutral postoperative alignment. Torsional corrections averaged 53.3° for internal femoral torsion and 36.3° for external tibial torsion. Sagittal corrections included 22° for femoral extension and 10° for tibial proximal flexion deformities. Patients treated with FAN achieved significantly earlier weight-bearing (mean 5.8 days). No clinically relevant secondary deformities, joint stiffness, or significant leg length discrepancies were identified during follow-up. Complications were rare and unrelated to the external fixator-assisted techniques. Implant removal was performed in 38.7% of cases.

CONCLUSIONS

FALP and FAN techniques are safe and effective methods for the acute correction of severe multiplanar lower limb deformities in adolescents. They enable precise 3-dimensional correction with reliable bone healing and early return to activities and may represent a useful alternative to gradual correction methods in appropriately selected cases.