What is External Fixation?
The term, “External Fixation” is a surgical one used to describe a specialized technique of correcting bone and soft-tissue deformities. Although casts and splints are technically forms of external fixation, what we are going to discuss here is the use of a specialized set of rings, rods, wires, and pins which hold the bones and soft-tissues quiet until healing can occur. To knowledgeable deformity correction surgeons, external fixation has been, quite simply, a blessing since it can allow slow correction of a deformity over time [which avoids excessive tension on vital structures like nerves and blood vessels] or used after correcting a deformity to hold everything in place until full healing has occurred. In either situation, partial or full weightbearing with crutches or a walker is employed immediately after surgery. This, along with use of a blood thinner, like aspirin, lessens the risk of a lower leg blood clot since you are moving from day one and not sitting still for blood to pool and begin a clot. Also, by allowing you to be slightly active and able to move about, you are able to keep a healthy mind [by doing things other than just read or sit in bed all day], body, and work environment if possible.
Specifically, thin metal wires or slightly thicker pins are placed into the bones of the lower leg, ankle, and foot based on the type of surgery to be performed. These wires are then “tensioned” [tightened] which dramatically increases there strength and ability to support your body weight. These wires and pins are connected to either metal, or more commonly in the USA, carbon fiber rings through which the lower leg, ankle, and foot rest. Since the carbon fiber rings and tensioned wires do not allow any movement, they are incredibly strong and can easily support our body weight [assuming the external fixator was applied by a knowledgeable surgeon]. The surgical term applied to this specialized technique is the “Ilizarov Method” named after the Russian surgeon, Gavriil Ilizarov, who developed the process and performed the original research on the use of external fixation in fracture repair and deformity correction. As with any good product, there are other “similar” versions of the Ilizarov external fixator but none that have been proven more versatile or resilient. However, a new computer assisted external fixator called a “Taylor Spatial Frame: has been developed for lower leg fractures and deformities. This allows the surgeon to “fine-tune” or “dial-in” the final correction or reduction over time using a sophisticated computer coordinate based program. Dr. Werber and Rogers recently applied the first Taylor Spatial Frame for the correction of a severe Charcot midfoot deformity, which had undergone several previous failed surgeries, with good success.
What kinds of foot and ankle deformities can be corrected with an Ilizarov external fixator?
Technically there is no foot or ankle deformity that could NOT be corrected with the use of an external fixator. However, there is simply no need to use this technique in each and every situation just because it exists. for correction of a wide range of severe foot and ankle deformities such as: neglected clubfeet, diabetic Charcot foot/ankle collapse, ankle arthritis, contractures and deformities which have developed following traumatic injuries, stroke, or previous surgery, as well as, to lengthen amputated foot and toe stumps.
Drs Werber and Rogers routinely uses this technique to prevent amputation of severe diabetic infected ulcers and reconstruct the deformed diabetic Charcot collapsed foot and ankle. Combined with the use of specialized skin and muscle flaps to provide stable coverage of the ulcers, We are able to correct the deformity and reconstruct the foot and ankle to a function properly and look “normal” in appearance so that the patient can wear a modest shoe with the use of either a low-profile brace or customized insole to prevent recurrence.
How long does the External Fixator remain attached to your foot and ankle?
The exact length of time depends on a number of factors such as the actual type of deformity corrected, age, health status, tobacco use, alcohol use, etc. However, a general rule the external fixator is left in place between 6-12 weeks if used to simply maintain the reduction obtained acutely on the operating room table and about twice as long if the bones are being lengthened since the rate of bone and soft-tissue growth available in our body is between 0.5 and 1-mm per day. There are certain issues that must be discussed such as: What kind of shoe do you walk on? What kind of clothes can you wear? Can you get it wet? Will it set off a metal detector in the airport? These questions are best discussed directly with you podiatric foot and ankle surgeon who specializes in deformity correction since the exact answers to these questions are individualized. However there is an excellent “Ilizarov Wearers Support Group” available on the internet: WWW.ILIZAROV.ORG.UK.
Drs. Werber and Rogers have attended over 15 training seminars nationally and internationally, completed a mini fellowship in the use of external fixation for correction of severe foot and ankle deformities at the Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, and are actively involved in the use of this sophisticated technique in their practice.