20: Distraction of Hypertrophic Nonunion

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3 Preoperative Problem List

Severe deformity
Long duration
Rheumatoid arthritis and diabetes mellitus

4 Treatment Strategy

Gradual deformity correction was combined with minimally invasive fixation. The foot was included when planning the deformity correction. Ankle range of motion was preserved, but the foot was included in the frame. The hypertrophic nonunion was distracted 0.5 mm/day at the concavity of the deformity. Additional bone grafting was not needed because the distraction allowed the regenerate process to occur. A cast was applied after frame removal to provide support and remained in place for 1 month.

5 Basic Principles

Gradually correct the deformity to avoid neurovascular injury. Also allow the hypertrophic nonunion to heal without bone graft. Address the ankle to avoid development of any equinus deformity. Include the foot in the frame for stability.