Ilizarov
Indications
Poor soft tissues
- prohibit ORIF
Non union
Infected non uniion
Malunion / deformity
Bone loss / bone transport / LLD
Concept
ilizarov
Management
Non operative
Ponseti casting
Aims of treatment
1. Correct the deformity early
2. Correct it fully
3. Hold the corrected position until foot stops growing
- AFO
- Denis Browne Boots
Timing
Start 1 - 3 weeks
- let parents settle and get used to diagnosis
- explain method and length of treatment required
Tibial Plateau
Schatzker Classification
I. Lateral Spilt
- seen in young patient
- lateral meniscus can be incarcerated in fracture
II. Lateral Split Depression
- often seen in young patients with high energy injuries
- vary in severity
Management
Goals
1. Equal leg lengths
- goal is mild to moderate isolated discrepancy
2. Unequal leg lengths
- goal with paralysis / equinus foot
- aim 1-2 cm short for clearance
3. Level Pelvis
- should use blocks to estimate functional correction
4. Vertical LS Spine
- vertical spine more important than level pelvis