title: Tibial Lengthening Using a Fixator-Assisted Lengthening Plate: A New Technique.
abstract: BACKGROUND
  There are many techniques that are used for limb lengthening. Lengthening a limb over a plate is an alternative choice used in children or when using an intramedullary nail is difficult.
  
  
  OBJECTIVE
  In this study, we presented a new technique for tibial lengthening using a monolateral external fixator over a lengthening plate.
  
  
  METHODS
  For tibial lengthening, a monolateral external fixator was attached to the composite bone model medially. After a corticotomy was performed, the lengthening plate was placed laterally. Three locking screws were inserted proximally, and two cortical screws were inserted into a lengthening hole that was 1 cm below the osteotomy site. We avoided contact between the screws of the lengthening plate and the pins of the external fixator. During bone lengthening with the monolateral external fixator, the screws at the lengthening hole were able to slide distally with the distal segment of the tibia to allow for tibial elongation. Two locking screws were fixed at the distal locking holes of the plate when the bone elongation was complete. The external fixator was then removed.
  
  
  RESULTS
  The fixator-assisted lengthening plate allowed bone lengthening without malalignment. There were no mechanical problems associated with the external fixator during the lengthening process. Plate osteosynthesis was stable after the fixator was removed. There was no contact between the screws of plate and the Schanz pins of the external fixator under C-arm fluoroscopy.
  
  
  CONCLUSIONS
  The fixator-assisted lengthening plate technique helps to maintain the stability and alignment at both sides of an osteotomy during tibial elongation. It allows the early removal of the external fixator immediately after lengthening is completed. This technique can be applied in children with open physes and in patients with a narrow medullary canal who are unsuitable for limb lengthening over an intramedullary nail.
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Haci Bayram
authors.initials: HB
authors.lastname: Tosun
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Agir
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Seyitali
authors.initials: S
authors.lastname: Gumustas
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey.
authors.forename: Sancar
authors.initials: S
authors.lastname: Serbest
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Abuzer
authors.initials: A
authors.lastname: Uludag
authors.affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Suat
authors.initials: S
authors.lastname: Celik
keywords: External Fixator; Lengthening Plate; Malalignment; Tibial Lengthening