In this week’s installment of Ask the Expert, Orthopedic Surgeon Dr. Austin Fragomen discusses three state-of-the-art ways to correct bowlegs. To read his previous post on why bowlegs should be corrected, click here.
In the 21st century, patients have become well-informed, medical tourists who take ownership of their health care. The world-wide-web has given patients accessibility to previously mythical doctors and procedures. This exposure to different surgical techniques has led patients to consider which may be the best fit for them. A great example of a procedure that has many different surgical options to arrive at the same result is bowleg correction. Although it may seem that these different procedures are interchangeable, there are often salient anatomic features that will dictate the need for one procedure over another.
- Monolateral External Fixation: This is my preferred method for correcting a simple bowleg deformity. It requires that the varus, or bow, be in the tibia bone, that the deformity is less than 10 degrees, that there is no rotational deformity, and that the bone is of normal density (not osteoporotic). Although the criteria are somewhat restrictive, the patients that undergo this procedure are quite comfortable. The surgery is minimally invasive and the frame (external fixator) is small. Weight bearing is allowed immediately post operatively. Patients adjust the frame while at home, and the accuracy of the correction is excellent. The bone is straightened gradually, which is excellent for healing, and it is fun for the patient to see their leg growing straighter.
- Circular External Fixation: Circular frames, or those that use rings, are versatile and powerful tools for deformity correction. They can correct many deformities simultaneously. So, patients who have severe bowing (varus greater than 10 degrees) or who have associated tibial torsion, a loss of knee extension, or a leg length discrepancy can have all of these malalignments fixed simultaneously. Patients may walk right after surgery, and adjustments are very accurate.
- Internal Fixation of the Femur: Although more invasive than the external fixators, internal plates and IM nails are fantastic for the correction of femur bowing. I will often suggest using internal hardware when contemplating a femoral osteotomy, or bone cut. The thick tissues around the femur make external fixation very uncomfortable. The thigh’s nerves and arteries also tolerate rapid bone shifts to correct deformity much better than the tibial tissues making gradual correction unnecessary in the femur. Even more exciting is the use of the internal lengthening IM nail to both correct bowing and lengthen the femur.
You can’t always get what you want, but you will get what you need. These three different approaches to correcting bowlegs are tailored to the exact needs of the patient as dictated by the bony deformity. Although a patient may desire a certain method of surgery, accurate exam and radiographs will direct optimal treatment.
Dr. Austin Fragomen is an orthopedic surgeon and the fellowship director of the Limb Lengthening and Complex Reconstruction Service at Hospital for Special Surgery. Skilled in the art of less invasive surgery, Dr. Fragomen performs a sophisticated and comprehensive analysis of each patient to determine an optimal treatment plan. Whether performing an all-arthroscopic rotator cuff repair or re-aligning a deformed limb through mini-incisions, the goal remains the same: to minimize the trauma of surgery and maximize a rapid and functional recovery.