External Fixators for Deformity Correction

  • Austin T. FragomenEmail author
  • Kristin S. Livingston
  • Sanjeev Sabharwal


External fixators have reinvented the art of deformity correction by incorporating the 4D technology of gradual correction over time into the operative strategy. Computer navigation through the use of hexapod technology has further advanced the surgeon’s ability to realign malunited fractures and nonunions safely and reproducibly. Frame stability is paramount to successfully controlling the fixated bone fragments and performing accurate deformity correction with reliable healing. The biomechanics begin with a thorough evaluation of the patient and the radiographs to generate a comprehensive preoperative plan. A stable frame is applied in the operating room, and a minimally invasive surgery is performed when possible. Careful follow-up is done to check the frame integrity including strut markings, the adjacent soft tissues, and the radiographs. Problems and obstacles are addressed. Frame removal is determined by assessing many factors.

The success of this method is proven and is the result of the hard work and courage of many surgeons and patients. Several studies have been cited in this chapter but only represent a fraction of the work that has been done in this field, particularly at the Ilizarov Scientific Center in Kurgan, Russia, where extensive research has taken place for decades. The field of deformity correction continues to evolve as we better understand which deformities can be corrected acutely and which require gradual approach. While internal lengthening technology has dominated femur limb reconstruction in recent years, there will always be a role for circular frames in this field.


Ilizarov Hexapod Taylor Spatial Frame (TSF) External fixator Biomechanics Stability Half pins Tensioned wires Deformity Nonunion Malunion Bone transport 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Austin T. Fragomen
    • 1
    • 2
    Email author
  • Kristin S. Livingston
    • 3
  • Sanjeev Sabharwal
    • 4
  1. 1.Weill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Limb Lengthening and Complex Reconstruction ServiceThe Hospital for Special SurgeryNew YorkUSA
  3. 3.Department of Orthopaedic SurgeryBenioff Children’s Hospital at Mission Bay, University of California at San FranciscoSan FranciscoUSA
  4. 4.Department of OrthopedicsBenioff Children’s Hospital of Oakland, University of California–San FranciscoOaklandUSA

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