• INTRODUCTION
    • Closed distraction of stiff tibial nonunions with a hexapod external fixator can predictably lead to union without the need for additional surgery or bone graft.
  • STEP 1 FIBULAR OSTEOTOMY
    • Resect 5 to 10 mm of the fibula, from its distal half or at the level of the fibular deformity if present.
  • STEP 2 APPLICATION OF HEXAPOD PROXIMAL RING USING “RINGS FIRST” METHOD
    • Apply the proximal ring orthogonal to the proximal bone segment.
  • STEP 3 APPLICATION OF HEXAPOD DISTAL RING USING “RINGS FIRST” METHOD
    • Apply the distal ring orthogonal to the distal bone segment.
  • STEP 4 CONNECTION OF STRUTS AND APPLICATION OF STERILE DRESSING
    • Connect the proximal and distal rings with 6 oblique struts.
  • STEP 5 POSTOPERATIVE PLANNING DEFORMITY CORRECTION AND DISTRACTION
    • Perform gradual deformity correction and distraction at a rate of 1 mm per day.
  • STEP 6 POSTOPERATIVE CARE UNTIL UNION
    • Perform pin-site care and functional rehabilitation.
  • STEP 7 “TRIAL OF UNION” AND FRAME REMOVAL
    • Ensure adequate union prior to removal of the circular fixator.
  • RESULTS
    • Hexapod closed distraction has been successfully used for the management of stiff hypertrophic tibial nonunions in our practice over the last 6 years.