The Art of Limb Alignment, Twelfth Edition

For more than 31 years, we have taught limb correction surgery at the annual Baltimore Limb Deformity Course (www.DeformityCourse.com). We have used these hands-on experiences with our students to guide us when creating this book. The Art of Limb Alignment is a concise guide for beginners starting on their journey to master the art of limb alignment. Understanding limb alignment and malalignment is a critical task for surgeons who treat lower extremity deformities. The first step is to characterize the deformity: Is the bone angulated? In what direction is the bone angulated? What is the level of the deformity? Where is the apex of the deformity? What is the magnitude of the deformity? Is the bone short? Is it rotated on its axis? All these questions must be answered before correcting the problem. In a new Chapter 16 for this twelfth edition, planning and considerations for internal lengthening are discussed. The anatomy of the mechanical intramedullary lengthening nail and its different variations are reviewed. A walkthrough is provided for determining the placement of the osteotomy and proper nail length. Planning cases are provided for retrograde femoral lengthening and tibial lengthening in adults. A substantial section on pediatric considerations for internal lengthening is also included; it contains the intraoperative technique and postoperative protocol for the more recent development of extramedullary internal lengthening. This edition also includes noteworthy updates to multiple chapters. Chapter 3 features 12 all-new illustrations. Chapter 11 has been revised to include four examples of calculating total limb length discrepancy with the Three Line Method, with four new illustrations to accompany them. Finally, Chapter 12 has been overhauled to include modifications to the classic reverse planning technique that was introduced in 2009. Extensive illustrations are provided for both the classic and modified methods, and the steps of planning a case are depicted in detail with 17 images from digital planning software. Several different deformity planning software programs exist. We are unable to provide specific instructions for all of them and have focused the contents of this book on using Bone Ninja, created at our institution and available as an iPad app educational tool through the App Store. However, Bone Ninja is not distinctly necessary for the planning and concepts outlined within this book. The Art of Limb Alignment is intentionally short, concise, and we hope, easy to grasp. The theme is that of student and teacher (sensei) embarking on a voyage to master the art of limb alignment. Enjoy the journey!