If present, the external fixator is adjusted to correct the angles to normal. If this step were skipped, permanent deformation of the alignment of the limb and of the joint position would remain after the lengthening. We routinely examine for this and correct the joint orientation angles to normal. This is especially important during double-level tibial lengthening. The other important adjustment that is also made at this stage for tibial lengthening is derotation.
Patients usually have abnormal in-toeing of the tibia.
This is easily corrected by an adjustment to the external fixator. These adjustments are painless and do not require surgery. They may require 1 to 2 hours of changing parts on the fixator. Uncorrected axial deviation is a frequent complication of the Villarubias method of lengthening. The reason for this is that the monolateral fixator used with that technique is difficult to adjust for mild angular deformities.