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Principles of deformity correction

Principles of deformity correction involve accurately analyzing a limb deformity in the coronal, sagittal, and axial planes, identifying its apex and underlying cause, and planning correction to restore normal mechanical alignment, joint orientation, limb length, and function. The CORA (Center of Rotation of Angulation) is a key concept used to determine the level and magnitude of correction. Treatment may involve acute or gradual correction using osteotomy, internal fixation, external fixation, or guided growth depending on the patient and deformity.

Deformity correction is the systematic process of restoring abnormal limb alignment to improve function, joint loading, cosmesis, and long-term mechanical balance. Proper correction begins with a detailed clinical and radiological assessment of the deformity in all planes, including angulation, translation, rotation, and limb-length discrepancy. The most important planning concept is the CORA (Center of Rotation of Angulation), which is determined by the intersection of the proximal and distal mechanical or anatomical axes. The magnitude of deformity is measured as the angle between these axes. Ideally, an osteotomy performed at the CORA allows angular correction without creating secondary translation. If the osteotomy is performed away from the CORA, translation may be required to maintain proper alignment. Deformities may be uniplanar or multiplanar, and correction must account for associated rotational and length abnormalities. Preoperative planning includes assessment of joint orientation angles, mechanical axis deviation, limb length, soft-tissue condition, growth potential, and the presence of joint contractures or instability. Correction may be performed acutely, using procedures such as closing-wedge, opening-wedge, dome, or rotational osteotomies, or gradually using external fixation and distraction osteogenesis. In skeletally immature patients, selected angular deformities may be corrected by guided growth or hemiepiphysiodesis. The overall goals are to restore the mechanical axis, joint orientation, limb length, rotational profile, and functional alignment while minimizing neurovascular injury, soft-tissue compromise, and recurrence. Accurate deformity analysis and careful planning are essential for achieving a stable and durable correction.

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Principles of deformity correction

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