Table 1.

Step-by-Step Surgical Procedure

Step	Description
1	The patient is anesthetized and positioned supine.
2	The apex of the deformity is marked using Kirchner wire to indicate the correct point of the hinge of the external fastener.
3	The distances of this apex are checked so that the appropriate clamps (straight, bar, or T) are chosen.
4	Under fluoroscopic guidance, the drill is placed 4.8 mm inside the drill guide in contact with the anterolateral cortex of the tibia to create the first channel through which the pin will be inserted parallel to the articular surface of the tibial plateau approximately 2 cm below this surface. A 6.0-mm conical external fixator pin is placed using the T-key until the second cortex is ironed.
5	Distally, the lower pin is placed, thus delimiting the size of the device in relation to the tibia and the point of the fixator hinge being exactly at the apex of the deformity.
6	One or two more pins are placed proximally and distally.
7	With the aid of fluoroscopy, the center of the tibia deformity is marked, with anterior access of approximately 5 cm being performed. With the visualization of the tibia, a partial osteotomy is performed of the tibia, leaving the area intact from the crest of the tibia to the medial cortex will function as a hinge.
8	Access to the fibula is performed 10 cm from the lateral maleollus and an osteotomy of the fibula is performed to prevent an impediment in the distraction of the tibia.
9	The self-centering switch is added to the self-centering body, which is responsible for the distraction of the external fastener. The L-key is used to perform the distraction by the distractor, and its results are checked by direct visualization of the focus and fluoroscopy.