Abstract
PurposeCircular external fixators have several advantages over other surgical options in the treatment of limb length discrepancy and axial deformity. The innovative Taylor Spatial Frame (TSF) combines a rigid hexapod fixation system with the support of a web-based software program, and thus offers the possibility of simultaneous corrections of multidirectional deformities. Whilst there is still some scepticism of many Ilizarov device users about the advantages of the TSF, the purpose of the study was to perform a comparison between the TSF and the Ilizarov ring fixator (IRF) with regard to the accuracy of deformity correction in the lower limb.MethodsTwo hundred and eight consecutive deformity corrections in 155 patients were retrospectively evaluated. There were 79 cases treated with the IRF and 129 cases treated with the TSF. The mean age of the patients at the time of surgery was 13.2 years (range; 2–49 years). Standing anteroposterior and lateral radiographs were evaluated preoperatively and immediately after removal of the frames. The final result was compared to the preoperatively defined aim of the deformity correction. According to the treated count of dimensions, we differentiated four types of deformity corrections. The results were graded into four groups based on the persisting axial deviation after removal of the frame.ResultsThe aim of the deformity correction was achieved in a total of 90.7% in the TSF group, compared to 55.7% in the IRF group. On the basis of the count of dimensions, the TSF achieved obviously higher percentages of excellent results (one dimension: TSF 100%; IRF 79.3%; two dimensions: TSF 91.8%; IRF 48.6%; three dimensions: TSF 91.1%; IRF 28.6%; four dimensions: TSF 66.7%; IRF 0%). In addition, the degree of the persisting deformity increased with the number of planes of the deformity correction.ConclusionsThe TSF allowed for much higher precision in deformity correction compared to the IRF. In two-, three- and four-dimensional deformity corrections in particular, the TSF showed clear advantages. This may derive from the TSF-specific combination of a hexapod fixator with the support of an Internet-based software program, enabling precise simultaneous multiplanar deformity corrections.
Highlights
Current methods of limb lengthening are based on gradual distraction osteogenesis [1,2,3,4].The Ilizarov Ringfixator (IRF) is thought to have several advantages over other surgical options in the treatment of limb length discrepancy and axial defor-J Child Orthop (2007) 1:55–61 mity [5], and has become widely accepted for the correction of various deformities of the upper and lower limb
Since there is still vivid discussion amongst the users of external devices about the benefit of the Taylor Spatial Frame (TSF) in complex deformity correction, the purpose of the present study was to investigate the accuracy of deformity correction achieved in the lower limb in a comparison between the TSF and the IRF
We reviewed a total of 278 lower-limb deformity corrections in 207 patients performed with either the IRF or the TSF between January 1, 1985 and December 31, 2004
Summary
Current methods of limb lengthening are based on gradual distraction osteogenesis [1,2,3,4].The Ilizarov Ringfixator (IRF) is thought to have several advantages over other surgical options in the treatment of limb length discrepancy and axial defor-J Child Orthop (2007) 1:55–61 mity [5], and has become widely accepted for the correction of various deformities of the upper and lower limb. The surgeon uses hinges and translation mechanisms to build a custom-made frame system for each distinct deformity [6]. Correction of complex deformities may require changes of the frame construct, which may be very time-consuming or even impossible [7, 8]. As a hexapod fixator with lengthening struts in oblique positions, the Taylor Spatial Frame (TSF) (Smith & Nephew, Memphis, TN, USA) offers the possibility of simultaneous correction of multidirectional deformities without the need of extensive changes to the system during correction [7,8,9,10,11,12]. In comparison to the traditional IRF the TSF uses one single frame construct, and no additional devices are needed for correction of translation or rotation deformities. The software-generated frame adjustments schedule allows an accurate overview of the course of the deformity correction for the surgeon and the patient (Fig. 1)
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