Die Korrektur posttraumatischer Deformitäten am Unterschenkel mit dem „Taylor Spatial Frame“

Abstract

Correction of posttraumatic lower leg deformities using percutaneous osteotomy, external fixation with a ring fixator, and computer-assisted gradual correction with the Taylor Spatial Frame (TSF). Posttraumatic lower leg deformities not suitable for acute correction and internal fixation or deformities that are suitable but have a significantly increased risk for complications: deformities with poor soft tissue coverage, rigid deformities that require gradual correction, complex mulitplanar deformities, deformities with shortening, and periarticular juvenile deformities. Posttraumatic lower leg deformities which are suitable for acute correction and internal fixation are also suitable for deformity correction using the TSF. In these cases, however, we recommend acute correction and internal fixation in order to improve the patient comfort. Lack of patient compliance for self-contained correction and pin care. Percutaneous fixation of the TSF rings to the main fragments using transosseous K-wires and half pins (hybrid fixation). Percutaneous osteotomy of the tibia either by drilling across both cortices and completion of the osteotomy using an osteotome (DeBastiani method) or by using the Gigli saw with preservation of the periostal envelope. Connection of both rings with six oblique telescopic struts via universal joints (hexapod platform). Computer-assisted planning of the correction. Gradual postoperative correction of the deformity by changing the strut lengths according to the correction plan. Strut changes, if required. Osseous consolidation of the osteotomy site with the TSF or revision to internal fixation. The correction of posttraumatic lower leg deformities using the TSF was performed in 6cases. The mean deformity was 15° (12-22°) in the frontal plane and 6° (4-8°) in the sagittal plane. The correction time was 19days (14-22 days). The deviation between planned and achieved correction was 0-3° in the frontal plane and 0-2° in the sagittal plane. The osseous consolidation of the osteotomy site was carried out in the TSF in 5cases with a mean external fixation time of 112days (94-134days). In one case, the TSF was removed after the correction and the osteotomy site was fixed using an intramedullary nail. Pin site infections were observed in 3cases. There were no further complications. The treatment goal was achieved in all cases. The examination at final follow-up was performed after 1year. All patients were able to walk without walking aids and with no pain at that time. They were able to perform all of their activities of the daily life and their leisure activities without limitations.