Taylor Spatial Frame Research Articles

Bone Transport for Large Segmental Tibial Defects Using Taylor Spatial Frame versus the Ilizarov Circular Fixator.

Bone transport has become the gold standard for treating large segmental tibial bone defects. The technique for application the Ilizarov circular fixator (ICF) has a long learning curve and is associated with many complications. There are few clinical studies on bone transport via the Taylor spatial frame (TSF). The main purpose of this study was to compare the radiological and clinical and outcomes of bone transport by using the TSF and the ICF. There were 62 patients included in this retrospective study from June 2011 to June 2021 and distributed to two groups according to the fixation method: a TSF group consisting of 30 patients and an ICF group consisting of 32 patients. Demographic information, surgical duration, external fixation times, external fixation index, final radiographic results, complications, and clinical outcomes were recorded and examined. The clinical outcomes were assessed using the ASAMI criteria during the most recent clinical visit. Then, statistical analysis such as independent-samples t tests or chi-Square test was performed. The mean surgical duration in the TSF group was 93.8 ± 7.3 min, which was shorter than that in the ICF group (109.8 ± 1.4 min) (p < 0.05). Compared to the ICF group (10.2 ± 2.0 months), the TSF group (9.7 ± 1.8 months) had a shorter average external fixation time (p > 0.05). The external fixation index was 1.4 ± 0.2 m/cm and 1.5 ± 0.1 m/cm in the two groups. Moreover, there was no significant difference between the two groups. At the last follow-up visit, the medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) in the TSF group were 88.1 ± 12.1° and 80.9 ± 1.3°, respectively. The MPTA and PPTA in the ICF group were 84.4 ± 2.4° and 76.2 ± 1.9°, respectively. There were statistically significant differences between the two groups (all p < 0.05). The complication rate was 50% in the TSF group and 75% in the ICF group. Moreover, the ASAMI score between the two groups was no statistically significant difference (p > 0.05). No statistically significant difference was found in clinical outcomes between the use of Taylor spatial frame and Ilizarov circular fixator for treating large segmental tibial bone defects. However, TSF is a shorter and simpler procedure that causes fewer complications and improves limb alignment.

Use of computer-assisted hexapod external fixators for complex foot and ankle reconstructions – An analysis of functional outcomes and complications

IntroductionFoot and ankle pathology can often require complex surgical reconstruction. Until recently, circular external fixators such as the Ilizarov frame have proven to be useful, yet they fall short when progressive, precise corrections are required. Computer-assisted hexapod external fixators seek to address many of the shortfalls of traditional circular fixators. However, evidence for their use is scarce. The objective of this work was to evaluate the functional and quality of life outcomes and post-operative complications of patients treated with computer-assisted hexapod external fixation. MethodsA retrospective, observational study was conducted. All cases were treated with either a TrueLok hex (TL-HEX) or a Taylor Spatial Frame (TSF) fixator. Primary outcomes were post-operative improvement in 12-Item Short Form Survey (SF12) and American Orthopaedic Foot and Ankle Score (AOFAS) scores, and complications following Paley’s classification. ResultsA total of 59 patients with complex foot and ankle conditions using 64 external fixation frames were included. The median sum of both SF12 score domains improved from a preoperative score of 63.6 to 91.3 at last follow-up (p < 0.001). Median AOFAS improved from a preoperative score of 35 to 75.5 at last follow up (p < 0.001). Functional improvement was not affected by the choice of external fixator. Complications occurred in 49 cases (77 %). The most common post-operative complications included pin tract complications in 37 (58 %) cases, joint rigidity in 24 (38 %) and axial deviation in 9 (14 %). ConclusionsComputer-assisted hexapod external fixation is an effective technique to correct complex foot and ankle deformities and leads to a marked improvement in post-operative functional and quality-of-life outcomes with a high minor complication rate.

Clinical Utility of Integrant’s FrameIt

This paper explores Integrant’s FrameIt, a novel external fixator based on the Taylor Spatial Frame (TSF). The TSF, invented by Dr. Charles Taylor, offers significant advantages over traditional Ilizarov frames in treating complex bone deformities and fractures. FrameIt leverages the TSF’s ability for precise six-axis adjustments and computer-assisted planning to achieve faster correction times and improved patient outcomes. The paper delves into the TSF’s background, highlighting its development as a solution to the limitations of the Ilizarov frame. It emphasizes the TSF’s reliance on principles from projective geometry, the Chasles’ Theorem and the Stewart Platform to achieve its superior accuracy. Furthermore, the paper explores the factors impacting the TSF’s success. It analyzes the influence of: Available and Emerging Technologies: The paper stresses the importance of utilizing advancements enhancing the TSF’s design and functionality Historical and Cultural Factors: The paper acknowledges the historical context that led to the development of external fixation systems, with the Ilizarov frame paving the way for the TSF Economic Factors: The paper discusses the economic considerations surrounding the TSF’s adoption, including equipment costs, procedures and aftercare. It highlights the limitations imposed by high costs on accessibility for some patients In conclusion, the paper positions Integrant’s FrameIt as a promising advancement in bone deformity correction. By building upon the TSF’s foundation and addressing economic barriers, FrameIt has the potential to revolutionize patient care in this field.

In vivo axial load-share ratio measurement using a novel hexapod system for safe external fixator removal

BackgroundExternal fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method’s feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators.MethodsA novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon’s diagnosis based on the clinical and radiological assessment (bone union achieved).ResultsNo significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05).ConclusionThe novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice.

The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture.

Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications. Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union. The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13-15.18], p = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant. Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union. The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis. Geetala R, Zhang J, Maghsoudi D, et al. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024;19(1):32-35.

The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture.

Multi-planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D-TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip-knee-ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow-up full-length X-rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow-up, Johner-Wruhs tibial fracture outcome criteria (J-W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi-square test or Fisher's exact test; the Mann-Whitney U test was used for rank data. No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D-TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner-Wruhs criteria were used to assess the function of the affected limb, the D-TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow-up X-rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow-up compared to the angle before surgery. At the final follow-up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). The D-TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture.

Design and Testing of an Intramedullary Nail Implant Enhanced with Active Feedback and Wireless Connectivity for Precise Limb Lengthening

This comprehensive study presents a pioneering approach to limb lengthening, leveraging the advancements in wireless technology to enhance orthopedic healthcare. Historically, limb lengthening has been a response to discrepancies caused by fractures, diseases, or congenital defects, utilizing the body’s innate ability to regenerate bone and surrounding tissues. Traditionally, this involved external or internal fixation devices, such as the Ilizarov and Taylor Spatial frames or the Precice nail and Fitbone. The focal point of this research is the development and testing of a wireless intramedullary nail implant prototype, controlled remotely via a mobile application. This implant comprises a microcontroller, Bluetooth Low Energy module, a brushed DC motor controlled through an H-bridge, and a force sensor, all powered by medical-grade batteries. The integration of wireless technology facilitates patient autonomy in managing limb lengthening, reducing the need for frequent clinical visits. The methodology involves a detailed block diagram for our proposed work, outlining the process from treatment planning to the initiation of limb lengthening via the mobile application. Osteogenesis, the formation of new bone tissue, plays a crucial role in this procedure, which includes pre-surgery assessment, osteotomy, latency, distraction, consolidation, and removal phases. Key challenges addressed include custom battery design for efficient operation, size constraints, and overcoming signal interference due to the Faraday cage effect. Attenuation testing, simulating human tissue interaction, validates the implant’s connectivity. In conclusion, this research marks a significant stride in orthopedic care, demonstrating the feasibility of a wireless implant for limb lengthening. It highlights the potential benefits of reduced clinical visits, cost efficiency, and patient convenience. Despite limitations such as battery requirements and signal interference, this study opens avenues for future enhancements in patient-centered orthopedic treatments, signaling a transformative shift in managing limb length discrepancies.

Salvage Algorithm for Deep Surgical Site Infections after HTO with Unstable Bone Situation Using a Hexapod System - Primary Results.

The incidence of deep surgical site infections following high tibial osteotomy (HTO) ranges between 0.4 to 4.7%. It is a severe complication with a high risk for poor clinical outcome. The aim of this study was to proof that a salvage algorithm for infected HTO with unstable bone situation leads to an infection-free status and bone union of the osteotomy and that correct limb alignment can be restored with good knee function.The study included seven patients with peri-implant infections following HTO. Infections occurred 83±58.9 days (range: 24-191) after HTO. All patients underwent the "RESTORE" algorithm: patients received (1) REmoval of the HTO hardware and extensive debridement; (2) the osteotomy was STabilized with a hexapod external fixator (Taylor Spatial Frame, TSF); (3) the osteotomy gap was Opened; and (4) the alignment was REconstructed using the TSF, aiming for the intended limb alignment of the initial HTO. Patient-reported outcomes were assessed 22-36 months after removal of the TSF.After 24 weeks (range: 11-35), an infection-free status and bone healing were achieved. In all cases, the limb was saved, and the previously targeted mechanical axis of the lower limb was restored. All patients reached full extension of the knee joint and at least 110° of flexion. For KOOS: Symptoms 67.86±18.1, Pain 73.41±16.58, ADL 78.99±21.32, Sports 52.14±25.96, and QoL 41.96±24.66. OKS 35.71±8.8, SF-12 Physical Health 38.89±10.3, and SF-12 Mental Health 46.86±13.76.The "RESTORE" algorithm is a safe and effective salvage procedure. The concept allows for saving the limb and obtaining the previously planned limb alignment. Patient-reported outcome measures showed slightly lowered values than healthy samples, but substantially better values than patients awaiting HTO. Due to the possibility of initial full weight-bearing, the risk of higher morbidity caused by immobilization is minimized.

Axial load-share ratio testing to assess the healing of open tibial fractures treated with the Taylor Spatial Frame

Axial load-share ratio testing to assess the healing of open tibial fractures treated with the Taylor Spatial Frame

Bone Transport with the Taylor Spatial Frame Technique: A Case Series.

Bone transport is a beneficial reconstructive method for bone defects caused by infected non-unions or bone tumours. The Taylor Spatial Frame (TSF) is a three-dimensional corrective external fixator that can be used to achieve bone transport and correct any residual deformities easily at any time. This study reports the results of bone transport using TSF. This is a retrospective study of ten patients who underwent bone transport using the TSF. The mean age was 32.3 years; the femur was affected in one case and the lower leg in nine. Bone defects were due to infected non-unions in seven cases and bone tumours in three. The duration of external fixation, bone transport distance, distraction index (DI), alignment at the end of correction, leg length discrepancy, and complications were investigated. The average bone transport distance was 76.0 mm. The external fixation period averaged 367 days with the DI at 20.8 days/cm. Deformity at the docking site was assessed to have an average 2.6° deformity and 2.0 mm translation in the frontal view, as well as 3.3° deformity and 3.7 mm translation in the lateral view. The mean leg length discrepancy was 10.9 mm and the percentage of the mechanical axis (%MA) was 40.6%. Four patients underwent plate conversion after correction and two required additional surgery for non-union at the docking site. Bone union was achieved in all patients and there was no reaggravation of infection or tumour recurrence. The TSF allowed for the correction of deformities and translations that occurred during bone transport giving excellent results. However, as with bone transport using this or other devices, additional procedures are often needed to obtain consolidation or docking site union. Shimokawa K, Matsubara H, Hikichi T, et al. Bone Transport with the Taylor Spatial Frame Technique: A Case Series. Strategies Trauma Limb Reconstr 2023;18(2):117-122.

Treatment of Complicated Clubfoot Using External Fixation: A Scoping Review

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The treatment of relapsed, resistant, or neglected clubfoot presents a challenge — some patients may not respond to the traditional Ponseti method. Studies involving gradual distraction using external fixators for treatment of these cases have been performed, but no systematic review has been conducted on the subject. Methods: A comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science according to PRISMA guidelines. Only articles that pertained to the treatment of pediatric patients with clubfoot using external fixation and contained three or more human subjects were included. Reviews, professional opinions, and studies with non-human subjects were excluded. Results: Of 6,469 articles generated from the initial search, 25 met inclusion criteria. 609 total feet (490 total patients) were included, and 533 of these feet (445 patients) were treated with external fixation. The mean age of patients was 8.5 [2-18] years with a mean follow-up length of 40.9 [5-126] months. 21 (84%) studies used the Ilizarov apparatus, two used Joshi’s external stabilization system, and one used the Taylor spatial frame. The most reported primary scoring systems were the 60-point International Clubfoot Study Group (ICFSG) score (20%), Dimeglio classification (12%), Pirani score (8%), and Reinker and Carpenter scales (8%). All but one study found significantly improved primary outcomes for the majority of respective patients. Conclusion: External fixation, which may or may not include open surgery, is a promising intervention for neglected or relapsed clubfoot. However, encouraging more standardized outcome measurements would allow for more thorough comparisons between studies.

1173 What Influences Taylor Spatial Frame Effectiveness in the Treatment of Tibial Osteomyelitis? A Major Trauma Centre Perspective

Abstract Aim Treatment of tibial osteomyelitis can be challenging, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) and analyse factors that affect outcomes. Method Between 2015-2020, 51 patients were treated with TSF for osteomyelitis at a Major Trauma Centre. Demographic, infection, and treatment factors were collected, with microbiology results, antibiotic treatment regimes, and time to partial weight-bear (PWB) and full weight-bear (FWB) prescriptions also noted. Outcomes of complications and time to union were obtained. Results Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six/three patients were further treated with fusion/amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin-site infection, malunion, and non-union being most prevalent. Staphylococcus epidermidis in bone debridement microbiology was significantly negatively associated with pin-site infection (OR = 0.093, 95% CI [0.011-0.828] ) and malunion (OR = 0.698 95% CI[0.573-0.849]), and enterococcus with non-union (OR = 0.775, 95% CI [0.656-0.916] ), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p = 0.035), time TSF was in (p = 0.021), presence of any complications (p = 0.045), bone loss complication (p = 0.037), time to FWB prescription (p = 0.001). Conclusions We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated the most important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union.

External fixation for the correction of complex deformities : From the classic Ilizarov ring fixator to modern software-driven hexapod fixators

The history and development of circular fixation is closely aligned with the history of limb lengthening. GavriilA. Ilizarov not only developed his circular fixator, but he also was the first to research and publish on distraction osteogenesis. Progress and dissemination of the method was initially based on individual pioneers; astandardized nomenclature and annual courses led to awider dissemination. The introduction of the Taylor spatial frame in 1997 was agame changer. Although various groups had already developed Hexapod-fixators, it was the TSF that hit the market and achieved market presence. After the patent for TSF expired, many companies developed hexapod fixators with various modifications. Anew version of the TSF, the Smart TSF, which included an intuitive planning software, was introduced in Baltimore in 2021. The introduction of intramedullary lengthening nails at the beginning of the 2000s and the wide dissemination starting approximately 2013 rendered external fixation obsolete for certain indications. However, ring fixators are still the method of choice for complex reconstruction of deformity in traumatology, as well as in pediatric orthopedics in the presence of open growth plates.

Half-pin Breakage in Multiplanar External Fixators Used for Pediatric Deformity Correction.

Pediatric patients with leg length discrepancies and complex deformities may require multiplanar external fixators for correction. We have encountered 4 cases of half-pin breakage with the Orthex hexapod frame. The purpose of this study is to report factors associated with half-pin breakage and compare various deformity correction characteristics between 2 hexapod frames - Taylor Spatial Frame (TSF) and Orthex. Pediatric patients with lower extremity deformities treated with an Orthex or TSF at a single tertiary children's hospital between 2012 and 2022 were included for retrospective review. Variables compared between frame groups include frame configuration, half-pin/wire fixation, length achieved, angular correction, and frame time. There were 23 Orthex frames (23 patients) and 36 TSF (33 patients) included. Four Orthex and zero TSF had proximal half-pin breakage. The Orthex group was younger on average (10 vs. 12y, P =.04*) at the time of frame placement. The majority (52%) of Orthex frames were used for simultaneous lengthening and angular correction, while the majority (61%) of TSF was used for only angular correction. Orthex had more half-pins used for proximal fixation (median 3 vs. 2, P <0.0001*) and more frames with nonstandard configuration (7 (30%) vs. 1 (3%), P =0.004*). Orthex group had a longer total frame time (median 189 vs. 146 days, P =0.012*) and longer time required for regenerate healing (117 vs. 89d, P =0.02*). There were no significant differences in length gained, angular correction, or healing index between Orthex and TSF. Nonstandard configuration, increased number of proximal half-pins, younger age at index surgery, and increased lengthening were associated with pin breakage. This is the first study to report half-pin breakage while using multiplanar frames in pediatric lower extremity deformity correction. The Orthex and TSF groups consisted of significantly different patients and frame configurations, making it difficult to identify any specific cause for pin breakage. This study shows that pin breakage is likely caused by multiple factors and is associated with the increased complexity of deformity correction. Level III-Retrospective Comparison Study.

DRY GAUZE AND IODINE TULLE DRESSINGS FOR THE PREVENTION OF INFECTION IN PATIENTS WITH A LOWER LIMB EXTERNAL FIXATOR: A RETROSPECTIVE OBSERVATIONAL STUDY

DRY GAUZE AND IODINE TULLE DRESSINGS FOR THE PREVENTION OF INFECTION IN PATIENTS WITH A LOWER LIMB EXTERNAL FIXATOR: A RETROSPECTIVE OBSERVATIONAL STUDY

Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy

BackgroundSeveral studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate.MethodsSingle-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III–IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures.ResultsA significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking.ConclusionIn high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.

TIBIAL OSTEOMYELITIS TREATED WITH THE TAYLOR SPATIAL FRAME

Treatment of tibial osteomyelitis can be challenging and lengthy, with numerous complications possible during rehabilitation. We report on the usage of the Taylor Spatial Frame (TSF) for a large cohort of patients, and analyse factors that affect outcomesBetween 2015-2020, 51 patients were treated with TSF for osteomyelitis at a major trauma centre.Demographic, infection and treatment factors of: age, smoking status, diabetes, and BMI, acute (&lt;6 weeks post injury) or chronic (&gt;6 weeks) osteomyelitis, bacteria isolated, time to debridement, therapy/surgery number of TSF, time TSF was in, antibiotic treatment period, time to partial weight bear (PWB) and full weight bear (FWB) prescriptions, were collected. Outcomes of complications and time to union were obtained.Radiological union was achieved at mean 11.0 months. Mean follow up was 24.1 months. Six and three patients were further treated with fusion and amputation respectively. Mean treatment time with TSF was 12.1 months. 78% had some complications, with pin site infection, malunion, and non-union being most prevalent.Univariate factor analysis, multicollinearity diagnostics, then multivariate model construction were performed.Staphylococcus Epidermidis in bone debridement microbiology was significantly negatively associated with pin site infection (OR 0.093, 95% CI 0.011-0.828) and malunion (OR 0.698, 95% CI 0.573-0.849), and enterococcus with non-union (OR 0.775, 95% CI 0.656-0.916), during the treatment period. Time to union was significantly positively associated with time from admission to debridement (p=0.035), time TSF was in (p=0.021), presence of complications (p=0.045), bone loss complication(p=0.037), time to FWB prescription(p=0.001).We have analysed the effectiveness of TSF in the treatment of tibial osteomyelitis, and elucidated important injury, treatment and rehabilitation factors that affect outcome. The negative bacterial-complication cross associations could be due to successful eradication as culture specific antibiotics were used postoperatively. Earlier patient full weight bearing could enhance callous formation leading to faster union.

Taylor Spatial Frame Behavior in High Tibial Osteotomies: A Clinical–Mechanical Study

The introduction of Taylor Spatial Frame (TSF) in clinical practice allows for unique capabilities in long bone deformity corrections; however, a comprehensive understanding of its mechanical characteristics and their impact on callus formation at the osteotomy site is still unclear. The current study is concerned with the clinical application of TSF in high tibial osteotomy (HTO) and the mechanical testing of this device. Fifty-five (55) patients with symptomatic medial compartment knee osteoarthritis and varus deformity underwent open-wedge HTO with the use of TSF and were prospectively monitored with regard to callus formation pattern at the site of osteotomy. Clinical evaluation revealed that the callus formation pattern was eccentric in all patients. In addition, the experimental results from mechanical testing of a clinically relevant TSF configuration indicate, that vertical deflection of the upper bone part during weight-bearing is accompanied by a rotation of the bone axis, which acts in the same direction to the rotation applied during the clinical correction process. The complementary contributions of the deformity correction process and the mechanical response of the TSF under compressive loads, lead to asymmetric gap closure, which promotes the eccentric callus formation in the osteotomy site. The study provides useful information for clinical decision-making regarding callus formation process when TSF external fixator is applied in HTOs.

A comparative evaluation of the time to frame removal for tibia fractures treated with hexapod and Ilizarov circular frames.

Traditional Ilizarov and hexapod frames have different biomechanical properties and there is limited literature regarding their effect on time to fracture union or time to frame removal. Tibial fractures managed with a circular frame at a tertiary limb reconstruction referral centre between 2011 and 2018 were retrospectively identified from a prospectively maintained database. They were classified into three treatment groups; Ilizarov style, Taylor Spatial Frame (TSF) and TrueLok Hex (TL-Hex). Data were extracted from electronic patient records and digital radiographs. The primary outcome was time to frame removal, which was seen as an indicator of clinical and radiological fracture union. Odds ratios were calculated with the clinical significance set at 30 days. 274 patients (median age 49 years, 36% female) were included in the analysis. 8.4% Ilizarov, 10.5% TSF and 13.5% TL-Hex frames required further surgery to aid fracture healing (p=0.38). 30% of patients had open fractures. Median time to removal for Ilizarov, TSF & TL Hex frames was 167, 198 and 185 days respectively. There was a significant difference between Ilizarov and hexapod frames. Both TSF (OR 2.2, p<0.003) and TL-Hex (OR 1.8, p<0.04) had a significantly increased time to removal of 30 days or more compared with Ilizarov frames.The time to frame removal in metaphyseal fractures was significantly shorter for Ilizarov frame fixation than hexapod frames (p=0.04). Open fractures were significantly more likely to require at least 30 days extra time to removal than closed fractures (OR 3.3, p<0.001). There was no significant difference in the time to frame removal between fracture location, age or sex. Ilizarov frames have demonstrated a reduced time to frame removal in the management of tibial fractures than hexapod frames. Differences in the time to frame removal, an indicator of time to fracture union, may be due to the different mechanical properties of the frame, or early disruption of the fracture haematoma through secondary frame manipulation and fracture reduction, increased proportion of metaphyseal fractures treated with Ilizarov, or patient selection. The healing time was comparable across the tibia. Pooled meta-analyses may be able to further quantify these associations.

Taylor spatial frame versus ortho SUV for correction of lower limb deformities: A comparative study

Taylor spatial frame versus ortho SUV for correction of lower limb deformities: A comparative study