Taylor Spatial Frame Research Articles

Taylor spatial frameのパーツを使用した松下法による足関節尖足拘縮の治療法

Taylor spatial frameのパーツを使用した松下法による足関節尖足拘縮の治療法

In Acute Closed Tibial Shaft Fractures, Surgery with the Taylor Spatial Frame Versus Reamed Intramedullary Nailing Did Not Differ for Quality of Life or Pain at 2 Years.

In Acute Closed Tibial Shaft Fractures, Surgery with the Taylor Spatial Frame Versus Reamed Intramedullary Nailing Did Not Differ for Quality of Life or Pain at 2 Years.

Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System.

PurposeComparison of two hexapod frame systems in paediatric tibial deformity correction; the Taylor Spatial Frame (TSF) and Orthex Hexapod System.MethodsPaediatric patients with congenital and acquired tibial deformities treated with either TSF (between 2014 and 2016) or Orthex (between 2017 and 2019) frames were included in a retrospective comparative study. Outcome measures were healing index, pin infection rate, regenerate quality and density, software residual rate, deformity correction accuracy, strut exchanges and quality of life (QoL).ResultsThe TSF group had 17 patients (18 frames) and the Orthex group had 21 patients (25 frames). The most common indications for tibial deformity correction were fibular hemimelia (14) and septic or traumatic growth arrest (8). The median time in frame was 230 days (TSF) versus 203 days (Orthex) (p= 0.06). The mean lengthening achieved was 54 mm (TSF) and 51 mm (Orthex) (p = 0.41). The healing index was 41 days/cm (TSF) versus 43 days/cm (Orthex) (p = 0.70). Pin site infections occurred more in the TSF cohort (40%) than in the Orthex cohort (18%) (p < 0.001). The regenerate in the Orthex group showed higher density at three months (p = 0.029) and was more homogenous (p = 0.023) at six months after frame application. Strut exchanges were less frequent with the Orthex system (p < 0.0001). QoL measures were similar in both cohorts (p = 0.92).ConclusionsThis is the first study to compare two hexapod designs in paediatric orthopaedics. The Orthex system showed superiority in regenerate quality and a significant reduction in pin site infection rates. Both systems delivered predictable and accurate limb deformity correction.Level of evidenceIII

Accuracy of radiographic measurement techniques for the Taylor spatial frame mounting parameters

AimThe correction accuracy of the Taylor Spatial Frame (TSF) fixator depends considerably on the precise determination of the mounting parameters (MP). Incorrect parameters result in secondary deformities that require subsequent corrections. Different techniques have been described to improve the precision of MP measurement, although exact calculation is reportedly impossible radiologically. The aim of this study was to investigate the accuracy of intraoperative and postoperative radiographic measurement methods compared to direct MP measurement from TSF bone mounting.MethodsA tibial Sawbone® model was established with different origins and reference ring positions. First, reference MPs for each origin were measured directly on the frame and bone using a calibrated, digital vernier calliper. In total 150 MPs measured with three different radiographic measurement techniques were compared to the reference MPs: digital radiographic measurements were performed using soft-copy PACS images without (method A) and with (method B) calibration and calibrated image intensifier images (method C).ResultsMPs measured from a non-calibrated X-ray image (method A) showed the highest variance compared to the reference MPs. A greater distance between the origin and the reference ring corresponded to less accurate MP measurements with method A. However, the MPs measured from calibrated X-ray images (method B) and calibrated image intensifier images (method C) were intercomparable (p = 0.226) and showed only minor differences compared to the reference values but significant differences to method A (p < 0,001).ConclusionThe results demonstrate that MPs can be accurately measured with radiographic techniques when using calibration markers and a software calibration tool, thus minimizing the source of error and improving the quality of correction.

Long bone fracture reduction and deformity correction using the hexapod external fixator with a new method: a feasible study and preliminary results

BackgroundThe hexapod external fixator (HEF), such as the Taylor spatial frame (TSF), offering the ability of multidirectional deformities correction without changing the structure, whereas there are so many parameters for surgeons to measure and subjective errors will occur inevitably. The purpose of this study was to evaluate the effectiveness of a new method based on computer-assisted three-dimensional (3D) reconstruction and hexapod external fixator for long bone fracture reduction and deformity correction without calculating the parameters needed by the traditional usage.MethodsThis retrospective study consists of 25 patients with high-energy tibial diaphyseal fractures treated by the HEF at our institution from January 2016 to June 2018, including 22 males and 3 females with a mean age of 42 years (range 14–63 years). Hexapod external fixator treatments were conducted to manage the multiplanar posttraumatic deformities with/without poor soft-tissue that were not suitable for internal fixation. Computer-assisted 3D reconstruction and trajectory planning of the reduction by Mimics were applied to perform virtual fracture reduction and deformity correction. The electronic prescription derived from the length changes of the six struts were calculated by SolidWorks. Fracture reduction was conducted by adjusting the lengths of the six struts according to the electronic prescription. Effectiveness was evaluated by the standard anteroposterior (AP) and lateral X-rays after reduction.ResultsAll patients acquired excellent functional reduction and achieved bone union in our study. After correction, the mean translation (1.0 ± 1.1 mm) and angulation (0.8 ± 1.2°) on the coronal plane, mean translation (0.8 ± 1.0 mm) and angulation (0.3 ± 0.8°) on the sagittal plane were all less than those (6.1 ± 4.9 mm, 5.2 ± 3.2°, 4.2 ± 3.5 mm, 4.0 ± 2.5°) before correction (P < 0.05).ConclusionsThe computer-assisted three-dimensional reconstruction and hexapod external fixator-based method allows surgeons to conduct long bone fracture reduction and deformity correction without calculating the parameters needed by the traditional usage. This method is suggested to apply in those unusually complex cases with extensive soft tissue damage and where internal fixation is impossible or inadvisable.

Ankle arthrodesis using the Taylor Spatial Frame for the treatment of infection, extruded talus and complex pilon fractures.

The treatment of complex pilon fractures and talus fracture-dislocations present several challenges, like avoiding infection, achieving union, management of bone loss and function preservation. Retrospective cohort review of fourteen patients who underwent ankle arthrodesis (AA) using the Taylor Spatial Frame (TSF) after pilon and talus fracture-dislocations. Ten tibiocalcaneal (TC) and four tibiotalar (TT) fusions were performed. Eleven of these cases were Gustilo III open fractures. Seven cases involved an open extruded talus. Four cases had established infections. There was a mean of 2.7 (range 0 - 8) operations prior to AA using TSF. The primary objective was to determine infection and union rates. Patient-reported outcomes (Short Form 36, SF-36) and functional outcomes (Ankle Osteoarthritis Score, AOS) were the secondary measures. Eradication and prevention of deep infection was achieved in all cases. Radiological union was achieved at a mean of 9 months (range 5 - 17). Solid AA was achieved in 12 of 14 cases using the TSF. Two TC fusions required a hindfoot fusion nail to achieve union. Eleven cases had concurrent bone transport, mean of 63mm (range 33 - 180). Mean time of TSF treatment was 11.1 months (range 6 - 16). One case required delayed amputation. Eight patients were able to fully weight bear unaided after the treatment. Mean SF-36 was 65 (range 35 -100). Mean AOS was 36.5 (range 6.6 - 77.5) with 69.3% of scores graded good to excellent. Mean total number of operations was 5.9 (range 2 - 10). Minimum follow up time was 12 months (range 12 - 56). AA using TSF can be considered for complex pilon fractures and extruded talus. It has shown to be effective in achieving a solid fusion and infection eradication. While using the TSF in isolation, non-union must be suspected in TC fusions, absence of radiological signs of healing, massive bone loss, and possibly not using bone graft. Patients must be aware that while treatment of these injuries will be prolonged and carries the risk of many potential complications, it provides a good alternative to amputation.

A bloodless technique for correction of equinovarus deformities by Taylor spatial frame: a prospective case series

Background: Rigid ankle and foot deformities as a sequela of relapsed talipes equinovarus or vascular or neurological disorders are a challenge for orthopedic surgeons. This study introduces a bloodless technique to correct the deformities of the ankle in patients with these disorders using the Taylor Spatial Frame (TSF). Methods: Eighteen feet in 18 patients with equinovarus deformities were prospectively enrolled in this study. All patients underwent preoperative clinical evaluation that included neurovascular assessment. Deformity components were measured using a goniometer. All patients had gradual correction of the rigid equinovarus ankle and foot by TSF without any soft-tissue or bony procedures. Preoperative and postoperative ankle and foot equinus and varus angles, in association with the American Orthopaedic Foot and Ankle Society (AOFAS) score, were used for assessment of the functional outcome. Results: There were 13 male patients (72.2%) and five female patients (27%). The mean age of the patients was 25.89 (range 14 to 43, SD 7.28) years. The right side was affected in 11 patients (61.1%), and left side was affected in seven patients (38.9%). At the final follow-up the average AOFAS ankle hindfoot scores improved from 25.17 (range 12 to 39, SD 9.91) preoperatively to 74.78 (range 48 to 88, SD 15.33) postoperatively, (t=22.13, P&lt;0.001). Fifteen patients (83.3%) were categorized as “good”, and three patients (16.7%) were categorized as “fair”. Conclusions: TSF is a safe, effective, and simple method of correcting rigid equinovarus deformities of the ankle without soft-tissue releases or bone osteotomies and is a bloodless technique. Level of Evidence: Level IV.

Circular external fixation as an alternative method of stabilization for extra-articular tibia fractures in the elderly

Background: Recent epidemiologic reports from national fracture registries demonstrate an increase in the incidence of tibia fractures in the elderlies. Objectives: the objective of this retrospective study is to evaluate Circular External Fixation (CEF) for primary and definitive fixation of tibia extra-articular fractures (TEF) in the elderly treated at a level I trauma center. Materials and Methods: we evaluated a subset of 31 elderly patients (over 70 years) with 31 TEF (mean age 76 years, range 70-89) of which six (19.4%) were open treated with CEF between 2010 and 2017. 29 (93.5%) fractures underwent definitive fixation with traditional Ilizarov, 2 were treated with Sheffield and Taylor Spatial frames and evaluated clinically and radiologically accordingly to ASAMI bone and functional scores. Results: All fractures consolidated without additional procedures at an average of 21.3 weeks (range 9-42). No deep infections were observed. Four malunions within 8° occurred. ASAMI bone results were excellent in 93.6% of patients and revealed an excellent result in 21 (67.7%) of patients, eight patients (25.8%) had a good result, and 2 (6.5%) a fair result. Conclusions: CEF gave excellent results in the treatment of a variety of tibial shaft fractures in an elderly population, in terms of early return to ambulation, with average time to union, rate of delayed union, and misalignment rate comparable or superior to intramedullary nail and plate osteosynthesis, that represent the options more frequently proposed in clinical practice and literature. Advantages of circular external fixation in osteosynthesis of extra-articular tibia fractures in these patients are the minimal impact on soft tissues and the stability of the construct, that allows immediate weight bearing and early return to ambulation.

Evaluating the accuracy of the SMART taylor spatial frame software – Comparison with manual radiographic analysis methods

Background: The accuracy of hexapod circular external fixator deformity correction is contingent on the precision of radiographic analysis during the planning stage. The aim of this study was to compare the SMART Taylor spatial frame (TSF) in suite radiographic analysis methods with the traditional manual deformity analysis methods in terms of accuracy of correction. Methods: Sawbones models were used to simulate two commonly encountered clinical scenarios. Traditional manual radiographic analysis and digital SMART TSF analysis methods were used to correct the simulated deformities. Results: The final outcomes of all six analysis methods across both simulated scenarios were satisfactory. Any differences in residual deformity between the analysis methods are unlikely to be clinically relevant. All three SMART TSF digital analyses were faster to complete than manual radiographic analyses. Conclusion: With experience and a good understanding of the software, manual radiographic analysis can be extremely accurate and remains the gold standard for deformity analysis. In suite SMART TSF radiographic analysis is fast and precise to within clinically relevant parameters. Surgeons can with confidence trust the SMART TSF software to provide analysis and corrections that are clinically acceptable.

Redesign of OrthoLPPDUNS External Fixation for Bone Reconstruction Using the Function Analysis System Technique (FAST) Method

Taylor Spatial Frame (TSF) better known as an external fixation product from several types of fixation devices in the orthopedic field. The Laboratory of Product Planning and Design has manufactured TSF or called OrthoLPPDUNS external fixations. The OrthoLPPDUNS design found that frame instability forming ring-strut angles caused by strut screw rotations was feeling rough due to backlash. The purpose is how to redesign an OrthoLPPDUNS with a Function Analysis System Technique (FAST). FAST method is applied at each stage of starting from the information stage to the interpretation of the results. The OrthoLPPDUNS design with the joint system uses custom components that cause weakness in frame stability. The use of standard components in joint systems can provide solutions to external fixations, although there are still weaknesses in the ring-strut angle. The OrthoLPPDUNS redesign has a better success rate in terms of stability parameters, allowing more precise bone reconstruction.

Reducing the Risk of Ring Breakage in Taylor Spatial Frames: The Effect of Frame Configuration on Strain at the Half-ring Junction.

AimWe have encountered four cases with Taylor spatial frames (TSF) (Smith & Nephew, Memphis, TN, USA) with breakage at the half-ring junction of the distal ring. This study examines the strain produced on different locations of the distal ring during loading and the effects on the strain of altering the frame construct.Materials and methodsWe mounted two ring TSF constructs on tibia saw bone models. The proximal ring was the same in all constructs and consisted of a 2/3 180 mm ring attached with three wires. Construct 1 is reproducing the configuration of cases where failure was seen. The distal 155 mm ring is attached with three half pins. The half-ring junction is located in the midline. Construct 2 has a different half pin placement and an additional wire on the distal ring. Constructs 3 and 4 have the same half pin configuration to construct 1 but the distal ring is rotated 60° internally and externally, respectively. Strain gauges were attached to different locations and measurements recorded during loading. Statistical analysis was performed.ResultsHighest strain values were recorded at the half-ring junction of constructs 1 and 2 (>600 microstrains (με) in tension). Rotating the ring 60° internally significantly reduces the strain at the half-ring junction (<300 με) whilst external rotation by 60° further reduces the strain (<180 με). Ring strain is higher in areas close to half pin attachments.ConclusionThe highest strain is in the half-ring junction as the half rings are subjected to different loading modes. The thickness of the half-ring is halved and the second moment of area reduced further increasing breakage risk. Placing this junction close to the half pin–frame interface, as dictated by the anatomical safe zone further increases the strain. Rotating the distal ring 60° significantly reduces the strain at the half-ring junction.Clinical significanceRing breakage is a rare but significant complication. This is the first study to address this potential mode of TSF failure. Insights and technical tips from this study can help reduce this.How to cite this articleIliadis AD, Bebja R, Wang K, et al. Reducing the Risk of Ring Breakage in Taylor Spatial Frames: The Effect of Frame Configuration on Strain at the Half-ring Junction. Strategies Trauma Limb Reconstr 2020;15(3):146–150.

Taylor Spatial Frame or Reamed Intramedullary Nailing for Closed Fractures of the Tibial Shaft: A Randomized Controlled Trial.

To compare a modern ring fixator [Taylor Spatial Frame (TSF)] and reamed intramedullary nailing (IMN) for the treatment of closed tibial shaft fractures. Randomized controlled trial. Two university hospitals. Patients between 18 and 70 years of age surgically treated for an acute tibial shaft fracture. TSF (n = 31) versus a reamed intramedullary nail (n = 32). The patients were followed up for 2 years. The physical component summary of Short Form 36 (SF-36) at 2 years was the primary outcome measure. Secondary outcomes included the other components of the SF-36, pain assessed by a visual analogue scale (VAS), complications, and resource consumption. The mean age was 43 years (SD 14.0), and 42 (67%) were men. The physical component summary at 2 years was 52.4 (SD 6.3) in the TSF group and 53.3 (SD 8.0) in the IMN group (P = 0.35). There were modest differences in the other SF-36 scores during the follow-up period. Up to and including 12 months, the TSF group had less knee pain [at 12 months: VAS 0.5 (SD 1.2) vs. VAS 2.4 (SD 2.2; P < 0.001)], but this was not statistically significant at 24 months [VAS 0.7 (SD 1.4) vs. VAS 1.5 (SD 2.0; P = 0.11)]. Superficial skin infections were more frequent in the TSF group [22 (71%) vs. 4 (13%); P < 0.001]. The number of other complications was similar between the groups. Both TSF and IMN provided good clinical results. TSF had more pin-track infections but less knee pain the first year. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Application of elliptic registration and three-dimensional reconstruction in the postoperative measurement of Taylor spatial frame parameters

BackgroundThe Taylor spatial frame offered the ability of simultaneous correction of the multidirectional deformities without the need to change the frame, and it was widely used for limb lengthening, deformity correction, and fracture reduction in recent years. There are still some inherent limitations that can affect the accuracy of correction, especially for the measurement of the mounting and rotational parameters. The purpose of our study was to propose some more precise postoperative measurement of Taylor spatial frame (TSF) parameters by application of elliptic registration and three-dimensional reconstruction. MethodsThis retrospectively study included 28 trauma patients who suffered tibial fracture treated by the TSF at our institution from January 2016 to January 2018, including 25 males and 3 females with a mean age of 43 years (range 14-70 years). We conducted standard full-length anteroposterior and lateral X-rays of the injured extremity and the computed tomographic scans of the bilateral extremities after the operation. Elliptic registration and 3D reconstruction were used to calculate the parameters by two types of software Mimics and CorelDRAW. Correction of the deformity was conducted by adjusting the struts of the TSF according to the electronic prescription. The standard anteroposterior and lateral X-rays after correction were taken to evaluate the effectiveness. ResultsAll patients acquired functional reduction, which was evaluated by digital radiography. The mean coronal plane translation(1.9±2.2 mm), coronal plane angulation(1.2±1.0°), sagittal plane translation(2.7±2.1 mm), and sagittal plane angulation(1.2±1.0°) after correction were all less than those(5.5±4.6 mm, 4.9±3.9°, 4.7±4.0 mm, 2.7±2.3°) before correction. ConclusionsThe TSF system can correct the 6-axis deformities simultaneously with the accurate parameters. Elliptic registration and three-dimensional reconstruction are alternative methods to precisely measure the parameters needed by the TSF system, especially for the mounting and rotational parameters of unusually complex cases.

Ortho-Plastic Approach in Management of Open Pilon Fractures

Category:Trauma; AnkleIntroduction/Purpose:The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines including relatively aggressive bone debridement.Methods:A retrospective analysis of open pilon fractures treated between 2014 and 2019 was conducted. Injuries were graded according to the Gustillo-Anderson classification and all patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot & Ankle Score (AOFAS) at 6 months after definitive surgery. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 (Range: 3-24) hours. Definitive fixation was performed when the wound was healed, with the mean time from primary surgery to definitive surgery being 24.5 (Range: 7-60) days.Results:There was a total of 20 patients. The mean age was 50.5 (Range: 16-88) years. Follow-up was for an average of 25.1 (Range: 9-36) months. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 9.3 (Range: 4-18) months. The mean AOFAS score was 64.4 (Range: 15-90). Definitive treatment via Taylor Spatial Frame was performed on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement, while 3 patients had Stimulan beads with antibiotics. There were no cases of deep infection, however a superficial wound infection was found in 9 patients (45%).Conclusion:Results of our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with antibiotics, external fixators and patient tailored timing of definitive surgery achieves low rates of wound infection and complications for patients with open pilon fractures. We suggest treating these fractures with the availability of Orthoplastic care and with an MDT approach.

Integrated Reconstruction for Chronic Foot Dislocations

Category:Hindfoot; Diabetes; Midfoot/ForefootIntroduction/Purpose:Chronic dislocations of the hindfoot and midfoot are a treatment challenge due to difficulties in achieving re-alignment without bone or soft tissue compromise. Neuropathy and diabetes are often associated with the chronic foot dislocation, and further complicate treatment. Our prior studies with integrated fixation methods (ring external fixation and internal fixation) for severe tibia pilon fractures and deformed, infected neuroarthopathic ankles has shown that internal fixation around the ankle can be safely combined with external fixation in single stage procedures.In this study, a staged approach is utilized to limit bone resection and minimize risks of soft tissue compromise and neurovascualar injury with severe and rigid defomity corrections. The purpose is to assess the results and complications of this surgical treatment approach.Methods:Medical records, clincal evaluation, and radiographs for 9 patients treated with gradual hexapod realignment and staged arthrodesis of chronic foot dislocations were retrospectively reviewed. There were six female and three male patients with a mean age of 59 (range, 43-71) years. Follow-up ranged from 12 months to 12 years. All had neuropathy; seven were diabetic, one CMT, one idiopathic, and one rheumatoid. Dislocation was present for a minimum of 16 weeks (range, 4 to 36 months). Seven patients had preoperative ulcerations. Seven had peritalar dislocations (subtalar and talonavicular), and two had midfoot dislocations (naviculocuneiform-1, talonavicular-1).Treatment protocol included: Surgical stage 1- soft tissue releases and Taylor spatial frame application; gradual correction of dislocation; Surgical stage 2-open arthrodeses with internal fixation and frame modification or removal.Results:All nine patients achieved a stable plantigrade and functional foot position. All fusions healed except for one talonavicular nonunion. All preoperative ulcerations healed. Six patients with peritalar dislocations had frame modification at the time of arthrodesis (mean frame time was 5.9 months). Three patients had frame removal at time of arthrodesis (mean frame time was 3 months). Average time from hexapod realignment to arthrodesis surgery was 8 (range, 3-16) weeks.Outcome with the Reinker/Carpenter scale was 5 excellent, 2 good, and 2 fair. Two peritalar dislocations developed complications; one talonavicular nonunion, and one deep infection. Other complications included further surgery in two midfoot dislocations, two forefoot wire complications, and one ankle deformity during peritalar correction.Conclusion:Staged integrated realignment/arthrodesis for chronic neuropathic foot dislocations resulted in good clinical outcomes with manageable complications. The Taylor spatial frame miter and butt constructs were successful in reducing hindfoot and midfoot dislocations, respectively. There was reliable fusion and ulcer healing with our staged protocol. This case series furthers our successful clinical results with the combined use of ring external fixation and internal fixation methods for complex foot and ankle pathology.

A Staged Treatment Algorithm for the Management of Severe Charcot Hindfoot Arthropathy, using Tibiotalocalcaneal Arthrodesis with Femoral Head Allograft

Category:Diabetes; Ankle; Diabetes; HindfootIntroduction/Purpose:Charcot neuroarthropathy of the hindfoot (Brodsky type 2 and 3) can involve significant talar collapse / bone loss leading to hindfoot instability, the goal of treatment to create a stable plantigrade shoeable ulcer and infection free foot. This can often be achieved with tibiotalocalcaneal (TTC) arthrodesis but a plantigrade foot can be challenging in setting of significant talar bone loss. Structural allograft has been used in association with TTC fusions in a number of settings but not explored in the treatment of charcot hindfoot. The goal of this study was to examine the outcomes of structural allografting combined with TTC arthrodesis for the treatment of charcot hindfoot.Methods:Retrospective review of all patients treated at our institution with a Brodsky type 2 or 3 was performed over a five year period from 2014 - 2019. We identified twenty-two patients, 12 males and 10 females with a mean age of 57 years. All underwent surgery by the senior author, a fellowship trained foot and ankle orthopedic surgeon. Patients with infection were treated with antibiotics and a Taylor spatial frame prior to definitive stabilization. Non-infected patients were either placed in a total contact cast (TCC) if they were in active charcot or underwent primary charcot reconstruction. If after initial treatment patients had a plantigrade foot, they were placed in stiff soled rocker bottom shoe with custom accommodative insoles. Patients who did not have a plantigrade foot underwent TTC arthrodesis to achieve this. Femoral head allograft was used if excessive talar bone loss or collapse of the hindfoot was noted.Results:At final follow up 13 patients (59%) of the cohort achieved grade 1, an infection and ulcer free plantigrade foot that was able to fit in a shoe. 7 (32%) of patients achieved grade 2, a plantigrade foot in brace, and 2 (9%) achieved level 3 a plantigrade foot. No patients in this cohort underwent amputation. Average duration of treatment until final status was 18 months (minimum 2, maximum 37), number of interventions 3.9 (minimum 1, maximum 10). Of the twelve patients who required allograft, they averaged 4.25 interventions and average time of 17.6 months until final status. Of those who did not require allograft, they averaged 3.4 interventions with follow up of 11.9 months.Conclusion:Our data suggests that patients with Brodsky type 2 and 3 charcot arthropathy of the ankle and hindfoot even with infection can be successfully treated with staged treatment. This includes external fixation and infection management, followed by tibiotalocalcaneal intramedullary nail fixation with or without femoral head allograft to allow for a plantigrade foot and weight bearing in a stiff soled rocker bottom shoe. Further study is needed to determine long term outcomes and relapse rates.

Can Na18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia: insights from 41 patients

PurposeTo demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone.MethodsForty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18F− in the region of healing bone by a time-sequenced movie allowed qualitative evaluation.ResultsNumerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion.ConclusionNumerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient’s progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18F− in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications.

Definitive management of open pilon fractures with fine wire fixation

IntroductionThe BOAST (British Orthopaedic Association Standards for Trauma) guidelines advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines alongside a treatment protocol which consisted of early wound debridement and spanning external fixation, delayed soft tissue coverage with a flap when necessary and delayed definitive fixation with the use of a Fine Wire Fixator. Material and methodsWe conducted a retrospective analysis of open pilon fractures treated between 2014 and 2019. All patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot and Ankle Score (AOFAS) at 12 months post injury. ResultsThere were 20 patients including 16 males and 4 females. The mean age was 50.45 years. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 hours. The mean time from primary surgery to definitive fixation was 24.5 days.There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 10.4 (Range: 2-18) months. The mean AOFAS score was 74.2 (Range: 28-97). A Taylor Spatial Frame was used on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement. There was 1 case of deep infection and 9 cases of superficial infection. There were also 4 cases of delayed union which required bone grafting from their femur using a RIA (Reamer Irrigation Aspirator). ConclusionOur study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with systemic and local antibiotics, external fixators and patient tailored conversion from spanning external fixator to fine wire frame achieves low rates of wound infection and complications for patients with open pilon fractures.

The Application of the Taylor Spatial Frame for Deformity Correction at the Lower Extremity.

The Taylor Spatial Frame (TSF) can be used for the treatment of bone infections, deformity correction, contracture correction or to reconstruction by segment transportation. The TSF is very solid and allows even a full weight bearing mobilization. The TSF consists at least of two partial or full rings connected by six telescopic struts. It allows simultaneous correction of deformities in all possible planes without frame modification only by adjusting the strut length. The accurate frame assembly is very important to achieve a stable frame construct and to reduce pin infections, pin loosening or wrong deformity correction. Therefore, good knowledge of the frame assembly is necessary to achieve treatment success. This video demonstrates and teaches the key knowledge of TSF assembly using an artificial bone with varus deformity.

Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex.

ABSTRACTAimThe purpose of this study was to compare the functional and radiological outcomes of complex tibia fractures treated with two different hexapod fixators.Material and methodsThis is a retrospective comparative study of patients treated for complex tibial fractures between 2010 and 2015. Inclusion criteria was patients between 18 years and 60 years of age, who sustained a complex comminuted open or closed tibial fracture with or without bone loss, who had a minimum of 12 months’ follow-up, and who have been treated definitively using either Taylor Spatial Frame (TSF) or TrueLok-Hexapod System (TL-HEX). The outcome measures were Association for the Study and Application of the Method of Ilizarov (ASAMI) score, foot function index (FFI), EQ5-D, four-step square test (FSST), and timed up and go (TUG) test. Descriptive statistics were used to assess patient demographic information. Categorical variables (ASAMI and EQ5D-5L) were analysed using the χ2 test. Continuous variables (FFI, functional tests, and radiographic outcomes) were analysed with two-tailed Student’s t tests.ResultsIn all, 24 patients were treated with the TL-HEX and 21 with the TSF. The mean time for external fixation was 219 ± 107 days (TL-HEX) and 222 ± 98 days (TSF). Union occurred in 92% (TL-HEX) and 100% (TSF). The mean follow-up was 777 ± 278 days (TL-HEX) and 1211 ± 388 days (TSF). Using the ASAMI scores, there were 17 excellent and 6 good results for the TL-HEX and 10 excellent and 11 good results for the TSF (p = 0.33). The FFI was 30 ± 28.7 (TL-HEX) and 26.1+23.9 (TSF) (p = 0.55). The EQ5D was 0.67 ± 0.3 (TL-HEX) and 0.73 ± 0.2 (TSF) (p = 0.43). The mean TUG and FSST were 9.2 ± 3.2 and 10 ± 2.9 seconds (TL-HEX) and 8.4 ± 2.3 and 9.6 ± 3.1 seconds (TSF) (p = 0.34 and 0.69).ConclusionThe results of this study suggest that both hexapod external fixation devices have comparable clinical, functional, and radiographic outcomes. Either fixator can be used for the treatment of complex tibial fractures, anticipating good and excellent clinical outcomes in approximately 80% patients.Level of evidenceTherapeutic level IIIHow to cite this articleNaude J, Manjra M, Birkholtz FF, et al. Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex. Strategies Trauma Limb Reconstr 2019;14(3):142–147.