Taylor Spatial Frame in Treatment of Equinus Deformity

Abstract

A bstract Background An equinus deformity interferes with activities of daily living. Correction of the deformity ranges from conservative (heel cord stretching, orthotics) to surgical treatment (Baumann, Strayer, Achilles lengthening, soft tissue releases). Severe contractures increase surgical intervention with extensive dissections to release soft tissues. This study investigated the clinical outcomes of gradual overcorrection using a Taylor spatial frame (TSF) with tendo-Achilles lengthening (TAL) added as necessary. Materials and methods This retrospective chart review evaluated patients with significant equinus treated with a TSF at a single large tertiary referral centre. Data collected included: diagnosis; patient demographics; laterality; time in frame; additional procedures; complications; degree of equinus deformity preoperatively and at every follow-up visit. Patients were followed at 1 week, 3 weeks, 6 weeks, 3 months, and 6 months intervals, and yearly thereafter. Results Twenty-four patients (26 procedures) were treated with a TSF for equinus and had complete preoperative and follow-up measurements over 2 years. The angle of deformity increased from a preoperative –21.5 (range, –69.0 to –1.0) degrees to a postoperative 4.9 (range, –17.0 to 17.0) degrees ( z = –4.4573, p = 0.0001, N = 26, Wilcoxon signed-rank test). A secondary outcome was a weak association (not statistically significant) between time in the TSF and the postoperative deformity angle. Four complications occurred during the follow-up (two pin site infections, one broken pin, and one plantar abscess). Three patients had recurrence of equinus deformity at time of last follow-up. Conclusion Using a TSF for correcting severe, fixed equinus contractures of the ankle joint is successful with minimal soft tissue-related complications. Overcorrection should be achieved in order to compensate for the loss of some dorsiflexion after frame removal. No added benefit was observed from having the frame on for a long time after correcting the deformity. Adding TAL is not necessary in all cases and required only in severe deformities of more than 25°. How to cite this article Dabash S, Potter E, Catlett G, et al. Taylor Spatial Frame in Treatment of Equinus Deformity. Strategies Trauma Limb Reconstr 2020;15(1):28–33.

Aneurismal bone cyst of the medial cuneiform bone: a case report of a new surgical approach and literature review

“…Complications associated with transosseous osteosynthesis and external fixation in foot and ankle surgery were reported by many authors [26,27]. No complications related to vessels and nerves, and wire/pin-site infection were observed during and after our treatment, using Ilizarov external fixation.…”

Correction of Equinus Deformity by Ilizarov Frame Using the Matsushita Method and Achilles Tendon Lengthening

“…This technique is simple, but there is a risk of compression of the talus or anterior subluxation because of stress concentration on the anterior tibiotalar joint 3 . The Taylor spatial frame has 6 extensors attached for external fixation, the lengths of which are adjusted by computer simulation for correction 4 . Although excellent for correcting various deformities, this method is problematic because it requires familiarity with planning correction, errors occur with the simulation 6 , and the equipment is expensive.…”

“…However, it is difficult to place the hinge accurately because the axis of ankle rotation is not parallel to the joint line, and even if the center of rotation is changed during correction, sufficient adjustment is not possible, resulting in compression of the talus or anterior subluxation 3 . Therefore, the natural hinge 3 , Taylor spatial frame 4 , and Matsushita 5 methods have been developed, which do not require the use of hinges.…”