Taylor spatial frame-software-controlled fixator for deformity correction-the early Indian experience

Abstract

Background:Complex deformity correction and fracture treatment with the Ilizarov method needs extensive preoperative analysis and laborious postoperative fixator alterations, which are error-prone. We report our initial experience in treating the first 22 patients having fractures and complex deformities and shortening with software-controlled Taylor spatial frame (TSF) external fixator, for its ease of use and accuracy in achieving fracture reduction and complex deformity correction.Settings and Design:The struts of the TSF fixator have multiplane hinges at both ends and the six struts allow correction in all six axes. Hence the same struts act to correct either angulation or translation or rotation. With a single construct assembled during surgery all the desired axis corrections can be performed without a change of the montage as is needed with the Ilizarov fixator.Materials and Methods:Twenty-seven limb segments were operated with the TSF fixator. There were 23 tibiae, two femora, one knee joint and one ankle joint. Seven patients had comminuted fractures. Ten patients who had 13 deformed segments achieved full correction. Eight patients had lengthening in 10 tibiae. (Five of these also had simultaneous correction of deformities). One patient each had correction of knee and ankle deformities. Accurate reduction of fractures and correction of deformities and length could be achieved in all of our patients with minimum postoperative fixator alterations as compared to the Ilizarov system. The X-ray visualization of the osteotomy or lengthening site due to the six crossing struts and added bulk of the fixator rings which made positioning in bed and walking slightly more difficult as compared to the Ilizarov fixator.Conclusions:The TSF external fixator allows accurate fracture reduction and deformity correction without tedious analysis and postoperative frame alterations. The high cost of the fixator is a deterrent. The need for an internet connection and special X-rays to operate the fixator add to its complexity.

Role of External Fixation in Open Tibial Fractures and Patient’s Satisfaction

“…These cases need repeated debridement of wounds and due to source of infection internal fixation is not suitable. [12][13][14][15] In our study grade-3A fractures were more common than other types, which is different as compared to a study conducted by Cole et al in 1995 and reported grade-3B fractures most common. Patients with grade-2 and grade-3 wounds were included in this study.…”

Taylor spatial frame in the treatment of open tibial shaft fractures

“…The Ilizarov method has been used successfully in the treatment of tibial fractures, nonunions, and malunions, deformity, and shortening 6–11. The dynamic frame enables gradual lengthening, deformity correction, and nonunion or delayed union compression while remaining minimally invasive 12–16…”

Accuracy of a hexapod parallel robot kinematics based external fixator

“…Many studies in recent years have reported on the successful use of hexapod-based external fixators in clinical practice for various indications. In some of these studies, the authors define the achieved clinical accuracy as the amount of remaining bone deformity (angulation and torsion in degrees, and translation in millimeters or percentage of dislocation) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). In other studies, the standard joint angle system established by Paley and colleagues (2,3) is used as the reference to report clinical accuracy (9,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38).…”

“…For the TSF system, mean values are between 1.3 mm and 2 mm or 0% to 9% remaining translational deformity/dislocation and 0.5°to 3°remaining angulation deformity, with maximum values ranging from 3 mm to 5 mm or 6% to 40% and 2.5°t o 30°, respectively (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Furthermore, maximum values exceeding 5°of remaining angulation deformity only occur very rarely (9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)…”