The Management of Tibial Bone Defects: A Multicenter Experience of Hexapod and Ilizarov Frames

Abstract

Introduction: Bone defects may be managed with bone transport or acute shortening and lengthening using circular external fixation devices. We performed a multicenter retrospective cohort study to compare the outcomes between the Ilizarov frames and hexapod frames for the management of bone defects. Methods: Patients treated for bone defects using either Ilizarov or hexapod frames were included for analysis in two specialist institutions. Primary outcomes were time to consolidation, bone healing index (BHI), and external fixator index (EFI). Radiographic parameters included the medial proximal tibial angle, lateral distal tibial angle, posterior proximal tibial angle, and anterior distal tibial angle. Results: There were 137 hexapods and 90 Ilizarov frames in total. The mean time to follow-up was 3.7 years in the hexapod group and 4.0 years in the Ilizarov group. Hexapods had a significantly lower time to consolidation (253 days versus 449 days) (P < 0.0001) and BHI (59.1 days/cm versus 87.5 days/cm) (P < 0.0001). Hexapods had a significantly better EFI (72.3 days/cm versus 96.1 days/cm) (P = 0.0009). Conclusion: Hexapods may confer a significant advantage over Ilizarov frames in the management of bone defects. Time to consolidation, radiographic parameters, BHI, and EFI are all superior in hexapods.

A new ring fixator system for automated bone fixation

“…Recent studies show that software‐assisted hexapod systems are more precise and/or easier to use in complex multiplanar deformities 25–28 . A thorough comparison of TSF with conventional Ilizarov ring fixator in the treatment of different types and severity of lower‐limb bone deformities has revealed that the automated TSF system is much more precise and less prone to posttreatment malalignment 29 .…”

“…Recent studies show that software-assisted hexapod systems are more precise and/or easier to use in complex multiplanar deformities. [25][26][27][28] A thorough comparison of TSF with conventional Ilizarov ring fixator in the treatment of different types and severity of lower-limb bone deformities has revealed that the automated TSF system is much more precise and less prone to posttreatment malalignment. 29 It also noted that the usage of software-assisted systems such as TSF and the one presented here require much less clinical experience compared to the Ilizarov ring fixator.…”