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Background The 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. Methods This 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. Results All 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. Conclusions The 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.

Background: U-osteotomy with Taylor Spatial Frame correction is a rarely reported treatment method particularly well-suited for severe rigid equinus deformity in adults. The purpose of this study was to evaluate the effectiveness and efficacy of deformity correction and clinical outcome using this technique. Methods: We present a retrospective review of 30 feet in 26 patients who received U-osteotomy with Taylor Spatial Frame. Radiologic outcomes were measured using the anterior tibiotalar angle (TTA) with conventional weightbearing radiographs. Functional assessments included American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores and patient satisfaction using Likert scale. Results: The etiology included trauma (9), neglected or relapsed clubfoot (6), spina bifida (5), poliomyelitis (4), Charcot-Marie-Tooth disease (4), and iatrogenic (2). All patients had equinus deformity with TTA more than 140 degrees (median 157.5, 141-177). There were varus deformity in 19 feet, limb length discrepancy in 6 legs, and genu procurvatum deformity in 2 legs. The duration of gradual correction was 53.6±13.5 days (33-73 days), and the external fixation time was 147.8±25.2 days (98-203 days). At last follow-up, TTA in all patients improved significantly ( P < .001) to 113.5 degrees (111.8-116.0). All patients had plantigrade feet, except for 2 cases of residual mild equinovarus deformity, 2 cases of residual mild hindfoot varus deformity, 1 case of moderate hindfoot varus recurrence. The AOFAS scores significantly improved ( P < .001) from 51.0 points (29.0-66.0) to 76.0 points (69.5-88.0). Eighteen patients were very satisfied, 6 patients were somewhat satisfied, and 2 patients were somewhat dissatisfied. Conclusion: Using minimally invasive U-osteotomy with Taylor Spatial Frame to gradually correct the adult severe rigid equinus deformity proved to be an effective and relatively safe method associated with high patient satisfaction rates. Level of Evidence: Level IV, case series.

Long-leg radiographs are used to plan and supervise the correction of bone deformity in patients treated with the Taylor Spatial Frame (TSF). Often radiographs are performed with malpositioning of the limb leading to wrong alignment measurements. The aim of this retrospective study was to show the usefulness of a simple device which might enhance the reproducibility of limb rotation on long-leg radiographs. We included 20 consecutive patients with TSF treatment and at least three long-leg radiographs (4.9 ± 1.3). Eight out of 20 patients received radiographs with the help of a rotation rod (device with two clamps and a carbon tube). It is placed at the most frontal tab of the reference ring while conducting the radiograph. By this means, limb rotation can be controlled. To show the usefulness of this device, two observers measured the relation of the distances between the middle of the reference ring to the medial and lateral fourth hole on the reference ring (TSF-RR). The standard deviation and range of the TSF-RR of all radiographs for each patient was calculated and compared between patients without and with the rotation rod. The standard deviations of TSF-RR in patients without the rotation rod was significantly higher compared to patients with rotation rod (observer 1: p = 0.0228, observer 2: p = 0.0038). Also, the range of the TSF-RR within one patient is significant higher (observer 1: p = 0.0279, observer 2: p = 0.0038) in patients without the rotation rod compared to patients with the rotation rod. The variability of rotation on radiographs was lower with the rotation rod. Therefore, more reproducible and better comparable radiographs can be conducted. Radiologic exposure might be reduced as repetition of wrongly positioned limbs on radiographs are less frequent.

The treatment of post-traumatic femoral deformity with circular frames can be difficult both for the patient and for the surgeon. Patients frequently suffer from residual knee stiffness, and the cumbersome location of the frame can even result in psychiatric problems such as depression and anxiety during their treatment. Here we describe a novel technique of constructing the Taylor spatial frame (TSF) eccentrically from the femur to allow the same level of comfort as a monolateral external fixator, while applying trigonometric principles to successfully retain the utility of the TSF prescription software. Deformity correction and fracture compression can therefore still be achieved in a controlled and predictable manner on an outpatient basis.

Introduction: We herein report a case of idiopathic unilateral external torsion of the tibia treated with Taylor spatial frame (TSF) fixation combined with performance of the wake-up test under anesthesia. The wake-up test is performed toward the end of a surgical procedure after all corrections have been made and hardware has been placed. The patient is slowly awakened and asked to move their feet. After recovery from anesthesia, patients do not remember performing this test. Case Report: A 17-year-old Japanese male patient complained of a gait disturbance because of external torsion of his foot. The patient was determined to have lateral tibial torsion with a pre-operative foot progression angle of 40.8°. Deformity correction using the TSF was considered to be safe. The tibia was derotated by −34.8°, and the patient had a post-operative foot progression angle of 7.0°. His symptoms and signs improved after derotation osteotomy at the low tibial portion. Two years postoperatively, the patient exhibited no leg length discrepancy or rotation malalignment of the lower extremities as measured both clinically and radiographically. Conclusion: To the best of our knowledge, there are no reports on the combined use of the TSF and wake-up test for acute correction of idiopathic external torsion of the tibia. Intraoperative use of the wake-up test with subsequent TSF fixation is effective and safe for acute correction of limb deformities.

Background: The Taylor Spatial Frame (TSF) has been widely used for tibiofibular fractures. However, traditional radiograph measurement method is complicated and the reduction accuracy is not high enough for correcting residual deformities. We proposed the marker-3D measurement method to solve these problems. This study aimed to compare the reduction accuracy of the traditional radiograph measurement method and the marker-3D measurement method in tibiofibular fracture treated with TSF.Methods: From January 2016 to June 2019, A retrospective analysis was performed based on the patients with tibiofibular fracture treated with TSF in our department. 41 patients were qualified for this study, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiograph measurement group (control group). In the experimental group, CT scan was performed for 3D reconstruction with 6 markers installed on the TSF, to determine the adjusting plan. In the control group, the anteroposterior (AP) and lateral radiographs were performed for the deformity parameters. X-rays were taken to measure the residual deformities after correction.Results: All patients reached functional reduction. The residual displacement deformity (RDD) in AP radiograph was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group. The residual angle deformity (RAD) in AP radiograph was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As to the Lateral radiograph, the RDD was 0 (0, 1.22) mm in experimental group and 2.02 (0, 3.74) mm in control group. The RAD was 0 (0, 0) ° in experimental group and 1.42 (0, 1.93) ° in control group. Significant differences in all above comparisons were found between the groups (AP radiograph RDD: P = 0.024, RAD: P = 0.020; Lateral radiograph RDD: P = 0.016, RAD: P = 0.004). Conclusions: Both groups achieved satisfactory fracture reduction. However, the residual deformities in the experimental group were significantly smaller. This study proved that the marker-3D measurement method could further improve the reduction accuracy.

Background: The Taylor spatial frame (TSF) is increasingly used for acute tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the TSF for fracture reduction and definitive management in patients with acute tibial shaft fractures.Methods: The study was conducted on 34 patients with acute tibial shaft fractures who were admitted or referred to our institution and consented to TSF treatment from Jan 2016 to June 2019, including 27males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients remained in the TSF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions: Fracture reduction and definitive management using the Taylor spatial frame is an alternative and effective method for acute tibial shaft fractures, including technical advantages of early trauma-control, ease of soft tissue care, the versatility of achieving excellent alignment, and the continuity of device until bone union.

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.

Aim The purpose of this study was to compare the functional and radiological outcomes of complex tibia fractures treated with two different hexapod fixators. Material and methods This 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 χ 2 test. Continuous variables (FFI, functional tests, and radiographic outcomes) were analysed with two-tailed Student's t tests. Results In 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). Conclusion The 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 evidence Therapeutic level III. How to cite this article Naude 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.