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Abstract Background With the assistance of smart fixator technologies, the correction of complex deformities has been facilitated; however, the accurate integration of specialized radiographs and measurements into the system remains the greatest disadvantage, necessitating specialized imaging and an experienced team. When inexperienced technicians and doctors perform these specialized postoperative radiographs, excessive exposure of the patient and team to radioactive rays exacerbates inadequacies in measurements and delays the correction of residual deformities due to angular and translational adjustments. In this study, we compared postoperative measurements with those taken peroperatively via fluoroscopy, hypothesizing that it reduces the exposure of the patient and team to radioactive rays, allows for more accurate and timely correction of deformities and assembly parameters, and reduces time and costs. Methods Between 2013 and 2022, 84 patients with bone deformities were retrospectively reviewed. All patients had bone deformities and were treated with computer-assisted circular external fixator systems (Ca-CEF). Assembly parameter measurements began to be corrected via artificial neural network software via peroperative fluoroscopy in 37 patients and postoperative radiography in 47 patients. The surgical duration for all patients, peroperative measurement values, and number of radiographs taken on postoperative day 1, week, and month until deformity correction were recorded. Results The duration until deformity correction was shorter in patients who underwent postoperative measurements (mean 50.24 days) than in those who underwent peroperative measurements (mean 42.31 days), but this difference was not statistically significant (p = 0.102). The surgical duration was significantly shorter in patients with postoperative measurements (mean of 130.37 min) than in those with peroperative measurements (mean of 155.88 min) (p = 0.045). For patients with postoperative measurements, 56.04 postoperative radiographs were taken. In contrast, patients with peroperative measurements had fewer radiographs totaling 28.7. This difference was statistically significant (p

Background: Grade III open tibial diaphyseal fractures are challenging to treat and controversy exists on whether to treat them with an intramedullary nail (IMN) or a circular frame (CF). This study aims to compare outcomes for intramedullary nail and circular frame in the treatment of open tibial diaphyseal fractures. Methodology: Retrospective study at a major trauma center of all patients admitted with a grade III open tibial diaphyseal fracture between January 2016 and January 2022. The primary outcome measures were major complications: non-union, malunion, refracture, DBI and amputation. Secondary outcome measures were time to union and reoperation rates. Results: Fifty-five patients were included in the study, 32 patients in CF group and 23 patients in IMN group. There were no significant differences in the baseline demographics of patients in both groups. Major complications were recorded in 13 limbs (54%) in IMN group and in 18 limbs (56%) in CF group which were not statistically significant (p = 0.797). Deep bone infection rates were noted in 4 (12.5%) in the CF group, compared to 1 (4%) in IMN group; however, the result was not statistically significant (p = 0.240). Amputation rates as a result of infected non-unions were seen in 1 limb (4%) in IMN group and 2 limbs (6%) in CF group (p = 0.99). Median time to union was significantly shorter in IMN group at 30 weeks compared to 30 weeks for CF group (p = 0.04). Conclusion: IMN should be the treatment of choice in the treatment of grade III open tibial diaphyseal fracture, but CF should be considered for delayed treatment and in patients with bone loss. [ABSTRACT FROM AUTHOR]

Objectives Multi‐planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. Methods We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D‐TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip–knee–ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow‐up full‐length X‐rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow‐up, Johner–Wruhs tibial fracture outcome criteria (J‐W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi‐square test or Fisher's exact test; the Mann–Whitney U test was used for rank data. Results No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D‐TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner–Wruhs criteria were used to assess the function of the affected limb, the D‐TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow‐up X‐rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow‐up compared to the angle before surgery. At the final follow‐up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). Conclusion The D‐TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture.

Objectives: Multi‐planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. Methods: We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D‐TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip–knee–ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow‐up full‐length X‐rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow‐up, Johner–Wruhs tibial fracture outcome criteria (J‐W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi‐square test or Fisher's exact test; the Mann–Whitney U test was used for rank data. Results: No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D‐TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner–Wruhs criteria were used to assess the function of the affected limb, the D‐TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow‐up X‐rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow‐up compared to the angle before surgery. At the final follow‐up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). Conclusion: The D‐TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture. [ABSTRACT FROM AUTHOR]

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Background: Deformity of long bones of lower limb leads to frequent gait and joint problems, in addition to the esthetic problems. Correction of such deformities proves to be a challenge due to spatial and soft-tissue considerations. Taylor Spatial Frame (TSF) and Ortho-SUV Frame (SUV) are two six axis correction devices which utilize the Ilizarov methods and allow easier correction of complex deformities. This study was performed to compare the efficacy of TSF and SUV for correction of lower limb long bone deformities. Materials and Methods: The Study was held at Sir Ganga Ram Hospital, New Delhi between January 2015 and November 2019. Twenty patients were included for each correction group. Assessment of correction was done in terms of rate and accuracy of deformity correction, lengthening index, total lengthening achieved, time in frame, assessment of ability to perform Activities of Daily Living, functional outcome using Association for the Study and Application of the Method of Ilizarov (ASAMI) score, and complications during treatment. Results: Both groups showed excellent correction of deformity in all planes and good functional outcomes. TSF group showed lesser incidence of joint stiffness as well as a shorter time in Frame. Pin site infection was the most common complication followed by major residual deformity. Conclusion: Both TSF and SUV provide excellent outcome in correction of complex spatial deformities of lower limb with high accuracy and good functional outcome. The TSF provides an advantage over SUV with reduced time in Frame, lesser joint stiffness and increased patient compatibility due to smaller frame size and reduced bulk as compared to SUV.

The introduction of Taylor Spatial Frame (TSF) in clinical practice allows for unique capabilities in long bone deformity corrections; however, a comprehensive understanding of its mechanical characteristics and their impact on callus formation at the osteotomy site is still unclear. The current study is concerned with the clinical application of TSF in high tibial osteotomy (HTO) and the mechanical testing of this device. Fifty-five (55) patients with symptomatic medial compartment knee osteoarthritis and varus deformity underwent open-wedge HTO with the use of TSF and were prospectively monitored with regard to callus formation pattern at the site of osteotomy. Clinical evaluation revealed that the callus formation pattern was eccentric in all patients. In addition, the experimental results from mechanical testing of a clinically relevant TSF configuration indicate, that vertical deflection of the upper bone part during weight-bearing is accompanied by a rotation of the bone axis, which acts in the same direction to the rotation applied during the clinical correction process. The complementary contributions of the deformity correction process and the mechanical response of the TSF under compressive loads, lead to asymmetric gap closure, which promotes the eccentric callus formation in the osteotomy site. The study provides useful information for clinical decision-making regarding callus formation process when TSF external fixator is applied in HTOs. [ABSTRACT FROM AUTHOR]

Traditional Ilizarov and hexapod frames have different biomechanical properties and there is limited literature regarding their effect on time to fracture union or time to frame removal. Tibial fractures managed with a circular frame at a tertiary limb reconstruction referral centre between 2011 and 2018 were retrospectively identified from a prospectively maintained database. They were classified into three treatment groups; Ilizarov style, Taylor Spatial Frame (TSF) and TrueLok Hex (TL-Hex). Data were extracted from electronic patient records and digital radiographs. The primary outcome was time to frame removal, which was seen as an indicator of clinical and radiological fracture union. Odds ratios were calculated with the clinical significance set at 30 days. 274 patients (median age 49 years, 36% female) were included in the analysis. 8.4% Ilizarov, 10.5% TSF and 13.5% TL-Hex frames required further surgery to aid fracture healing (p = 0.38). 30% of patients had open fractures. Median time to removal for Ilizarov, TSF & TL Hex frames was 167, 198 and 185 days respectively. There was a significant difference between Ilizarov and hexapod frames. Both TSF (OR 2.2, p <0.003) and TL-Hex (OR 1.8, p <0.04) had a significantly increased time to removal of 30 days or more compared with Ilizarov frames.The time to frame removal in metaphyseal fractures was significantly shorter for Ilizarov frame fixation than hexapod frames (p = 0.04). Open fractures were significantly more likely to require at least 30 days extra time to removal than closed fractures (OR 3.3, p <0.001). There was no significant difference in the time to frame removal between fracture location, age or sex. Ilizarov frames have demonstrated a reduced time to frame removal in the management of tibial fractures than hexapod frames. Differences in the time to frame removal, an indicator of time to fracture union, may be due to the different mechanical properties of the frame, or early disruption of the fracture haematoma through secondary frame manipulation and fracture reduction, increased proportion of metaphyseal fractures treated with Ilizarov, or patient selection. The healing time was comparable across the tibia. Pooled meta-analyses may be able to further quantify these associations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background The Taylor Spatial Frame (TSF) has been widely used for tibial fracture. However, traditional radiographic measurement method is complicated and the reduction accuracy is affected by various factors. The purpose of this study was to propose a new marker- three dimensional (3D) measurement method and determine the differences of reduction outcomes, if any, between marker-3D measurement method and traditional radiographic measurement in the TSF treatment. Methods Forty-one patients with tibial fracture treated by TSF in our institution were retrospectively analyzed from January 2016 to June 2019, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiographic measurement group (control group). In the experimental group, 3D reconstruction with 6 markers installed on the TSF was performed to determine the electronic prescription. In the control group, the anteroposterior (AP) and lateral radiographs were performed for the traditional parameter measurements. The effectiveness was evaluated by the residual displacement deformity (RDD) and residual angle deformity (RAD) in the coronal and sagittal plane, according to the AP and lateral X-rays after reduction. Results All patients achieved functional reduction. The residual RDD in AP view was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group. The residual RAD in AP view was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As for the lateral view, 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 observed between the two groups (AP view RDD: P = 0.024, RAD: P = 0.020; Lateral view RDD: P = 0.016, RAD: P = 0.004). Conclusions The present study introduced a marker-3D measurement method to complement the current TSF treatment. This method avoids the manual measurement error and improves the accuracy of fracture reduction, providing potential advantages of bone healing and function rehabilitation.

We report the case of an 18-year-old male with congenital absence of quadriceps and hypoplasia of the patella who presented with a significant leg length discrepancy (LLD) and knee flexion contracture. Surgical management was aimed toward lengthening the limb, stabilizing the joint, and correcting the knee flexion contracture. Correction of a significant congenital LLD and knee flexion contracture poses challenges due to long-standing altered biomechanics. These are rare conditions for which no accepted surgical algorithms exist. It is essential to anticipate the biomechanical consequences of limb lengthening and flexion contracture correction that might arise and plan comprehensive interventions accordingly.

Abstract Aim The 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. Methods A 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). Results MPs 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

Abstract Background The 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. Methods This 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. Results All 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

Obtaining alignment during end-stage knee osteoarthritis with extraarticular deformities has always been challenging. Therefore, we report a case of total knee arthroplasty, following the application of Taylor Spatial Frame to treat knee osteoarthritis with severe tibia extraarticular deformity due to a proximal tibia fracture injury for more than 50 years ago. First, proximal tibial opening wedge osteotomy was conducted below the patellar tendon insertion from the anterior to the posterior direction to correct the deformity in multiple planes gradually. Then, osteotomy was done to restore both the varus and recurvatum deformities. Finally, Taylor Spatial Frame was used as a virtual hinge, with gradual adjustments to correct the deformity. Afterward, patient-specific instrumentation-assisted total knee arthroplasty was conducted after correcting the extraarticular deformity. During the two-year follow-up, no superficial and deep infection occurred, and his Oxford Knee Score had improved from 32 to 19 out of 48 at the time of the latest follow-up. Moreover, the patient walked using a one-hand clutch without protective limping. Hence, patient-specific instrumentation-assisted total knee arthroplasty, following proximal tibial osteotomy with Taylor Spatial Frame, should be considered a treatment option for patients with knee osteoarthritis having severe proximal tibia extraarticular deformity.

Background: The Taylor Spatial Frame (TSF) has been widely used for tibial fracture. However, traditional radiographic measurement method is complicated and the reduction accuracy is affected by various factors. The purpose of this study was to propose a new marker- three dimensional (3D) measurement method and determine the differences of reduction outcomes, if any, between marker-3D measurement method and traditional radiographic measurement in the TSF treatment.Methods: Forty-one patients with tibial fracture treated by TSF in our institution were retrospectively analyzed from January 2016 to June 2019, including 21 patients in the marker-3D measurement group (experimental group) and 20 patients in the traditional radiographic measurement group (control group). In the experimental group, 3D reconstruction with 6 markers installed on the TSF was performed to determine the electronic prescription. In the control group, the anteroposterior (AP) and lateral radiographs were performed for the traditional parameter measurements. The effectiveness was evaluated by the residual displacement deformity (RDD) and residual angle deformity (RAD) in the coronal and sagittal plane, according to the AP and lateral X-rays after reduction.Results: All patients achieved functional reduction. The residual RDD in AP view was 0.5 (0, 1.72) mm in experimental group and 1.74 (0.43, 3.67) mm in control group. The residual RAD in AP view was 0 (0, 1.25) ° in experimental group and 1.25 (0.62, 1.95) °in control group. As for the lateral view, 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 observed between the two groups (AP view RDD: P = 0.024, RAD: P = 0.020; Lateral view RDD: P = 0.016, RAD: P = 0.004).Conclusions: The present study introduced a marker-3D measurement method to complement the current TSF treatment. This method avoids the manual measurement error and improves the accuracy of fracture reduction, providing potential advantages of bone healing and function rehabilitation. [ABSTRACT FROM AUTHOR]

BACKGROUND: The number of patients with osteomyelitis, bone defects, and lower extremity deformities due to open fractures of the lower limb has increased significantly, leading to an increasing use of Ilizarov circular external fixators. Although the Ilizarov circular external fixator has achieved good results in the treatment of these conditions, there are still many defects. OBJECTIVE: To summarize the progress of the development and application of hexapod external fixator in the treatment of lower limb deformity. METHODS: Articles from PubMed, CNKI and Wanfang database from February 2001 to February 2021 were retrieved with the key words of “hexapod external frame, taylor spatial frame, ortho-SUV, truelok-Hex” in both English and Chinese. Fifty articles were included, and the application progress of the hexapod external fixator in the treatment of lower limb deformity was reviewed. RESULTS AND CONCLUSION: (1) The application of circular external fixator in the treatment of extremities fracture and limb deformity that are not suitable for internal fixation has achieved positive results, and can be used to pull bone and regenerate soft tissue following the tension-stress rule, curing various diseases that cannot be treated by traditional orthopedic technology. (2) The Ilizarov circular fixator suffers from defects such as long treatment cycle, complex operation and high requirement on physician experience. (3) The main feature of the hexapod external fixator is that it forms a virtual hinge through six adjustable telescopic struts to realize multi-plane deformities and correct simultaneously, and there is no need to replace the hinge during the treatment. With the help of computer software, the accuracy of correction is improved significantly, and the residual rate of malformation is reduced significantly. (4) The hexapod external fixator has been widely used in the treatment of lower limb non-union, bone defect, clubfoot, joint deformity and other diseases, and can significantly reduce the incidence of postoperative complications compared with the Ilizarov circular external fixator. (5) The shortcomings of the hexapod external fixator, such as poor stability, misuses, difficult learning process and high price, make it unable to be further popularized. (6) In the future, it is necessary to improve the prescription software, reduce the influence of human factors, gradually realize intellectualize and informationize hexapod external fixator. Also, it is critical to achieve independent research and development and reduce the cost of use so as to make hexapod external fixator being widely used. [ABSTRACT FROM AUTHOR]

Context: The management of multiapical and multidirectional deformities of the proximal tibia is still a challenging task with acute correction. The Taylor spatial frame (TSF) enables gradual correction in all planes. Aims: The study investigated the accuracy of correction for multiplanar proximal tibial deformities which had performed with the preassembled TSF. The complications and functional outcome were investigated. Settings and Design: Retrospectively, we compared the parameters of proximal tibial angles before and after using the preassembled TSF frame technique for correction. We used the mechanical axis deviation (MAD), medial proximal tibial angle (MPTA), posterior proximal tibial angle (PPTA), and tibial rotation as reference parameters for accuracy judgment. The deformities were divided into three main planes, each plane subdivided by two directions of angulations. Subjects and Methods: The study included 15 patients (20 tibiae), who underwent a tibial osteotomy surgery after obtaining informed consent for deformity correction using the TSF (Smith and Nephew, Memphis, TN, USA) between June 2016 and May 2018. Results: The three-plane deformities experienced an accurate correction of MAD. MPTA and PPTA were accurately corrected in patients with coronal and sagittal plane deformities, respectively. Rotational deformities were corrected to a satisfactory degree of accuracy in all cases. TSF correction for multiplanar proximal tibial deformities achieved an excellent result regarding functional outcome. Conclusions: Gradual correction for multiplanar proximal tibial deformities with the TSF is accurate, simple and with few complications.

The introduction of Taylor Spatial Frame (TSF) in clinical practice allows for unique capabilities in long bone deformity corrections; however, a comprehensive understanding of its mechanical characteristics and their impact on callus formation at the osteotomy site is still unclear. The current study is concerned with the clinical application of TSF in high tibial osteotomy (HTO) and the mechanical testing of this device. Fifty-five (55) patients with symptomatic medial compartment knee osteoarthritis and varus deformity underwent open-wedge HTO with the use of TSF and were prospectively monitored with regard to callus formation pattern at the site of osteotomy. Clinical evaluation revealed that the callus formation pattern was eccentric in all patients. In addition, the experimental results from mechanical testing of a clinically relevant TSF configuration indicate, that vertical deflection of the upper bone part during weight-bearing is accompanied by a rotation of the bone axis, which acts in the same direction to the rotation applied during the clinical correction process. The complementary contributions of the deformity correction process and the mechanical response of the TSF under compressive loads, lead to asymmetric gap closure, which promotes the eccentric callus formation in the osteotomy site. The study provides useful information for clinical decision-making regarding callus formation process when TSF external fixator is applied in HTOs.

Background: Postoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.Methods: We carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure.Results: All patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction.Conclusions: The temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation. [ABSTRACT FROM AUTHOR]

Abstract Background Arteriovenous malformations (AVMs) are rare congenital vascular lesions associated with early quiescence, late expansion, and, ultimately, infiltration and destruction of local soft tissue and bone. The extremities are a common location. Incidence of bony involvement by AVM has been reported as high as 31%. However, there are few reports on management of pathologic fracture associated with AVM. Teriparatide is a recombinant parathyroid hormone (PTH) analogue consisting of the 1–34 fragment of PTH. Recently, some reports have shown the ability of teriparatide to improve fracture healing. Here, we present a case of pathologic femoral shaft fracture associated with large AVMs that was treated successfully by external fixation and teriparatide. Case presentation A 68-year-old Japanese woman, previously diagnosed as having large AVMs, sustained a right femoral shaft fracture due to a fall. At the time of admission, she presented with massive swelling and venous varicosities of the right thigh. Plain radiography of the right thigh revealed femoral shaft fracture with bony erosion and calcification of soft tissue. We planned closed reduction and intramedullary nailing with a unilateral external fixator following embolization of the feeding artery. However, closed reduction using the fracture table was difficult. When we attempted open reduction, massive bleeding (1000 mL) after incision of subcutaneous tissue occurred. Finally, we carefully applied a Taylor Spatial Frame. Fracture displacement was corrected successfully and bony union was obtained with administration of teriparatide 15 months after the initial surgery. The patient is able to walk using 1 cane. Conclusion We present the first report of pathologic fracture associated with large AVMs that achieved bony union using a 3-dimensional external fixator and teriparatide.

Purpose Comparison of two hexapod frame systems in paediatric tibial deformity correction; the Taylor Spatial Frame (TSF) and Orthex Hexapod System. Methods Paediatric 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). Results The 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). Conclusions This 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. [ABSTRACT FROM AUTHOR]

Aim: The 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.Methods: A 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).Results: MPs 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).Conclusion: The 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. [ABSTRACT FROM AUTHOR]

Background: The 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.Methods: This 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.Results: All 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).Conclusions: The 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. [ABSTRACT FROM AUTHOR]

Purpose: To 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. Methods: Forty-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. Results: Numerical 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. Conclusion: Numerical 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Correction of deformities around the knee joint in the frontal and sagittal axis, torsion, length and translation., Indications: Complex deformities of the proximal tibia, and to a lesser extent of the distal femur, which cannot be treated with acute correction using plate or nail osteosynthesis., Contraindications: Nicotine abuse, soft tissue problems, lack of patient compliance., Surgical Technique: First, mounting of the proximal ring of the ring fixator strictly parallel to the joint line in 2 planes, fixation with 3 or 4 pins or wires. Then mounting of the distal ring, fixation also with 3 or 4 wires, connection of both rings with 6 struts (movement units with which the length can be adjusted). Then the fibula osteotomy is performed in the transition from the distal to the middle third, and finally the tibial osteoclasia is performed via a mini-incision as a drill hole chisel osteotomy in the CORA (center of rotation and angulation) of the malposition., Postoperative Management: Immediately postoperatively, the deformity is defined usimg computer software, the exact position and size of the ring and struts are entered, and a knee image is taken in 2 planes with X‑ray signal adapter (beacon) on the ring fixator to plan the continuous correction. Thereupon continuous correction of the deformity via daily rotation on the 6 struts, which is done by the patients themselves at home after the hospital stay. At the time of correction, pain-adapted partial weight-bearing with 20 kg up to half body weight. After completion of the correction, repeat X‑ray diagnosis and check whether the correction goal has been achieved. If necessary, reprogram a program for renewed continuous correction if residual deformity remains. When the correction goal is reached, X‑ray check. After 6 weeks, with bony consolidation, gradual loading. The treatment of the correction can either be carried out in the ring fixator (wearing time of 0.5-1 year not unusual) or secondarily via a change of procedure to plate osteosynthesis., Results: We report on 25 knee joint corrections in 23 patients (12 women and 11 men) using hexapods (Taylor spatial frame) during the period 2016-2023. One patient had a femoral and a tibial fixator at the same time; another patient had a triple fixator at the tibia. The mean age was 32 (6-73) years. 15 left and 10 right corrections were performed. 19 fixators had been applied tibial, 5 fixators femoral, and 1 fixator cross-jointly (for contracture). The indications were 6 congenital complex deformities, 10 posttraumatic complex deformities, 3 pseudarthroses after correction osteotomies, 2 patients with osteomyelitis, 1 knee contracture and 1 infection after fracture osteosynthesis with nails. The forms of correction performed were varizations and valgizations in frontal axis, extension and flexion in sagittal plane, torsional corrections, lengthening also after acute shortening (pseudarthrosis resection) and segmental transport. Acute shortening without lengthening was also treated with the fixator only until bone healing and a Masqualet procedure was bridged with it. The average duration of fixator wear was 144 (31-443) days. All patients were followed up until final metal removal. There were 19 change of procedure to another osteosynthesis procedure (18 plate osteosynthesis, 1 ESIN); 6 times the treatment in TSF (Taylor Spatial Frame) was performed until final bone healing., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided. Using a web-based software program, a gradual reduction in all planes was achieved. Adequate fixation, stability, reduction, and quick healing were obtained in the 2 cases, with minimal complications. The patients returned to their activity level a few months after external fixation removal.

Background Multiplanar knee deformity needs correction in different axes; this can be achieved by the Ilizarov system, which utilizes the hinges and translation mechanism; this needs an effort or orientation and gradual correction. The Taylor spatial frame (TSF) fixator solves this problems; it consist of two rings or partial rings connecting by six telescopic struts at special universal joints. Patients and methods The study included six patients with complex post-traumatic knee deformity. They had genu varus, recurvatum, and shortening; two female individuals and four male individuals, with an age range from 16 to 20 years comprised our study sample. The TSF was used for correction. Mean follow-up postoperatively lasted for 10 months. All cases were assisted clinically, radiologically, and by the Lysholm and the Oxford knee scores. Result All patients' knee deformities were corrected by application of TSF. All patients are very satisfied; the Lysholm knee score improved from 55 to 90%. One patient has a 5° recurvatum which was compensated postoperatively without any complications. There were no leg length discrepancies. Conclusion The TSF fixator was able to correct a six-axes deformity and also leg length discrepancies by adjusting only strut lengths; one ring can be repositioned with respect to the other ring.

Aims: Severe infantile Blount's disease can result in a challenging multiplanar deformity of the proximal tibia with intra-articular and metaphyseal components. We describe our results using the Taylor's spatial frame (TSF) for acute tibial hemiplateau elevation combined with gradual metaphyseal correction in patients with severe infantile Blount's disease with an associated physeal bony bar. Patients and Methods: Eight patients (ten knees) underwent tibial hemiplateau elevation and metaphyseal correction from 2012 to 2016. We undertook a retrospective case note and radiographic review of clinical and radiographic outcomes. The mean age at the time of surgery of was 11.7 years and the mean length of follow-up was 18.2 months. Results: Improvement in radiographic parameters was seen in all patients. The mean tibiofemoral angle improved from −28.3° to −5.9° postoperatively. The angle between femoral condyles and the tibial shaft improved from the mean of 56.3° to 90.3°. The joint depression angle was also seen to improve from the mean 47.4° to 9.8°. No significant complications were seen. Conclusion: This technique is effective in correcting the complex deformity encountered in severe infantile Blount's disease. Use of the TSF may provide certain advantages in comparison to previously described approaches.

Monolateral external fixator (MEF) has been commonly used for limb lengthening in both upper and lower extremities. Since MEF can only lengthen or shorten the bone, sagittal, coronal, and torsional deformities need to be corrected acutely at the time of MEF application. Acute correction, particularly torsional correction, may endanger the radial or peroneal nerves. Gradual correction of torsion may be safely achieved using a circular external fixator (CEF) frame. We present a case study of humeral lengthening with derotation to describe a technique, whereby it is possible to first lengthen with MEF and then derotate with CEF. This is a case report of a 14-year-old boy with a history of neonatal sepsis and growth arrest of the proximal humerus that led to a short right humerus and loss of external rotation. Humerus lengthening was achieved (6.6 cm) using MEF. Conversion to CEF was done after the distraction phase and prior to regenerate bone consolidation. Two 2/3 rings were connected to the proximal and distal fixation half-pins, and then the six connecting struts were added. The rotation deformity correction was then performed gradually to achieve 60° of external rotation. The described technique to convert the MEF into CEF is versatile and can be employed in the clinic safely and without sedation.

Introduction: Limb reconstruction using circular frames requires complex accurate measurements to achieve correction of mechanical bone axis. Inadequate imaging could ultimately lead to poor clinical outcome. Therefore, radiographs should be obtained in a standardised manner to yield accurate results. Our aim is to improve the effectiveness of post-operative imaging by obtaining precise examinations and improving the accuracy of frame correction; therefore, reducing technical repeats, radiation exposure, time waste in clinic, and achieving cost effectiveness. Methods: We implemented a simple technique for obtaining adequate imaging using standard X-ray equipment. This technique was introduced to the radiographers in the radiology department to image patients with circular frames. Images were taken by obtaining a field of view using the X-ray machine cone of light that is orthogonal to the location of interest in both the antero-posterior (AP) and lateral planes. We compared the quality of radiographs, number of repeated X-rays and radiation dose both before and after implementing our protocol Results: We assessed 54 consultations before and 63 consultations after the implementation of our protocol. The results showed a reduction in inadequate radiographs from 78% to 13% department at Addenbrooke's Hospital at a statistical significance of p < 0.00001. In addition, we found a potential radiation dose reduction of 2.7–0.32mSev between the two cohorts. Our results indicate that there would also be a reduction in the cost to the department as well as time spent repeating inaccurate radiographs. Conclusion: We have been able to achieve a significant improvement in the quality of post-operative radiographic imaging and have expanded its use to adult frame patients with a background of traumatic or infectious aetiologies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

External fixation has a wide variety of orthopedic applications. Although external fixator frames may have a complex appearance, these constructs are formed from several basic components and can be broadly categorized into unilateral, circular, or hybrid designs. The introduction of computer-aided circular external fixation devices (hexapod frames) has simplified the treatment of multiaxial and especially rotational deformities. Serial radiography plays a central role in the evaluation of callus formation (at the level of treated fracture or nonunion as well as the regenerate and docking site with distraction osteogenesis), tailoring the rate and rhythm of distraction during distraction osteogenesis, evaluation of frame complications, and determination of the timing of frame removal. The goals of this article are to review: the components, types, and relevant terminology of external fixator constructs with special emphasis on the Taylor spatial frame, the principles and techniques of distraction osteogenesis, and complications of external fixation. [ABSTRACT FROM AUTHOR]