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Geetala R, Zhang J, Maghsoudi D, Madigasekara A, Krkovic M. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024; 19:32-35. [PMID: 38752193 PMCID: PMC11091894 DOI: 10.5005/jp-journals-10080-1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/09/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications. Materials and methods Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union. Results The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13-15.18], p = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant. Conclusion Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union. Clinical significance The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis. How to cite this article Geetala R, Zhang J, Maghsoudi D, et al. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024;19(1):32-35.
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Affiliation(s)
- Rahul Geetala
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - James Zhang
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Daniel Maghsoudi
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Amindu Madigasekara
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Clinical School of Medicine, University of Cambridge; Addenbrooke's Hospital, Cambridge, United Kingdom
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Danişman M, Yilmaz ET, Özdemir E, Tuncay O, Yilmaz G. Accuracy of the hexapod external fixator in treating tibial angular deformities with or without limb length discrepancy: a retrospective study. J Pediatr Orthop B 2023; 32:611-616. [PMID: 37278281 PMCID: PMC10529806 DOI: 10.1097/bpb.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Hexapod external fixator systems allow simultaneous deformity correction in multiple planes as well as limb lengthening. The aim of this study is to evaluate the accuracy of a hexapod frame (smart correction frame) in different types of tibial deformities requiring correction with or without lengthening. METHODS A total of 54 tibial angular deformities and limb length discrepancies operated with a hexapod frame between January 2015 and January 2021 were classified into four groups: "Group A ( n = 13): only lengthening," "Group B ( n = 14): lengthening and uniplanar correction," "Group C ( n = 16): only uniplanar correction," and "Group D ( n = 11): biplanar correction." The accuracy of angular deformity correction/lengthening was calculated by dividing the actual correction/lengthening achieved after frame removal by the preoperative planned lengthening/correction. RESULTS The lengthening accuracy in Group A and Group B was 96.3 ± 7.1% and 95.7 ± 5.9%, respectively ( P = 0.685). The angular deformity correction accuracy was 85.1 ± 9.9% for Group B, 85.2 ± 13.9% for Group C, and 80.2 ± 18.4% for Group D ( P = 0.852). A revision program was performed in six cases (1 in Group B, 1 in Group C, and 4 in Group D) for full correction of the deformities. CONCLUSION The accuracy of tibial lengthening is high with the hexapod frame and is minimally affected by simultaneous deformity correction; however, the accuracy of angular correction slightly reduces as the deformity becomes more complex. Surgeons should be aware that reprogramming may be required after complex deformity correction.
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Affiliation(s)
- Murat Danişman
- Department of Orthopaedics and Traumatalogy, Giresun University Faculty of Medicine, Giresun
| | - Engin Türkay Yilmaz
- Department of Orthopaedics and Traumatalogy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdi Özdemir
- Department of Orthopaedics & Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ozan Tuncay
- Department of Orthopaedics and Traumatalogy, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güney Yilmaz
- Department of Orthopaedics and Traumatalogy, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Jiao S, Qin S, Wang Z, Guo Y, Xu H, Liu Z, Chen J. [Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:839-845. [PMID: 37460181 DOI: 10.7507/1002-1892.202303121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Objective To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. Methods Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. Results Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. Conclusion Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.
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Affiliation(s)
- Shaofeng Jiao
- The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, 100176, P. R. China
| | - Sihe Qin
- The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China
| | - Zhenjun Wang
- The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China
- Key Laboratory of Intelligent Control and Rehabilitation Technology of the Ministry of Civil Affiairs, Beijing, 100176, P. R. China
| | - Yue Guo
- The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China
- Key Laboratory of Intelligent Control and Rehabilitation Technology of the Ministry of Civil Affiairs, Beijing, 100176, P. R. China
| | - Hongsheng Xu
- The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, 100176, P. R. China
| | - Zhijie Liu
- The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, 100176, P. R. China
| | - Jianwen Chen
- Department of Reconstructing Orthopedics, the Affiliated Hospital, Southern University of Science and Technology, Shenzhen Guangdong, 518000, P. R. China
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Lu Y, Li J, Qiao F, Xu Z, Zhang B, Jia B, He J, Qi L, Wang M, Fei C, Cao X. Correction of severe lower extremity deformity with digital hexapod external fixator based on CT data. Eur J Med Res 2022; 27:252. [PMCID: PMC9670579 DOI: 10.1186/s40001-022-00887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Our goal was to examine the therapeutic effect of a self-designed digital six-axis external fixator technique for the correction of severe lower extremity deformities. Patients and methods Between January 2017 and December 2020, our institution employed self-developed digital hexapod external fixator technology (QSF), based on CT data, to gradually correct 28 severe tibial deformities, and 15 femurs underwent osteotomy and internal fixation. The mean patient age was 32.6 ± 14.3 years, and the mean follow-up duration was 27.4 ± 16.1 months. We also recoded and analyzed the values of preoperative and final follow-up MAD, mFTA, MPTA, LLD, mLDFA, LEFS, KSS, and functional score. Results The QSF adjustment duration was 21.4 ± 10.8 days, and the healing duration of the tibial osteotomy site was 17.6 ± 7.0 weeks. The preoperative MAD, mFTA, and MPTA were 54.1 ± 26.2 mm, 167.7 ± 15.7°, and 75.2 ± 12.0°, respectively. At the last follow-up, the MAD was 8.2 ± 9.9 mm, mFTA was 177.6 ± 3.4°, and MPTA was 87.6 ± 2.4°. Based on these data, we achieved significant improvement post operation. The preoperative LLD and mLDFA values were 13.8 ± 18 mm and 83.7 ± 10.8°, respectively, and the values were 7.6 ± 7.6 mm and 87.8 ± 2.6°, respectively, at the last follow-up. This indicated no significant difference in these values before and after the operation. Finally, the LEFS, KSS, and functional scores improved from preoperative 51.6 ± 11.2, 68.5 ± 11.7, and 67.8 ± 11.2 to postoperative 72.3 ± 6.1, 92.9 ± 3.4, and 94.2 ± 6.3, respectively. Conclusions Based on our analyses, the QSF technique accurately corrected severe multiplanar tibial deformities in adults. When combined with femoral osteotomy, satisfactory lower extremity alignment was obtained while correcting for femoral deformity. This technology has the advantages of simple operation, reliable fixation, less trauma, and less complications.
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Affiliation(s)
- Yufeng Lu
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Jinfeng Li
- grid.449637.b0000 0004 0646 966XShaanxi University of Chinese Medicine, Xianyang, 712046 Shaanxi People’s Republic of China
| | - Feng Qiao
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Zhaochen Xu
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Baogang Zhang
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Bin Jia
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Jinlong He
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Liang Qi
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | - Min Wang
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
| | | | - Xiaoming Cao
- grid.452452.00000 0004 1757 9282Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710054 Shaanxi People’s Republic of China
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Liu Y, Wang F, Liu K, Cai F, Zhang X, Li H, Zhang T, Yusufu A. Staged correction trajectory with hexapod external fixator for the satisfactory reduction of long bone shaft fracture. BMC Musculoskelet Disord 2022; 23:224. [PMID: 35260138 PMCID: PMC8905859 DOI: 10.1186/s12891-022-05172-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
Backgroud When the reduction of long bone shaft fracture fragments is performed by a hexapod external fixator, the collision and interference between bony ends often results in an incomplete reduction and a time-consuming procedure. The purpose of this study was to present and determine the clinical effectiveness of staged correction trajectory with hexapod external fixator in the reduction of a long bone shaft fracture. Methods A total of 57 patients with tibial shaft fractures treated by hexapod external fixator were retrospectively analyzed from June 2016 to February 2020. Thirty-one cases (Group I) underwent a conventional one-step reduction trajectory from June 2016 to July 2018. Starting in September 2018, the other twenty-six patients (Group II) underwent staged correction trajectory (three key points reduction trajectory of “distraction-derotation-reduction”). The demographic data, residual deformities before and after correction, number of repeated X-rays after the first postoperative X-ray, duration of deformity correction process, and external fixation time were analyzed. Johner-Wruhs criteria were used to evaluate the final clinical outcomes. Results All the 57 patients achieved satisfactory fracture reduction and bone union. There were no significant differences between the two groups in demographic data, residual deformities before and after correction, external fixation time, and final clinical outcomes (p > 0.05). The average number of repeated X-rays after the first postoperative X-ray and mean duration of deformity correction process in Group II (1.3 times, 2.9 days) were all less than those in Group I (2.3 times, 5.1 days) (p < 0.05). Conclusion Compared with the conventional one-step reduction trajectory, there is no differences in final clinical outcomes, but the staged correction trajectory provides less repeated X-rays and shorter reduction process duration.
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Affiliation(s)
- Yanshi Liu
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Fei Wang
- Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Feiyu Cai
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xingpeng Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Hong Li
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Tao Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Liu Q, Liu Y, Li H, Fu X, Zhang X, Liu S, Zhang J, Zhang T. Marker- three dimensional measurement versus traditional radiographic measurement in the treatment of tibial fracture using Taylor spatial frame. BMC Musculoskelet Disord 2022; 23:155. [PMID: 35172802 PMCID: PMC8849035 DOI: 10.1186/s12891-022-05112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Qixin Liu
- Graduate College of Tianjin Medical University, Tianjin, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hong Li
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Xuefei Fu
- Department of Orthopedics, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Xingpeng Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Sida Liu
- College of Mechanical Engineering, Tianjin University, Tianjin, China
| | - Jinli Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
| | - Tao Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
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Rao M, Jamil K, Tasarib R. An Alternative Technique to Strut Change in Hexapod Circular External Fixator. Malays Orthop J 2021; 15:157-158. [PMID: 34966516 PMCID: PMC8667230 DOI: 10.5704/moj.2111.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- M Rao
- Department of Orthopaedics, Hospital Serdang, Kajang, Malaysia
| | - K Jamil
- Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - R Tasarib
- Department of Orthopaedics, Hospital Serdang, Kajang, Malaysia
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Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis. Pain Res Manag 2021; 2021:8609921. [PMID: 34900072 PMCID: PMC8654534 DOI: 10.1155/2021/8609921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022]
Abstract
Background High tibial osteotomy (HTO) is used to treat medial degeneration of the osteoarthritis (OA) knee. However, shortcomings still exist in the current procedure, like unprecise creation, inability to correct knee rotation, and internal fixed failure. Here, we reported a novel procedure: patient-specific 3D-printed plates for opening wedge high tibial osteotomy (OWHTO) combined with Taylor spatial frame (TSF). The detailed technique was described, and the clinical outcomes were evaluated. Methods We prospectively evaluate outcomes of patient-specific 3D-printed plates for OWHTO with use of TSF in 25 patients with knee OA and varus alignment. Postoperative efficacy was evaluated using the HSS knee score, pain visual simulation score (VAS), and knee joint motion (ROM), and lower limb alignment was evaluated by measuring femorotibial angle (FTA) and hip-knee-ankle (HKA). Results and Conclusion. All patients did not experience complications such as wound infection, nerve damage, or bone amputation. 25 patients were followed up for 6–18 months. The bony union at bone amputation was achieved in 3 months after surgery, and the pain symptoms were significantly alleviated or disappeared. The VAS score was significantly reduced in 6 months after surgery compared with preoperative; the HSSS score was significantly added in 6 months after surgery compared with preoperative. The ROM of knee joint increased significantly 6 months after operation compared with that before operation, and the difference was statically significant (P < 0.05). The FTA and HKA after operation were significantly superior to that before operation, and the difference was statically significant (P < 0.01). Conclusions Our study showed that patient-specific 3D-printed plates for HTO with the use of TSF have the advantages of small trauma, few complications, simple operation, and fast recovery in treating knee OA and varus alignment.
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Singh P, Sabat D, Dutt S, Sehrawat R, Prashanth B, Vichitra A, Kumar V. Accuracy and Efficacy of Software-guided Bony Realignment in Periarticular Deformities of the Lower Limb. Strategies Trauma Limb Reconstr 2021; 16:65-70. [PMID: 34804221 PMCID: PMC8578247 DOI: 10.5005/jp-journals-10080-1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim and objective Software-guided realignment is proposed as an easy and accurate method of achieving simultaneous multiaxial correction. The accuracy and efficacy in periarticular problems have not been investigated fully. This study investigates the results and possible clinical benefits. Materials and methods A retrospective review was performed in 24 patients with 27 periarticular deformities of the lower limb treated by the Ilizarov technique. Bony realignment was achieved by a software-guided hexapod realignment device. The deformity category, deformity severity score (DSS) and individual deformity component scores were measured for objective quantification of each deformity. The periarticular level, number of manoeuvres, correction period and any difficulties in the execution of the correction manoeuvre were noted. Pre-procedure and post-procedure values of deformity parameters were analysed to estimate the accuracy and efficacy of the realignment device. Results The correction manoeuvre was accomplished successfully in all patients except two. The mean correction period was 14.9 days (range, 5–38 days). The mean pre-procedure DSS was 18.7 (range 6.3–27.3), which reduced to a mean post-procedure value of 1.5 (range, 0–7.9) with a 92.0% deformity correction (p-value < 0.001)). There was a significant reversal of individual deformity components. DSS values were achieved to an excellent level (< 3.5) in 25 deformities and to good and poor levels in one deformity, respectively. Conclusion Software-guided realignments are effective for accurate realignment of periarticular deformities using Ilizarov fixators. These devices offer simultaneous multidimensional corrections even in complex multiplanar deformities and simplify the task of deformity correction. Clinical significance The present study assesses the accuracy and efficacy of software-guided realignments using novel concepts of deformity category, DSS and individual deformity component scores, which may overcome some of the shortcomings of conventional assessment methods. How to cite this article Singh P, Sabat D, Dutt S, et al. Accuracy and Efficacy of Software-guided Bony Realignment in Periarticular Deformities of the Lower Limb. Strategies Trauma Limb Reconstr 2021;16(2):65–70.
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Affiliation(s)
- Pritish Singh
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Dhananjay Sabat
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Saurabh Dutt
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Rakesh Sehrawat
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Balu Prashanth
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anubhav Vichitra
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Vinod Kumar
- Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Liu Y, Liu K, Cai F, Zhang T, Yusufu A. Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring. J Orthop Surg Res 2021; 16:668. [PMID: 34774063 PMCID: PMC8590332 DOI: 10.1186/s13018-021-02820-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. METHODS We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group I) and 34 patients under the control of foot ring during the radiographic process (Group II). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner-Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. RESULTS Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.3 days) (P < 0.05). CONCLUSIONS The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.
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Affiliation(s)
- Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Feiyu Cai
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tao Zhang
- Department of Orthopedics and Trauma, Tianjin Hospital, Tianjin, China.
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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11
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Intraoperative acute correction versus postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. BMC Musculoskelet Disord 2021; 22:803. [PMID: 34537029 PMCID: PMC8449448 DOI: 10.1186/s12891-021-04505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the differences in clinical outcomes, if any, between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. METHODS We retrospectively analyzed 58 consecutive patients with tibial shaft fractures treated by the hexapod external fixator at our institution from January 2015 to April 2019. Twenty-three patients (Group I) underwent intraoperative acute correction, from January 2015 to October 2016. Starting in November 2016, the other 35 patients (Group II) all underwent postoperative gradual correction. The demographic data, operation duration, original residual deformities before correction, residual deformities after correction, and external fixation time were collected and analyzed. The clinical outcomes were evaluated by the Johner-Wruhs criteria at the last clinical visit. RESULTS All patients achieved complete bone union with a mean time of 28.7 ± 4.6 weeks (range 21 to 37 weeks) in Group I and 27.9 ± 4.8 weeks (range 19 to 38 weeks) in Group II (P > 0.05). The operation duration in Group I (88.9 ± 7.7 min) was longer than that in Group II (61.9 ± 8.4 min), and there was a statistically significant difference (P < 0.05). There were no statistically significant differences between the two groups in original residual deformities before correction and residual deformities after correction (P > 0.05). The rate of postoperative complication was similar between the two groups. There was no statistical significance in demographic data and clinical outcomes between the two groups (P > 0.05). CONCLUSIONS There is no difference in clinical outcomes between intraoperative acute correction and postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator. Postoperative gradual correction may shorten the duration in the operation room and decrease the potential intraoperative risk.
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12
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Messner J, Chhina H, Davidson S, Abad J, Cooper A. Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System. J Child Orthop 2021; 15:114-121. [PMID: 34040657 PMCID: PMC8138794 DOI: 10.1302/1863-2548.15.200165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
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. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Juergen Messner
- Department of Orthopaedic Surgery, BC Children’s Hospital Vancouver, Canada,Royal Hospital for Sick Children, Edinburgh, UK,Correspondence should be sent to Juergen Messner, British Columbia Children’s Hospital, Orthopaedic Department, 4500 Oak Street, Vancouver, Canada. E-mail:
| | - Harpreet Chhina
- Department of Experimental Medicine, Faculty of Medicine, University of British Columbia, Canada
| | - Sophia Davidson
- School of Kinesiology, Faculty of Education, University of British Columbia, Canada
| | - Jero Abad
- Faculty of Science, University of British Columbia, Canada
| | - Anthony Cooper
- Department of Orthopaedic Surgery, BC Children’s Hospital Vancouver, Canada,Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
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13
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Liu Y, Li H, Liu J, Zhang X, Yushan M, Liu Z, Ma C, Yusufu A. Long bone fracture reduction and deformity correction using the hexapod external fixator with a new method: a feasible study and preliminary results. BMC Musculoskelet Disord 2021; 22:221. [PMID: 33627096 PMCID: PMC7905621 DOI: 10.1186/s12891-021-04097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022] Open
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 < 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.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hong Li
- Department of Orthopedics, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xingpeng Zhang
- Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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14
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Liu Y, Liu J, Yushan M, Liu Z, Zhang T, Ma H, Ma C, Yusufu A. Management of high-energy tibial shaft fractures using the hexapod circular external fixator. BMC Surg 2021; 21:95. [PMID: 33612116 PMCID: PMC7897373 DOI: 10.1186/s12893-021-01106-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/15/2021] [Indexed: 01/01/2023] Open
Abstract
Background The hexapod external fixator (HEF) is increasingly used for high-energy 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 HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males 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 HEF 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 Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tao Zhang
- Department of Orthopaedics and Trauma, Tianjin Hospital, Tianjin, China
| | - He Ma
- Department of Orthopaedics and Trauma, Tianjin Hospital, Tianjin, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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15
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Balakrishnan TM, Pakkiri S, Nagalingam A, Selvaraj R, Jaganmohan J. Distally Based Pedicled Fibula Flap for Reconstruction of Infected Charcot's Midtarsal Collapse-Diabetic Rocker Bottom Foot. Indian J Plast Surg 2021; 54:20-28. [PMID: 33814738 PMCID: PMC8012786 DOI: 10.1055/s-0040-1719197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction and Methods
Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot’s degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches.
Results
In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author’s procedure was 96.4% (
p
= 0.045).
Conclusion
Author’s protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.
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Affiliation(s)
- T M Balakrishnan
- Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
| | - Sathya Pakkiri
- Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
| | - Arounkumar Nagalingam
- Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
| | - R Selvaraj
- Department of Orthopedic Surgery, Institute of Orthopedic and Traumatology, Madras Medical College, Chennai, Tamil Nadu, India
| | - J Jaganmohan
- Department of Plastic and Faciomaxillary Surgery, Madras Medical College, Chennai, Tamil Nadu, India
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16
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Kani KK, Porrino JA, Chew FS. External fixators: looking beyond the hardware maze. Skeletal Radiol 2020; 49:359-374. [PMID: 31515594 DOI: 10.1007/s00256-019-03306-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Jack A Porrino
- Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, 06520-8042, USA
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
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