A comparative evaluation of the time to frame removal for tibia fractures treated with hexapod and Ilizarov circular frames

Watts, Arun; Sadekar, Vilas; Moulder, Elizabeth; Souroullas, Panos; Hadland, Y; Barron, E; Muir, Ross; Sharma, Hemant

doi:10.1016/j.injury.2022.12.027

Cited by 6 publications

(7 citation statements)

References 40 publications

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“…External fixation is a well-established technique in fracture and deformity treatments with several benefits, including the preservation of soft tissues, limited surgical intervention, and early mobilization [ 26 , 27 ]. The prolonged use of external fixators can cause significant discomfort and necessitate ongoing nursing, so patients aspire to remove the external fixator as early as possible.…”

Section: Discussionmentioning

confidence: 99%

In vivo axial load-share ratio measurement using a novel hexapod system for safe external fixator removal

Liu,

Lu,

Chen

et al. 2024

BMC Musculoskelet Disord

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Background External fixation is widely used in the treatment of traumatic fractures; however, orthopedic surgeons encounter challenges in deciding the optimal time for fixator removal. The axial load-share ratio (LS) of the fixator is a quantitative index to evaluate the stiffness of callus healing. This paper introduces an innovative method for measuring the LS and assesses the method’s feasibility and efficacy. Based on a novel hexapod LS-measurement system, the proposed method is to improve the convenience and precision of measuring LS in vivo, hence facilitating the safe removal of external fixators. Methods A novel hexapod system is introduced, including its composition, theoretical model, and method for LS measurement. We conducted a retrospective study on 82 patients with tibial fractures treated by the Taylor Spatial Frame in our hospital from September 2018 to June 2020, of which 35 took LS measurements with our novel method (Group I), and 47 were with the traditional method (Group II). The external fixator was removed when the measurement outcome (LS < 10%) was consistent with the surgeon’s diagnosis based on the clinical and radiological assessment (bone union achieved). Results No significant difference was found in the fracture healing time (mean 25.3 weeks vs. 24.9 weeks, P > 0.05), frame-wearing duration (mean 25.5 weeks vs. 25.8 weeks, P > 0.05), or LS measurement frequency (mean 1.1 times vs. 1.2 times, P > 0.05). The measurement system installation time in Group I was significantly shorter compared to Group II (mean 14.8 min vs. 81.3 min, P < 0.001). The LS value of the first measurement in Group I was lower than that of Group II (mean 5.1% vs. 6.9%, P = 0.011). In Group I, the refracture rate was 0, but in Group II it was 4.3% (2/47, P > 0.05). Conclusion The novel hexapod LS-measurement system and involved method demonstrated enhanced convenience and precision in measuring the LS of the external fixator in vivo. The LS measurement indicates the callus stiffness of fracture healing, and is applicable to evaluate the safety of removing the fixator. Consequently, it is highly recommended for widespread adoption in clinical practice.

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Section: Discussionmentioning

confidence: 99%

In vivo axial load-share ratio measurement using a novel hexapod system for safe external fixator removal

Liu,

Lu,

Chen

et al. 2024

BMC Musculoskelet Disord

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“…In this study this is termed as a non-union as the primary treatment methodology has been replaced and, hence has not led to union. This represents a 4.3% incidence rate, which compares favourably with the 11% maximum suggested by Ekegren et al 17 The Mean Time to Union (MTTU) for the remaining 66 patients was 136.7 days, but two outliers were identified and when these were excluded MTTU was 127 days, which compares – favourably – with: 175 days for a similar study by Beltsios et al 18 for monolateral fixation; Checketts and Young 19 reported a range of averages of 68 to 168 days dependent on fracture severity; and 181 days for frame fixation by Watts et al 20 No patient suffered a refracture post fixation removal, there was no incidence of malunion attributable to the treatment method. There was no incidence of pin-tract infection leading to osteomyelitis.…”

Section: Discussionmentioning

confidence: 93%

Tibial fractures treated with mono-lateral fixation: Principles of design and application

Ogrodnik,

Thomas,

Collingwood

2024

Proc Inst Mech Eng H

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This paper presents the outcome of a data review of patients treated with the IOS external fixation system at the Royal Stoke University Hospital: a fixation designed to meet four requirements for external fixation proposed in this paper. Demographic data and outcome were collected and assessed. From 69 initial patients, 64 patients (55 males and 9 females) had an average age of 35.9 years. The mean time to union was 127 days. There were no incidences of malunion, or refracture post fixation removal attributable to the treatment method. In addition, in this cohort, there was no incidence of pin tract infection resulting in osteomyelitis. Of all the factors assessed the only factor to have any significant effect on healing was smoking: an average delay of 31 days. An examination of RUST (radiographic union score tibia) and modified RUST scores illustrated a potential false negative of up to 80%. Hence, this study cannot support the use of either scoring system to diagnose fracture healing. IOS external fixation was shown to be an effective method for the treatment of unstable tibial fractures. The reduction at fixation removal was shown to be very good. There was no incidence of osteomyelitis. It is, therefore, suggested that appropriately used external fixation is a viable alternative to intramedullary nailing if designed and surgically applied using four design principles outlined in this paper. Furthermore, it is proposed that external fixation be designed and applied to meet these four principles.

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“…Furthermore, the mechanical load test of the external frame guides patients' rehabilitation exercises and subsequent frame removal, leading to precise, comprehensive, and intelligent fracture treatment. 14,15,[18][19][20][21] Effectiveness of D-TSF for Segmental Tibial Fracture In our retrospective study, we evaluated the effectiveness of D-TSF for segmental tibial fracture fixation. Our findings revealed a mean fracture healing time of (33.33 AE 8.21) weeks and a mean external frame removal time of (36.24 AE 8.34) weeks, consistent with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Patients in the D-TSF and Ilizarov groups were followed for a median of 14 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months. 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; Table 3).…”

Section: Demographic Datamentioning

confidence: 99%

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The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture

Zhao,

Liu,

Sun

et al. 2024

Orthopaedic Surgery

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ObjectivesMulti‐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.MethodsWe 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.ResultsNo 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).ConclusionThe 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.

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A comparative evaluation of the time to frame removal for tibia fractures treated with hexapod and Ilizarov circular frames

Cited by 6 publications

References 40 publications

In vivo axial load-share ratio measurement using a novel hexapod system for safe external fixator removal

In vivo axial load-share ratio measurement using a novel hexapod system for safe external fixator removal

Tibial fractures treated with mono-lateral fixation: Principles of design and application

The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture

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