Combined medial malleoplasty and Taylor Spatial Frame after a supramalleolar osteotomy in the treatment of ankle deformity in skeletally immature patients: A prospective study of a novel technique and the short-term results

Abstract

Background: This study examined the effectiveness of the Taylor Spatial Frame (TSF) in the treatment of deformity and limb shortening caused by distal tibial physeal arrest and the effectiveness in maintaining alignment and stability by reconstruction of the medial malleolus and the medial collateral ligament using an autogenous iliac crest graft and attached sartorius muscle-tendon. Methods: Thirteen pediatric patients with angular deformity of the distal tibia were enrolled in this prospective study. The mean age was 8.3 yr (range, 6 to 12 yr). All patients had open fractures with skin loss. Ten patients had Salter-Harris type IV physeal fractures, while three had Salter-Harris type V physeal injury. All patients had a varus ankle deformity (range, 15 to 33 degrees) and limb shortening (range, 1.9-cm to 3.3-cm). All patients were treated by a supramalleolar osteotomy and TSF for deformity correction for limb-length equalization. The absent medial malleolus was treated by medial malleoplasty with a graft from the ipsilateral iliac crest. Results: The mean follow-up period was 30 mo. The mean preoperative shortening of the tibia in relation to the fibula was 2.6 cm (range, 1.9 cm to 3.3 cm). The length of the short tibia was restored in all patients, and correction of the ankle deformity and stability were restored with a satisfactory outcome. Conclusions: TSF is highly effective in the treatment of distal tibial deformity in pediatric patients due to traumatic physeal arrest. Reconstruction of the medial malleolus and its ligamentous attachment is crucial for ankle joint stability. Level of Evidence: Level IV.

Outcome of correction of complex femoral rotational deformities using Taylor Spatial Frame in skeletally immature patients: a retrospective case series

“…6 The use of the Taylor Spatial Frame (TSF) allows six axes of deformity correction and utilizes computer software and virtual hinges that allow accurate deformity correction. [7][8][9] Although the use of TSF is popular, there are only a few studies that have reported the results of rotational deformity correction, especially in skeletally immature patients. The aim of this study was to evaluate the effectiveness of the TSF as a primary tool in the treatment of severe rotational deformities of lower limbs that were caused by neglected malunited femoral fractures in pediatric and adolescent patients.…”

“…The correction of complex deformities with the Ilizarov frame requires a long learning curve, and correction of rotational deformities is a complex task requiring frequent modifications and adjustments of the frame during the correction process 6. The use of the Taylor Spatial Frame (TSF) allows six axes of deformity correction and utilizes computer software and virtual hinges that allow accurate deformity correction 7–9…”