Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex

Naude, Jaco; Manjra, Muhammad Ahmed; Birkholtz, Franz; Barnard, Annette-Christy; Glatt, Vaida; Tetsworth, Kevin; Hohmann, Erik

doi:10.5005/jp-journals-10080-1443

Cited by 12 publications

(7 citation statements)

References 42 publications

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“…In principle, each bone segment should be xed with 1-2 rings. The metal ring should be xed at both ends of each bone segment (distance principle) [17]. (2) Each ring has at least 3 xed components, which can be reinforced with 2 olive wires and 1 HA-coated half wire.…”

Section: Discussionmentioning

confidence: 99%

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

Zhao,

Shu,

Jia

et al. 2023

Preprint

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Background It’s difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs. Methods A total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit. Results There were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05). Conclusion For STFs, HEF is superior to IMN in aspects of completely closed reduction, early full weight bearing, early bone union and alignment.

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Section: Discussionmentioning

confidence: 99%

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

Zhao,

Shu,

Jia

et al. 2023

Preprint

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“…The treatment duration, correction success and adverse events observed in our study indicate that utilizing the Auto Strut device with the hexapod external fixator for automatic gradual deformity correction is safe and as accurate as manually adjusted struts. 6 , 11 , 14 , 20 Manual strut adjustment is dependent on patient/patient family collaboration and is prone to errors. Errors may rise as the numbers of daily manual operations increase.…”

Section: Discussionmentioning

confidence: 99%

“… 6 , 7 , 9 , 10 It has at least two circular rings connected by six telescopic crossing struts that allow external control in six degrees of freedom. 11 It does not require construction of mechanical hinges and precise mounting of the ring fixator, and relies on the adjustment of the strut lengths. 12 The surgeon assembles the computerized correction plan via a frame software algorithm.…”

Section: Introductionmentioning

confidence: 99%

Auto Strut: A novel smart robotic system for external fixation device for bone deformity correction, a preliminary experience

Gigi

Mor

Lidor

et al. 2021

Journal of Children's Orthopaedics

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Purpose Several hexapod external fixators are used in the treatment of bone fracture and deformity corrections. One characteristic of all of them is the requirement for manual adjustment of the fixator struts. The purpose of this study was to introduce a novel robotic system that executes automatic adjustment of the struts. Methods Ten patients were treated for various bone deformities using a hexapod external fixator with the Auto Strut system. This new system automatically adjusts the fixator struts according to a hexapod computer-assisted correction plan. During each visit, the progress of the correction was assessed (clinically and radiographically) and reading of the strut scale numbers was performed and compared with the original treatment plan. Results All patients completed treatment during the follow-up period, achieving all planned correction goals, except from one patient who switched to manual struts due to personal preference. The device alarm system was activated once with no device-related adverse events. Duration of distraction ranged between ten and 90 days with a distraction index ranging between eight and 15 days/cm. Regenerate consolidation time between one and seven months. In total, 48 struts of eight patients were recorded and analyzed. In all, 94% of the final strut number readings presented a discrepancy of 0 mm to 1 mm between planned and actual readings, indicating high precision of the automatic adjustment. Conclusion This study presents preliminary results, showing that Auto Strut can successfully replace the manual strut adjustment providing important advantages that benefit the patient, the caregiver and the surgeon. Level of Evidence Level II

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“…The lack of validated patient-reported outcome measures is another weakness, which is mitigated by the assessment of patient satisfaction and the use of the ASAMI score that is used widely in the Ilizarov literature. 1,9,20,23,25,[34][35][36]40,49,60…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction

Tay

Langit²,

Fenton³

et al. 2023

Foot Ankle Int.

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Background: Circular frames for ankle fusion are reserved for complex clinical scenarios. The literature is heterogenous and conflicting. We aim to present the indications and outcomes of this procedure. Methods: A retrospective cohort study based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow-up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiologic and clinical outcomes, and adverse events. Factors influencing radiologic and clinical outcomes were analyzed. Results: 47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT. Conclusion: Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. Identified risk factors for poorer outcomes should be considered in patient counselling and prognostication. Level of Evidence: Level III, prognostic.

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Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex

Cited by 12 publications

References 42 publications

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

Auto Strut: A novel smart robotic system for external fixation device for bone deformity correction, a preliminary experience

Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction

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