THE ROLE OF THE TAYLOR SPATIAL FRAME IN THE MANAGEMENT OF UNSTABLE TIBIA AND FIBULA FRACTURES IN PAEDIATRIC PATIENTS

Abstract

Introduction: Treatment of high energy unstable lower leg fractures requires a fixation system that will provide skeletal stability, promote bone healing without residual deformity and allow wound care. The Taylor Spatial Frame is a device which provides excellent skeletal stability, allows immediate weight bearing and provides an opportunity for correction of residual deformity without return to the operating theatre.

Method: 9 patients (10 limbs), all male, mean age 12.6 (5.2–16.5 years old) were treated at Bristol Royal Hospital for Children for high energy tibial fractures between 2005 and 2008. There were 6 open fractures (3 fractures Gustilo IIIA and 3 IIIB) and 4 closed fractures. Of the 4 closed fractures, 3 required fasciotomies for compartment syndrome. The case notes and radiographs of all patients were retrospectively reviewed to assess outcomes.

Results: 2 patients were stabilized primarily with TSF, 1 had plaster backslab before applying TSF, 7 were treated primarily with unilateral external fixation prior to applying TSF. TSF was applied on average 7.3 days after initial injury. All fractures were reduced at the first visit to the operating theatre. In 6 cases malalignment developed and residual deformity corrections were performed via TSF programming, in 1 case frame was adjusted at the second visit to theatre to facilitate wound closure and then fracture reduced. Time of treatment with TSF was on average 107 days. Sound bone union and satisfactory wound healing was achieved in all cases. All tibiae were united without significant residual deformity or leg length discrepancy. There was one complication – muscle tethering at proximal fine wire fixation requiring adjustment of TSF with insertion of half pins.

Discussion: In this study group the results of TSF fixation were excellent. The commonest device used in this patient group is unilateral external fixation. Whilst this gives predictable results and allows good wound care there are limitations to the use of this technique. The TSF has two particular advantages that we believe make it more suitable than unilateral external fixation. The intrinsic stability of the ring structure allows immediate post-operative weight bearing and the programmable strut adjustments allow easy non-operative correction of residual deformity.