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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 45 - 45
1 May 2021
Zenios M Oyadiji T Zamani-Farahani A
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Introduction. A clinical case of catastrophic ring failure in a 13 year old autistic overweight patient during treatment for tibial lengthening and deformity using a Taylor Spatial Frame is reported. Ring failure was noted during the later stages of bone healing and the frame was removed. The clinical outcome was not affected by the catastrophic ring failure. The photograph of the deformed ring is presented below:. Materials and Methods. The patient's notes and X-rays were reviewed and a macroscopic examination of the deformed ring was performed. Mechanical tests of different Taylor Spatial frame constructs were performed in an attempt to simulate the deformity that was clinically observed. Different constructs of TSF of different ring sizes were fixed to polyurethane cylinders simulating bone, were mechanically tested to failure and load/deflection curves were produced. Results. Macroscopically the ring looked otherwise normal. Gradual mechanical compression tests of Taylor Spatial frame constructs showed that ring deformation increased by increasing the ring diameter and by using jointed rather than full joints without a ring. The ring deformation observed clinically was reproduced at the lab by applying high loads on frame constructs composed of large diameter jointed rings not rigidly fixed to bone. Conclusions. Taylor Spatial frame ring failure during treatment is a serious complication that has not been described in the literature. Possible causes are discussed. Clinicians are advised to use the smaller possible diameter rings. Where large diameter rings are required, these rings should preferably be not jointed. Half rings when used should be carefully and securely joined together by the operating surgeon in order to make a complete ring. For any figures or tables, please contact the authors directly


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 44 - 44
1 May 2021
Zenios M Oyadiji T Zamini-Farahani A
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Introduction. In my paediatric Orthopaedic practice I use Kirchner wires for the fixation of the TSF on bone. I noted a significant percentage of wire loosening during the post-operative period. The aim of this project was to establish the effectiveness of the wire clamping mechanism and find ways to reduce the incidence of wire loosening when using the TSF. Materials and Methods. In the first instance wire slippage was measured intra-operatively after the tensioner was removed using an intra-operative professional camera. Following this study mechanical tests were performed in the lab measuring the pull out properties of Kirchner wires using different bolts and different torque levels in order to tighten the wire on the fixator. Results. Our clinical study confirmed wire slippage intra-operatively immediately after the tensioner was removed. Wire slippage after the tensioner was removed was found to vary from 0.01 mm to 0.51 mm (mean 0.19 mm). Our mechanical tests showed that the ideal torque for tightening the wire on the frame using a bolt was around 15 N.m. A comparison between cannulated and slotted bolts suggested that cannulated bolts are more effective as a clamping mechanism. A comparison between aluminium made Taylor Spatial frame rings and stainless steel made Ilizarov rings suggested that the Taylor Spatial frame rings are more effective as part of a clamping mechanism. Conclusions. It is important that clinicians routinely measure the torque they use to clamp wires on circular external fixators. Clinicians and manufacturers are informed that the type of bolt used is important in maintaining wire tension. Manufacturers should design the ideal bolt which effectively grips the wire without the risk of fracture. The Ilizarov frame clamping mechanism can be effectively used with the Taylor Spatial frame


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_13 | Pages 28 - 28
1 Sep 2014
Botha A Du Toit J
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Purpose of study. The primary treatment of congenital talipes equinus varus with the Ponsetti method remains the gold standard of treatment. Relapsed, neglected and/or teratogenic clubfeet pose a significant treatment challenge as the long term outcome of posteromedial release surgery is poor. Advances in circular fixation offer predictable deformity correction without the need for extensive soft tissue release. The Taylor Spatial Frame utilizes the correction principles of the “Ponsetti Method”, but little literature exists describing the correction of relapsed clubfeet with these fixators. This study assesses the outcome of relapsed clubfeet treated with the Taylor Spatial Frame Circular fixator. Methods. Ethics approval was obtained for a prospective descriptive study (N10-10-338). Patients with clubfeet who met inclusion criteria were treated with a Taylor Spatial Frame. The International Clubfoot Study Group Score was used to assess the feet preoperatively and six months postoperative. This scoring system scores the morphology, functionality and radiographic parameters of the clubfoot. Quality of life was assessed by means of the Child Health Questionnaire. Results. Ten feet (6 bilateral, 4 unilateral) were included in the study. Seven male and three female patients with average age of 6 years (range 3 – 13 years, sd ±4) qualified for the study. Feet were scored using the International Clubfoot Study Group Score. All feet scored poor preoperatively (average score 37±6). Postoperatively two feet scored excellent, seven good and one fair (Average score 9±4). This was statistically significant, p=0.00000. Two patients required additional surgical procedures for residual deformity. Five patients had superficial pin tract infection and one tibia fracture occurred. Conclusion. Treatment of relapsed clubfeet with the Taylor Spatial Frame gives a predictable correction of deformities without the need for extensive soft tissue and bony procedures. TSF assisted clubfoot correction constitute a useful salvage treatment modality. NO DISCLOSURES


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_2 | Pages 6 - 6
1 Jan 2013
Rudge B Jennings R Calder P
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Introduction. Lower limb mal-alignment as a result of fracture malunion can result in knee degenerative arthritis or predispose to early arthroplasty failure due to the altered mechanical axis. The choice of corrective osteotomy is often determined by potential complications. Opening wedge osteotomy is associated with poor bone healing especially in adult diaphyseal bone. Distraction osteogenesis enables gradual deformity correction with the gap filled by regenerate bone. Bone formation however is formed less favourably in the diaphysis and metaphyseal osteotomy is advised. We present a consecutive series of adult tibial diaphyseal correction using the Taylor Spatial Frame utilising the method of distraction osteogenesis. Method. 15 adults, 11 male and 3 female, underwent tibial deformity correction. A mid diaphyseal osteotomy was made using minimal soft tissue dissection and an osteotome. The site was determined by the centre of rotation of angulation (CORA). After a 6 day latency period distraction was undertaken by the Taylor Spatial Frame. Patients were encouraged to fully weight bear throughout the treatment process. Following regenerate consolidation the frame was removed and a below knee weight bearing cast applied for 4 weeks. Result. A mean correction of 11 degrees (4∼19) was undertaken. Correction time was a mean 13.5 days (6∼22). All osteotomies consolidated and frame removal was after a mean 136 days (92–192). All patients had at least one superficial pin site infection which responded to oral antibiotics. There were no deep infections or significant complications. Conclusion. Deformity correction at the CORA produces realignment without translation. The Taylor Spatial Frame allows accurate virtual hinge placement and stable correction of adult bone. Concern over diaphyseal osteotomy in adult bone has been previously raised but our study confirms that tibial diaphyseal correction using distraction osteogenesis is successful with minimal morbidity and rapid return to function. We believe that this should be considered as the optimal technique when undertaking tibial diaphyseal deformity correction


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 3 - 3
1 May 2021
Lahoti O Abhishetty N Shetty S
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Introduction. Charcot Arthropathy related foot and ankle deformities are a serious challenge. Surgical treatment of these deformities is now well established. The traditional surgical method of extensive surgical exposure, excision of bone, acute correction and internal fixation is not always appropriate in presence of active ulceration, deep infection and poor bone quality. Minimally invasive osteotomies and gradual correction of deformities with a circular frame are proving helpful in minimizing complications. We present our experience with the use of Taylor Spatial Frame (TSF) in 10 patients with recurrent ulceration and deformity. Materials and Methods. Our indication for the treatment with TSF is recurrent or intractable ulceration with or without active bone infection or a history of infection in a deformed foot and/or ankle. There are 2 female and 8 male patients in this cohort. We used a long bone module for ankle and hindfoot deformities (3 patients) and a forefoot 6×6 butt frame (7 patients) for midfoot deformities. An osteotomy through midfoot was performed in all chronic stable midfoot deformity cases and a calcaneal osteotomy and gradual correction through ankle in when hindfoot and ankle deformities co-existed. Results. Our outcome measures are a complete healing of ulcer and infection without recurrence, clinically plantigrade foot and ability to wear regular shoes or diabetic footwear. We achieved this outcome in 9 out of 10 patients. Successful patients remain ulcer free at minimum 7 and maximum 14 years follow up. Complications included eight episodes of pin infection that responded to oral antibiotics only and two pin breakages. Conclusions. Our results confirm that Taylor Spatial Frame treatment is a good alternative to traditional surgery in high-risk complex Charcot neuroarthropathy foot and ankle deformities


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 23 - 23
1 Feb 2013
Lahoti O Willmott H Abhishetty N
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Purpose of the study. To assess use of Taylor Spatial Frame to correct posttraumatic equinus contracture of ankle by soft tissue distraction. Description of a successful technique. Methods and end results. We have treated five cases of severe and resistant equinus contracture (20–30 degrees) between 2005 and 2010. All cases resulted from severe soft tissue injury and compartment syndrome of affected limb. They had undergone prolonged treatment for open fracture of tibia prior to referral to our institute and failed to respond to at least six months of aggressive physiotherapy. In all cases fractures did not involve ankle articular surface and all tibial fractures had united. Three out five cases also had associated peroneal nerve palsy. Our procedure included Tendo Achilles Lengthening, ankle and subtalar capsulotomy and application of two-ring Taylor Spatial Frame. We used long bone module to correct the deformity gradually. All deformities were over corrected by 5–10% to prevent recurrence. We successfully corrected equinus deformity in all cases. Follow up ranged from three months to five years and we found no recurrence. Patients with peroneal palsy were provided with Ankle Foot Orthosis (AFO). Conclusion. Taylor Spatial Frame treatment provides a safe, finely controllable, accurate and reproducible method of correcting soft tissue equinus deformity


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 2 - 2
1 May 2021
Tofighi M Somerville C Lahoti O
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Introduction. Open fractures are fortunately rare but pose an even greater challenge due to poor soft tissues, in addition to poor bone quality. Co-morbidities and pre-existing medical conditions, in particular, peripheral vascular diseases make them often unsuitable for free flaps. We present our experience in treating severe open fractures of tibia with Acute Intentional Deformation (AID) to close the soft tissues followed by gradual correction of deformity to achieve anatomical alignment of the tibia and fracture healing with Taylor Spatial Frame. Materials and Methods. We treated 4 geriatric (3 female and 1 male) patients with Gustillo-Anderson III B fractures of the tibia between 2017–18. All were unfit to undergo orthoplastic procedures (free flap or local flaps). The age range is 69 yrs to 92 years. Co-morbidities included severe rheumatoid arthritis, multiple sclerosis and heart failure. The procedure involved wound debridement, application of two ring Taylor Spatial Frame, acute deformation of the limb on the table to achieve soft-tissue closure/approximation. Regular neurovascular assessments were performed in the immediate post-operative period to monitor for compartment syndrome and nerve compression symptoms. After 7–10 days of latent period, the frame was gradually manipulated, according to a method we had previously published, to achieve anatomical alignment. The frame was removed in clinic after fracture healing. Results. Time in frame ranged from 1.5 months to 7 months. In one patient (92 yr old with an open fracture of the ankle) hindfoot nail was inserted after soft-tissue closure was achieved at 1.5 months, and frame removed. We achieved complete healing of soft tissue wounds without any input from plastic surgeons in all patients. All fractures healed in anatomical alignment. 3 patients had one episode of superficial pin infection each requiring 5 days of oral antibiotics. None of the patients developed a deep infection. Conclusions. Acute intentional deformation (AID) with Taylor Spatial Frame achieves good closure of soft tissues in physiologically compromised geriatric patients who were deemed unfit for plastic surgery. We also achieved fracture healing in all four cases without any major complications


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 96 - 96
1 May 2012
T. Y A. M S. M F. M J. L R. A M. J
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We present our experience of lower limb reconstruction for patients with obvious defects in the tibia, by bone transport using a stacked Taylor Spatial Frame. A retrospective review of 40 patients treated between 2003 and 2009. There were 19 cases of infected non union, 9 cases of acute bone loss following fracture, 6 cases of chronic osteomyelitis, 4 cases of aseptic non union, 1 case of neurofibromatosis and 1 case of a loose and infected total ankle replacement. Twenty-eight out of the 40 patients reviewed have completed their treatment. Of these 28 patients, bony union was achieved in 23 patients, of whom 22 were assessed at discharge to have regained good to excellent limb function, a functional assessment was not available for review in the remaining patient. In 5 patients, docking site union failed, 3 of whom then underwent below knee amputation. Two patients required treatment with an intramedullary nail following frame treatment to achieve consolidated union of the docking site. Anatomic sagittal and coronal alignment was achieved in 19 out of 23 patients. The mean bone regenerate was 53.3 mm (range: 15-180mm), with a mean healing index of 9.2 days/mm (range: 4.4-25 days/mm). The majority of patients experienced at least one complication, these included pin site and soft tissue infections, refracture, nerve palsy and joint stiffness. Surgical stimulation of the docking site was required in 12 of the 28 patients to promote union. The use of a stacked Taylor Spatial Frame system is effective for restoring bone length and limb function in patients with bone loss following complex trauma and orthopaedic cases. The computer assisted nature of the spatial frame allows for predictable bone regenerate, minimal residual deformity and accurate bone docking


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_5 | Pages 22 - 22
1 Apr 2022
France J Tucker A Norrish A Taylor A Ollivere B
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Introduction. The use of the Taylor Spatial Frame (TSF) in the management of tibial fractures and deformity correction is well established in the literature, however the majority of published papers are small in patient number. The aim of the project was to evaluate clinical and radiographic outcomes of patients with tibial fractures treated with a TSF. Materials and Methods. A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, frame construct, time duration in frame, union rates and complications of treatment. Results. In total, 111 tibial fractures managed with a TSF between 2009 and 2020 were reviewed. 55 were open fractures and 56 were closed. Overall union rate was 93.5%. Average time spent in the frame was 27.9 weeks. Complications included 4.6% deep infection rate, 3.7% of patients required component exchange and 8.3% required frame adjustment in theatre. Conclusions. The TSF is an effective way of managing tibial fractures. Our data has found high union rates when used in the management of both closed and open injuries with a low complication rate. Further data collection and analysis will help to aid the patient experience and clinical practice


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXI | Pages 100 - 100
1 May 2012
T. Y A. M S. M F. M J.A. L R.M. A M. J
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Introduction. We present our experience of lower limb reconstruction for patients with obvious defects in the tibia, by bone transport using a stacked Taylor Spatial Frame. Methods. A retrospective review of 40 patients treated between 2003 and 2009. There were 19 cases of infected non union, 9 cases of acute bone loss following fracture, 6 cases of chronic osteomyelitis, 4 cases of aseptic non union, 1 case of neurofibromatosis and 1 case of a loose and infected total ankle replacement. Results. 28 out of the 40 patients reviewed have completed their treatment. Of these 28 patients, bony union was achieved in 23 patients, of whom 22 were assessed at discharge to have regained good to excellent limb function; a functional assessment was not available for review in the remaining patient. In 5 patients docking site union failed, 3 of whom then underwent below-knee amputation. Two patients required treatment with an intramedullary nail following frame treatment to achieve consolidated union of the docking site. Anatomic sagittal and coronal alignment was achieved in 19 out of 23 patients. The mean bone regenerate was 53.3 mm (range: 15-180mm), with a mean healing index of 9.2 days/mm (range: 4.4-25 days/mm). The majority of patients experienced at least one complication; these included pin site and soft tissue infections, refracture, nerve palsy and joint stiffness. Surgical stimulation of the docking site was required in 12 of the 28 patients to promote union. Conclusion. The use of a stacked Taylor Spatial Frame system is effective for restoring bone length and limb function in patients with bone loss following complex trauma and orthopaedic cases. The computer assisted nature of the spatial frame allows for predictable bone regenerate, minimal residual deformity and accurate bone docking


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_20 | Pages 10 - 10
1 Apr 2013
Lahoti O Findlay I Abhishetty N
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Purpose of the study. To use a simple way of manipulating Taylor Spatial Frame to achieve soft tissue closure by acute intentional deformation and then gradually achieving anatomical alignment of the fracture without complex deformity and frame parameters. Methods and end results. 10 consecutive cases of Gustillo III B open fractures of tibia and of soft tissue defect due to infected implant were treated with a new technique of acute intentional deformation using Taylor Spatial frame to successfully close the soft tissue defect without plastic surgery. We describe a new simple technique of achieving anatomical alignment of the fracture after creating complex deformity to close the soft tissue defect. We achieved complete full thickness cover of the exposed bone in all cases without plastic surgery and restored the bone to anatomical alignment. Only one patient needed additional Taylor Spatial Frame total residual prescription to correct minor residual deformity. Conclusion. We describe a simple way of using Taylor Spatial Frame (TSF) for acute deformation of Gustilo IIIB tibial fractures and other tibial defects in order to close soft tissue defects and gradual correction to the anatomical alignment. We have used the Direct Scheduler Utility module of the web-based software for Taylor Spatial Frames (TSF) to successfully restore the anatomical alignment


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 17 - 17
1 Feb 2013
Asghar M Madan S Maheshwari R Munoruth A
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Introduction. Taylor Spatial Frame (TSF) has been designed to treat complex tibial, foot and ankle deformities using computer software. We have performed various osteotomies in combination with different soft tissue procedures, with the use of TSF. Material and Methods. A retrospective study of 20 consecutive patients operated by, senior author SSM, from 2004 onwards who underwent surgical correction of tibia, ankle, midfoot and hind foot including lateral column lengthening, calcaneal and midfoot osteotomies. Demographic details, diagnosis, procedures (including previous operations), length of follow-up, outcome and complications were recorded. Of the 20 patients, 13 were men and 7 women. The mean age was 39 years (range 18 to 70). 5 patients had TSF for malunion or non-union of ankle fractures, malunion of tibia (5), congenital talipes equino-varus(3), acute fracture of ankle (2), one patient each for spina bifida, Poliomyelitis, Charcot-Marie-Tooth disease, equino-varus due to periventricular leuco-encephalopathy and avascular necrosis of the talus. Bilateral TSF for torsional malalignment of tibia (1). Results. Follow up 6 to 54 months (mean 19.4). Patient based foot and ankle outcome criteria were used. Of the 20 patients, 16 had no pain and satisfactory range of movement and function at the last follow up. Post-operative complications included pin site infection(2) and frame hardware malfunction (2)patients, residual deformity requiring surgical correction at 22 months, (1) delayed union, neuropathic pain in (1), residual equinus deformity requiring Botox injections(1) and osteomyelitis requiring debridement(1). Conclusion. We present this series of complex congenital and acquired conditions of the foot and ankle treated with corrective osteotomies and Taylor Spatial Frame with good results


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 16 - 16
1 Feb 2013
Lahoti O Findlay I Abhishetty N
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Purpose of the study. To use a simple way of manipulating Taylor Spatial Frame to achieve soft tissue closure by acute intentional deformation and then gradually achieving anatomical alignment of the fracture without complex deformity and frame parameters. Methods and end results. 10 consecutive cases of Gustillo III B open fractures of tibia and of soft tissue defect due to infected implant were treated with a new technique of acute intentional deformation using Taylor Spatial frame to successfully close the soft tissue defect without plastic surgery. We describe a new simple technique of achieving anatomical alignment of the fracture after creating complex deformity to close the soft tissue defect. We achieved complete full thickness cover of the exposed bone in all cases without plastic surgery and restored the bone to anatomical alignment. Only one patient needed additional Taylor Spatial Frame total residual prescription to correct minor residual deformity. Conclusion. We describe a simple way of using Taylor Spatial Frame (TSF) for acute deformation of Gustillo IIIB tibial fractures and other tibial defects in order to close soft tissue defects and gradual correction to the anatomical alignment. We have used the Direct Scheduler Utility module of the web-based software for Taylor Spatial Frames (TSF) to successfully restore the anatomical alignment


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_6 | Pages 7 - 7
1 May 2021
Hogg J Madan S
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Introduction. Torsional malalignment syndrome (TMS) is a unique combination of rotational deformities in the lower limb, often leading to severe patellofemoral joint pain and disability. Surgical management of this condition usually consists of two osteotomies in each affected limb, with simultaneous correction of both femoral anteversion and external tibial torsion. However, we believe that a single supratubercular osteotomy followed by tibial derotation with the Taylor Spatial Frame (TSF) can be used to provide a significant improvement in both appearance and function. Materials and Methods. This is a retrospective case analysis in which we will be reviewing 16 osteotomies performed by one surgeon between 2006 and 2017. The study includes 11 patients with a mean age of 16.7 ± 0.8 years. Pre and post-operatively, patients were fully evaluated through history and physical examination, and CT rotational profiling. Statistical analyses were performed in order to determine whether or not any observed clinical or cosmetic improvements were statistically significant. Results. The results show significant improvements in scores reported on post-operative functional assessment, with mean Oxford Knee Score (OKS) increasing by 18.3 and mean Kujala Anterior Knee Pain Scale (AKPS) also increasing by 31.4. In addition to this, post-operative clinical assessment showed a reduced thigh-foot angle (TFA) in all cases, by a mean value of 31.9o. The angle of the transmalleolar axis (TMA) was successfully reduced in 14/16 cases, by a mean value of 8.6o. Statistical analysis showed all of these results to be statistically significant where p<0.05. Conclusions. The results show that supratubercular osteotomy, followed by gradual correction with TSF, can be used to provide a significant improvement in both appearance and function for patients suffering from TMS


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 18 - 18
1 Feb 2013
Menakaya C Hadland Y Barron E Sharma H
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Introduction. The optimal treatment of high-energy tibia fractures remains controversial. The role of external fixators has been shown to be crucial. This study aimed to compare the effectiveness of using either Taylor Spatial Frame (TSF) or Ilizarov frames in treatment of high-energy tibia fractures in a tertiary trauma referral centre. Methodology. Retrospective review of consecutive series identified two treatment groups; Group 1(TSF) and Group 2 (Ilizarov). Time in frame (healing time) was defined as time from insertion to removal of frame. All patients with incomplete data secondary to loss to follow-up or death were eliminated. Results. Data was available for 112 patients (Group 1 N37 and Group 2 N85) with average ages for of 46.43 and 44.64 years respectively and a male to female ratio of 23:14 and 63:22. 7 open tibial fractures and 24 distal tibia fractures were treated in Group 1 with 18 open tibia fractures and 24 pilon fractures in Group 2. Average healing time was 174.35 (124–340) and 176.41 (102–555) days respectively. Smoker's average healing time was 181.86 and 213.86 days per group. Non-smokers average healing time was 161.86 and 174 days for the two groups. N5 and N26 patients were recorded as high-energy injuries with associated other multiple fractures or visceral injuries with average frame times of 192.2 and 194.69 days respectively. All fractures went to union with only one infection in the Ilizarov group. Conclusion. Smoking and associated high-energy injuries lead to an increase in healing time for both groups. Despite the rigid nature of TSF, healing time is similar to Ilizarov frame


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_23 | Pages 30 - 30
1 May 2013
Hughes AM Raymond A Gillooly J Parry M Livingstone JA
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We would like to present this service evaluation of Taylor Spatial Frame use within a busy limb reconstruction unit. We present a cohort of 60 patients representing a year of work from January 2011 to January 2012 with a breakdown of coding data. Included are details of operative episodes, length of stay, outpatient follow up including software programming episodes, strut changes and general frame care from our specialist nurses. We have produced a comparison of cost to HRG coding tarifs with an audit of coding errors and cost implications of these corrections. Also included is a breakdown of comparison data from patients undergoing frame assisted deformity correction and internal fixation, Computer Hexapod Assisted Orthopaedic Surgery. Exact and careful coding of these procedures is required considering their relatively high cost


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 11 - 11
1 Feb 2013
Henderson D Hadland Y Barron E Sharma H
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Abstract. We present here the results of a prospective follow-up study of radiological and functional outcome in 43 patients treated using the Taylor Spatial Frame (TSF) for definitive management of tibial fractures. Patients & Methods. Over a five-year period data was collected from all patients completing treatment of a tibial fracture with the TSF. Residual deformity on x-ray and functional outcomes using the EQ-5D health status questionnaire, Iowa Knee and Ankle-Evaluation Rating System scores and Olerud & Molander Ankle Score (OMAS) were recorded one year following completion of frame treatment. Results. No residual deformity greater than 10° was seen on AP or lateral radiographs and EQ-5D outcomes showed no statistically significant difference to data representative of the UK population as a whole. “Good” or “excellent” outcome scores were recorded in 92.9% of our cohort on Iowa Knee scoring and in 79% on Ankle-Evaluation Rating System scoring (Mean scores 92 and 86.5). 93% of OMAS scores showed “good” or “excellent” outcomes (mean score 85). These results demonstrate good return of isolated knee and ankle function within one year of completion of frame treatment but also, more significantly, a complete return to normal day-to-day “health status” as compared to the population at large. Conclusion. As a result we conclude that in tibial fractures suited to treatment with a circular external fixator, use of the TSF has a number of technical advantages while producing good functional and radiological outcomes and an overall return of pre-injury “health status” levels


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_2 | Pages 8 - 8
1 Jan 2013
Jenkins P Bulkeley M Mackenzie S Simpson H
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Introduction. The Taylor Spatial Frame (TSF) is an hexapod external ring fixation system that can move with six degrees of freedom to correct complex limb deformities. The lengths of the struts between the rings are independently adjusted to correct the deformity. The struts form an acute and obtuse “ring-strut” angle with the ring with the sum of these angles totalling 180°. In the course of a correction schedule a strut may need to be exchanged for one of longer or shorter length. The manufacturer's instructions direct that a temporary seventh strut can be placed in any orientation to ensure stability during the exchange. We have noted several episodes of temporary frame instability during this procedure resulting in discomfort. The aim of this study was to investigate which temporary strut positions gave maximal stability. Methods. A TSF frame was constructed in a neutral alignment with a neutral strut height of 130mm. Strut 1 (red) was identified for exchange. There were 169 theoretical placement options for the temporary strut that were sequentially tested. Fast-FX™ struts were used. Strut 1 was released and the shortening that occurred was recorded using the strut length gauge. Shortening of over 10mm was considered grossly unstable. Results. There were 21 stable configurations and 11 unstable configurations. There were 68 mechanically impossible positions. The most important factors for frame stability were the avoidance of temporary strut crossing the strut being exchanged, and matching acute/obtuse “ring-strut” angle orientation of the temporary strut. Conclusions. This study identifies a positioning rule that ensures maximum stability of a neutral frame during strut changes. It further identifies grossly unstable positions that may result in pain during a change


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 6 - 6
1 Feb 2013
Chaturvedi A Hadland Y Sharma H
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Introduction

The Ilizarov (IF) and Taylor Spatial (TSF) external fixator frames are commonly used to manage complex fractures and bone deformities and a dedicated Frame Service Team at our unit supports patients during pre- and post-operative period. Few studies have assessed the satisfaction of patients who have been treated with Circular frames.

Methods

A questionnaire was designed and distributed to 56 consecutive patients treated with a circular frame. Data was collected prospectively. Questions were focused on information given pre op, during treatment, overall satisfaction with the frame, morbidity and areas in which the frame service could be improved.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 8 - 8
1 Feb 2013
Lahoti O Ahmed S Rashid A
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Purpose of the study

We conducted a study to assess the accuracy of Spatial CAD software in computing the mounting and deformity parameters.

Methods and end results

We mounted a two-ring construct on a sawbone tibia and accurately measured the mounting parameters of this frame. Then we obtained three sets of x-rays – orthogonal without magnification marker, orthogonal with magnification marker placed at the level of the bone and non orthogonal views – and put these images through software and obtained mounting and deformity parameters.

Results were independently assessed and we found that the Spatial CAD™ software was accurate within 1 mm and 1 degree when orthogonal images with marker sphere placed at the bone level were used. Non-orthogonal images, with marker sphere, yielded accurate axial frame offset but other mounting parameters were at least 6 mm more than the actual measurements. Understandably angular measurements were different. In the third set of films we used frame hardware – Rancho Cube width (12 mm) as a calibrator. Since the cube was not in the same plane as the bone all measurements were way off actual measurements.