Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIAO Shaofeng ^1,2 ,  QIN Sihe ¹ , WANG Zhenjun ^1,3 , GUO Yue ^1,3 , XU Hongsheng ^1,2 , LIU Zhijie ^1,2 , CHEN Jianwen ⁴

1. The First Department of Orthopedics, Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, P. R. China;
2. Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Beijing, 100176, P. R. China;
3. Key Laboratory of Intelligent Control and Rehabilitation Technology of the Ministry of Civil Affiairs, Beijing, 100176, P. R. China;
4. Department of Reconstructing Orthopedics, the Affiliated Hospital, Southern University of Science and Technology, Shenzhen Guangdong, 518000, P. R. China;

Corresponding author：

QIN Sihe, Email: qinsihe@163.com

Keywords：

Tibial multiplanar deformities; tibial biplanar osteotomy; Taylor external fixator; orthopaedic reconstruction

DOI：

10.7507/1002-1892.202303121

Video：

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Objective To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. Methods Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. Results Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference (P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant (P<0.05). The score of lower limb deformity was significantly higher than that before operation (P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. Conclusion Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.

Citation： JIAO Shaofeng, QIN Sihe, WANG Zhenjun, GUO Yue, XU Hongsheng, LIU Zhijie, CHEN Jianwen. Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(7): 839-845. doi: 10.7507/1002-1892.202303121 Copy

1.	Al Kaissi A, Farr S, Ganger R, et al. Windswept lower limb deformities in patients with hypophosphataemic rickets. Swiss Med Wkly, 2013, 143: w13904. doi: 10.4414/smw.2013.13904.
2.	Gizard A, Rothenbuhler A, Pejin Z, et al. Outcomes of orthopedic surgery in a cohort of 49 patients with X-linked hypophosphatemic rickets (XLHR). Endocr Connect, 2017, 6(8): 566-573.
3.	Wirth T. The orthopaedic management of long bone deformities in genetically and acquired generalized bone weakening conditions. J Child Orthop, 2019, 13(1): 12-21.
4.	Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev, 2017, 9: 51-61.
5.	Hughes A, Parry M, Heidari N, et al. Computer hexapod-assisted orthopaedic surgery for the correction of tibial deformities. J Orthop Trauma, 2016, 30(7): e256-e261.
6.	Koren L, Keren Y, Eidelman M. Multiplanar deformities correction using Taylor spatial frame in skeletally immature patients. Open Orthop J, 2016, 10: 71-79.
7.	陈建文, 颜景涛, 郭悦. 计算机辅助外固定支架在复杂胫腓骨畸形截骨矫正术中的应用. 中华创伤骨科杂志, 2015, 17(7): 589-593.
8.	佩利. 矫形外科原则. 北京: 中国医药科技出版社, 2006: 8-17.
9.	舒衡生, 马宝通, 王宏川, 等. Taylor空间支架矫正创伤后膝内、外翻畸形. 中华骨科杂志, 2012, 32(3): 205-210.
10.	Mare PH, Marais LC. Gradual deformity correction with a computer-assisted hexapod external fixator in Blount’s Disease. Strategies Trauma Limb Reconstr, 2022, 17(1): 32-37.
11.	Rozbruch SR, Segal K, Ilizarov S, et al. Does the Taylor Spatial Frame accurately correct tibial deformities? Clin Orthop Relat Res, 2010, 468(5): 1352-1361.
12.	Tsibidakis H, Panou A, Angoules A, et al. The role of Taylor spatial frame in the treatment of Blount Disease. Folia Med (Plovdiv), 2018, 60(2): 208-215.
13.	Duan D, Cao Y, Li R, et al. Opening wedge high tibial osteotomy with combined use of patient-specific 3D-printed plates and Taylor spatial frame for the treatment of knee osteoarthritis. Pain Res Manag, 2021, 2021: 8609921. doi: 10.1155/2021/8609921.
14.	焦绍锋, 秦泗河, 王振军, 等. Ilizarov技术治疗四肢畸形并发症分析. 中华骨科杂志, 2012, 32(3): 245-248.
15.	Meselhy MA. Management of adolescent tibia vara using Taylor spatial frame. Acta Orthop Belg, 2016, 82(4): 745-753.
16.	Lotzien S, Rosteius T, Jettkant B, et al. Locking the Taylor spatial frame-The effect of three additional longitudinal rods on osteotomy site movements. Clin Biomech (Bristol, Avon), 2022, 100: 105820. doi: 10.1016/j.clinbiomech.2022.105820.
17.	Hamada T, Matsubara H, Yoshida Y, et al. Comparison of treatment indices associated with the correction and lengthening of deformities along various lower limb frontal plane directions. J Clin Orthop Trauma, 2019, 10(Suppl 1): S57-S61.
18.	Basha K, Alawadhi A, Alyammahi M, et al. Comparison of three circular frames in lower limb deformity correction: a biomechanical study. Cureus, 2022, 14(5): e25271. doi: 10.7759/cureus.25271.
19.	Tucker A, Norrish AR, Fendius S, et al. Definitive Taylor Spatial Frame management for the treatment of high-energy open tibial fractures: Clinical and patient-reported outcomes. Injury, 2022, 53(12): 4104-4113.
20.	Hogg J, Hampton M, Madan S. Supra tubercular tibial osteotomy and gradual correction with Taylor spatial frame for the management of Torsional malalignment syndrome-surgical technique and outcomes. Knee, 2023, 40: 8-15.
21.	Messner J, Chhina H, Davidson S, et al. Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System. J Child Orthop, 2021, 15(2): 114-121.

1. Al Kaissi A, Farr S, Ganger R, et al. Windswept lower limb deformities in patients with hypophosphataemic rickets. Swiss Med Wkly, 2013, 143: w13904. doi: 10.4414/smw.2013.13904.
2. Gizard A, Rothenbuhler A, Pejin Z, et al. Outcomes of orthopedic surgery in a cohort of 49 patients with X-linked hypophosphatemic rickets (XLHR). Endocr Connect, 2017, 6(8): 566-573.
3. Wirth T. The orthopaedic management of long bone deformities in genetically and acquired generalized bone weakening conditions. J Child Orthop, 2019, 13(1): 12-21.
4. Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev, 2017, 9: 51-61.
5. Hughes A, Parry M, Heidari N, et al. Computer hexapod-assisted orthopaedic surgery for the correction of tibial deformities. J Orthop Trauma, 2016, 30(7): e256-e261.
6. Koren L, Keren Y, Eidelman M. Multiplanar deformities correction using Taylor spatial frame in skeletally immature patients. Open Orthop J, 2016, 10: 71-79.
7. 陈建文, 颜景涛, 郭悦. 计算机辅助外固定支架在复杂胫腓骨畸形截骨矫正术中的应用. 中华创伤骨科杂志, 2015, 17(7): 589-593.
8. 佩利. 矫形外科原则. 北京: 中国医药科技出版社, 2006: 8-17.
9. 舒衡生, 马宝通, 王宏川, 等. Taylor空间支架矫正创伤后膝内、外翻畸形. 中华骨科杂志, 2012, 32(3): 205-210.
10. Mare PH, Marais LC. Gradual deformity correction with a computer-assisted hexapod external fixator in Blount’s Disease. Strategies Trauma Limb Reconstr, 2022, 17(1): 32-37.
11. Rozbruch SR, Segal K, Ilizarov S, et al. Does the Taylor Spatial Frame accurately correct tibial deformities? Clin Orthop Relat Res, 2010, 468(5): 1352-1361.
12. Tsibidakis H, Panou A, Angoules A, et al. The role of Taylor spatial frame in the treatment of Blount Disease. Folia Med (Plovdiv), 2018, 60(2): 208-215.
13. Duan D, Cao Y, Li R, et al. Opening wedge high tibial osteotomy with combined use of patient-specific 3D-printed plates and Taylor spatial frame for the treatment of knee osteoarthritis. Pain Res Manag, 2021, 2021: 8609921. doi: 10.1155/2021/8609921.
14. 焦绍锋, 秦泗河, 王振军, 等. Ilizarov技术治疗四肢畸形并发症分析. 中华骨科杂志, 2012, 32(3): 245-248.
15. Meselhy MA. Management of adolescent tibia vara using Taylor spatial frame. Acta Orthop Belg, 2016, 82(4): 745-753.
16. Lotzien S, Rosteius T, Jettkant B, et al. Locking the Taylor spatial frame-The effect of three additional longitudinal rods on osteotomy site movements. Clin Biomech (Bristol, Avon), 2022, 100: 105820. doi: 10.1016/j.clinbiomech.2022.105820.
17. Hamada T, Matsubara H, Yoshida Y, et al. Comparison of treatment indices associated with the correction and lengthening of deformities along various lower limb frontal plane directions. J Clin Orthop Trauma, 2019, 10(Suppl 1): S57-S61.
18. Basha K, Alawadhi A, Alyammahi M, et al. Comparison of three circular frames in lower limb deformity correction: a biomechanical study. Cureus, 2022, 14(5): e25271. doi: 10.7759/cureus.25271.
19. Tucker A, Norrish AR, Fendius S, et al. Definitive Taylor Spatial Frame management for the treatment of high-energy open tibial fractures: Clinical and patient-reported outcomes. Injury, 2022, 53(12): 4104-4113.
20. Hogg J, Hampton M, Madan S. Supra tubercular tibial osteotomy and gradual correction with Taylor spatial frame for the management of Torsional malalignment syndrome-surgical technique and outcomes. Knee, 2023, 40: 8-15.
21. Messner J, Chhina H, Davidson S, et al. Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor Spatial Frame with the Orthex Hexapod System. J Child Orthop, 2021, 15(2): 114-121.

Chinese Journal of Reparative and Reconstructive Surgery

Correction of tibial multiplanar deformities using single Taylor external fixator combined with biplanar osteotomy

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