Bone Transport for Large Segmental Tibial Defects Using Taylor Spatial Frame versus the Ilizarov Circular Fixator

Abstract

Objective: Bone transport has become the gold standard for treating large segmental tibial bone defects. The technique for application the Ilizarov circular fixator (ICF) has a long learning curve and is associated with many complications. There are few clinical studies on bone transport via the Taylor spatial frame (TSF). The main purpose of this study was to compare the radiological and clinical and outcomes of bone transport by using the TSF and the ICF.

Methods: There were 62 patients included in this retrospective study from June 2011 to June 2021 and distributed to two groups according to the fixation method: a TSF group consisting of 30 patients and an ICF group consisting of 32 patients. Demographic information, surgical duration, external fixation times, external fixation index, final radiographic results, complications, and clinical outcomes were recorded and examined. The clinical outcomes were assessed using the ASAMI criteria during the most recent clinical visit. Then, statistical analysis such as independent-samples t tests or chi-Square test was performed.

Results: The mean surgical duration in the TSF group was 93.8 ± 7.3 min, which was shorter than that in the ICF group (109.8 ± 1.4 min) (p < 0.05). Compared to the ICF group (10.2 ± 2.0 months), the TSF group (9.7 ± 1.8 months) had a shorter average external fixation time (p > 0.05). The external fixation index was 1.4 ± 0.2 m/cm and 1.5 ± 0.1 m/cm in the two groups. Moreover, there was no significant difference between the two groups. At the last follow-up visit, the medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) in the TSF group were 88.1 ± 12.1° and 80.9 ± 1.3°, respectively. The MPTA and PPTA in the ICF group were 84.4 ± 2.4° and 76.2 ± 1.9°, respectively. There were statistically significant differences between the two groups (all p < 0.05). The complication rate was 50% in the TSF group and 75% in the ICF group. Moreover, the ASAMI score between the two groups was no statistically significant difference (p > 0.05).

Conclusion: No statistically significant difference was found in clinical outcomes between the use of Taylor spatial frame and Ilizarov circular fixator for treating large segmental tibial bone defects. However, TSF is a shorter and simpler procedure that causes fewer complications and improves limb alignment.

Keywords

Bone defects / Bone transport / External fixators / Ilizarov technique / Tibial fractures

References

[1] Mauffrey C, Barlow BT, Smith W. Management of segmental bone defects. J Am Acad Orthop Surg. 2015; 23(3): 143–153.

[2] Summers S, Krkovic M. Bone transport with magnetic intramedullary nails in long bone defects. Eur J Orthop Surg Traumatol. 2021; 31(6): 1243–1252.

[3] Dahl MT, Morrison S. Segmental bone defects and the history of bone transport. J Orthop Trauma. 2021; 35(Suppl 4): S1–s7.

[4] Abuomira IE, Sala F, Elbatrawy Y, Lovisetti G, Alati S, Capitani D. Distraction osteogenesis for tibial nonunion with bone loss using combined Ilizarov and Taylor spatial frames versus a conventional circular frame. Strategies Trauma Limb Reconstr. 2016; 11(3): 153–159.

[5] Napora JK, Weinberg DS, Eagle BA, Kaufman BR, Sontich JK. Hexapod stacked transport for Tibial infected nonunions with bone loss: long-term functional outcomes. J Orthop Trauma. 2018; 32(1): e12–e18.

[6] Ali A, Ren Y, Zhou CH, Fang J, Qin CH. Unprecedented tibial bone lengthening of 33.5 cm by distraction osteogenesis for the reconstruction of a subtotal tibial bone defect. A case report and literature review. BMC Musculoskelet Disord. 2021; 22(1): 88.

[7] Huang Q, Ren C, Li M, Xu Y, Li Z, Lin H, et al. Antibiotic calcium sulfate-loaded hybrid transport versus traditional Ilizarov bone transport in the treatment of large tibial defects after trauma. J Orthop Surg Res. 2021; 16(1): 568.

[8] Catagni MA, Azzam W, Guerreschi F, Lovisetti L, Poli P, Khan MS, et al. Trifocal versus bifocal bone transport in treatment of long segmental tibial bone defects. Bone Jt J. 2019; 101(2): 162–169.

[9] Rozbruch SR, Pugsley JS, Fragomen AT, Ilizarov S. Repair of tibial nonunions and bone defects with the Taylor spatial frame. J Orthop Trauma. 2008; 22(2): 88–95.

[10] Millonig K, Hutchinson B. Management of Osseous Defects in the tibia: utilization of external fixation, distraction Osteogenesis, and bone transport. Clin Podiatr Med Surg. 2021; 38(1): 111–116.

[11] Feng D, Zhang Y, Jia H, Xu G, Wu W, Yang F, et al. Complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects-a retrospective study of 199 cases. BMC Musculoskelet Disord. 2023; 24(1): 864.

[12] Antoci V, Ono CM, Antoci V Jr, Raney EM. Bone lengthening in children: how to predict the complications rate and complexity? J Pediatr Orthop. 2006; 26(5): 634–640.

[13] Horn J, Steen H, Huhnstock S, Hvid I, Gunderson RB. Limb lengthening and deformity correction of congenital and acquired deformities in children using the Taylor spatial frame. Acta Orthop. 2017; 88(3): 334–340.

[14] Russell GV. In acute closed Tibial shaft fractures, surgery with the Taylor spatial frame versus reamed intramedullary nailing did not differ for quality of life or pain at 2 years. J Bone Jt Surg Am. 2021; 103(16): 1554.

[15] Sibbel J, Abdulkarim A, Fisher R, Krkovic M. Eccentric Taylor spatial frame placement for the correction of femoral fracture deformity: a novel technique. Eur J Orthop Surg Traumatol. 2020; 30(5): 869–875.

[16] Messner J, Chhina H, Davidson S, Abad J, Cooper A. Clinical outcomes in pediatric tibial lengthening and deformity correction: a comparison of the Taylor spatial frame with the Orthex hexapod system. J Child’s Orthop. 2021; 15(2): 114–121.

[17] Dabash S, Potter E, Catlett G, McGarvey W. Taylor spatial frame in treatment of Equinus deformity. Strategies Trauma Limb Reconstr. 2020; 15(1): 28–33.

[18] Giotakis N, Narayan B, Nayagam S. Distraction osteogenesis and nonunion of the docking site: is there an ideal treatment option? Injury. 2007; 38(Suppl 1): S100–S107.

[19] Henderson DJ, Rushbrook JL, Harwood PJ, Stewart TD. What are the biomechanical properties of the Taylor spatial frame™? Clin Orthop Relat Res. 2017; 475(5): 1472–1482.

[20] Rozbruch SR, Fragomen AT, Ilizarov S. Correction of tibial deformity with use of the Ilizarov-Taylor spatial frame. J Bone Jt Surg Am. 2006; 88(4): 156–174.

[21] Liu Y, Yushan M, Liu Z, Liu J, Ma C, Yusufu A. Complications of bone transport technique using the Ilizarov method in the lower extremity: a retrospective analysis of 282 consecutive cases over 10 years. BMC Musculoskelet Disord. 2020; 21(1): 354.

[22] Saw A, Chua YP, Hossain G, Sengupta S. Rates of pin site infection during distraction osteogenesis based on monthly observations: a pilot study. J Orthop Surg. 2012; 20(2): 181–184.

[23] Napora JK, Weinberg DS, Eagle BA, Kaufman BR, Sontich JK. Hexapod frame stacked transport for Tibial infected nonunions with bone loss: analysis of use of adjunctive stability. J Orthop Trauma. 2017; 31(7): 393–399.

[24] Wu Y, Yin Q, Rui Y, Sun Z, Gu S. Ilizarov technique: bone transport versus bone shortening-lengthening for tibial bone and soft-tissue defects. J Orthop Sci. 2018; 23(2): 341–345.

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.