Correction of Deformity Using a Taylor Spatial Frame

Some patients acquire angular deformities as a result of trauma, infection and other causes.  While 'guided growth' is used in patients with open growth plates to modulate growth and correct simple angular deformities, patients who are skeletally mature cannot receive this treatment.  These adolescent and adult patients require a formal division of the bone (also known as an 'osteotomy') and a re-angulation of the bone to properly align the limb.  

Once the bone division (osteotomy) is performed, there are multiple ways of stabilizing the bone until healing in the new position is complete.  We can use plate and screw constructs and nails, which are all-inside devices (underneath the skin) or we can use external fixators. The most common external fixator that Dr Kollias uses for correction of deformity is called a Taylor Spatial Frame.

External fixators come in many shapes and sizes. These constructs in their simplest form are made by pins or wires through skin and bone which are joined together by rings, bars and rods outside of the body. There are many advantages of using a frame to correct deformity.  It generally requires very minimal skin incisions, is friendly to the bone biology to faciliate healing,  allows for fine-tuning in alignment many days after the surgery, and does not require significant surgery to remove plate and screws.  Another major advantage of using a frame is that is allows for lengthening of the bone at the same time as achieving a correction of angular deformity. Many deformities in limbs are combinations of shortening and bowing so a frame serves well in these situations.

There are some notable disadvantages of a frame as well and thus it may not be the right choice for every patient when all factors are taken into account.  Some of the more common problems include pin site infection during the course of treatment, muscular tightness in the calf and hamstrings, amongst others.  Many patients can find a frame burdensome for personal life as it requires special care during the months that it is in place.  It also requires a second short surgery to remove the pins under anesthetic once healing is complete.  The most important part of deformity correction is the planning and principles, rather than the specific device that is used, as there are often multiple solutions.

CASE 1

The following example is a patient who had a partial growth arrest after trauma and developed a bowed left leg.  The deformity was noted close to the end of growth and guided growth was not effective in reversing the deformity as there was not enough growth left at the growth plate in the tibia.  As such, a formal osteotomy was performed, which means the bone was divided.  In this particular patient, a Taylor Spatial Frame ring fixator was used to obtain a straight leg with a normalized mechanical axis.

 Pre-operative xrays

Pre-operative xrays

 After surgery with tibia realigned and Taylor Spatial Frame in place

After surgery with tibia realigned and Taylor Spatial Frame in place

 Final xrays after frame removal   

Final xrays after frame removal