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Zhao Q, Liu Z, Sun X, Zhang N, Xu W, Zhang T. The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture. Orthop Surg 2024; 16:1344-1355. [PMID: 38664223 PMCID: PMC11144511 DOI: 10.1111/os.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVES Multi-planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. METHODS We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D-TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip-knee-ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow-up full-length X-rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow-up, Johner-Wruhs tibial fracture outcome criteria (J-W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi-square test or Fisher's exact test; the Mann-Whitney U test was used for rank data. RESULTS No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D-TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner-Wruhs criteria were used to assess the function of the affected limb, the D-TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow-up X-rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow-up compared to the angle before surgery. At the final follow-up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). CONCLUSION The D-TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture.
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Affiliation(s)
- Qi‐Jun Zhao
- Clinical College of OrthopedicsTianjin Medical UniversityTianjinChina
- Department of OrthopedicsSinopharm North HospitalBaotouChina
| | - Zhao Liu
- Department of Orthopaedics Ward OneTianjin HospitalTianjinChina
| | - Xun Sun
- Department of Orthopaedics Ward OneTianjin HospitalTianjinChina
| | - Ning‐Ning Zhang
- Department of Orthopaedics Ward OneTianjin HospitalTianjinChina
| | - Wei‐Guo Xu
- Department of Orthopaedics Ward OneTianjin HospitalTianjinChina
| | - Tao Zhang
- Department of Orthopaedics Ward OneTianjin HospitalTianjinChina
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Zhao Z, Shu H, Jia P, Chen X, Guo F, Liu Y, Shi B, Ji G, Cai C, Shen Y. Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study. BMC Surg 2024; 24:44. [PMID: 38302963 PMCID: PMC10835845 DOI: 10.1186/s12893-024-02327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND It's difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs. METHODS A total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit. RESULTS There were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05). CONCLUSION In terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.
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Affiliation(s)
- Zhiming Zhao
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Hengsheng Shu
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Peng Jia
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Xu Chen
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Feng Guo
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Yabin Liu
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Bowen Shi
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Guoqi Ji
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Chengkuo Cai
- Department of Traumatic Orthopaedics, Tianjin Hospital, No 406, South Jiefang Road, Hexi District, Tianjin, 300211, China
| | - Yidong Shen
- Department of Orthopaedics, The First People's Hospital of Yancheng (Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School), Yancheng, China.
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