The management of the neglected congenital foot deformity in the older child with the Taylor spatial frame

Complex rigid foot deformity correction with hexapod external fixator system

PURPOSE

Complex rigid foot deformities include three-plane deformities and usually presents with poor soft tissue coverage. In the last decades, gradual correction with computer-assisted fixator became an appropriate option for the treatment rigid foot deformities. This study aims to report our experience about treatment of complex foot deformities using Smart Correction fixator system®.

METHODS

We retrospectively analyzed 13 complex rigid foot deformities of ten consecutive patients treated with Smart Correction fixator system® from 2016 to 2020. Primary outcomes were classified as good, fair, and poor according to previously determined criteria. The outcomes were also assessed with The Manchester-Oxford Foot Questionnaire (MOXFQ). Non-parametric analysis (Wilcoxon test) for continuous variables and the Fisher's exact test for categorical variables were used.

RESULTS

Plantigrade foot was achieved in all patients after correction program. Supramalleolar osteotomy was applied in nine feet, midfoot osteotomy was applied in two feet, hindfoot osteotomy was required in one foot, and only soft tissue distraction performed in two feet. Two patients had recurrent deformity managed by further acute corrections. The mean MOXFQ scores improved from 72.7 preoperatively to 24.8 at last follow-up.

CONCLUSIONS

Present study shows that SCF the reliable option for the treatment of complex foot deformities, which also facilitates three-plane correction and concomitant lengthening with gradual soft tissue balance.

Treatment of Severe Rigid Posttraumatic Equinus Deformity With Gradual Deformity Correction and Arthroscopic Ankle Arthrodesis

BACKGROUND

Posttraumatic ankle equinus is associated with rigid deformity, poor skin condition, and multiple prior surgeries. Open acute correction has been described using osteotomies, talectomy, and arthrodesis, but concerns exist about skin complications, neurologic alterations, secondary limb discrepancy, and bone loss. Gradual correction using a multiplanar ring fixator and arthroscopic ankle arthrodesis (AAA) may decrease these complications.

METHODS

We retrospectively reviewed patients undergoing correction of posttraumatic rigid equinus with at least 1 year of follow-up after frame removal. The procedure consisted of percutaneous Achilles lengthening, gradual equinus correction using a multiplanar ring fixator, and AAA retaining the fixator in compression with screw augmentation. Frame removal depended on signs of union on the computed tomography scan. Visual analog scale (VAS) and Foot Function Index (FFI) scores were assessed as well as preoperative and postoperative x-rays. Complications were noted throughout the follow-up period.

RESULTS

Five patients were treated with a mean age of 35 years and mean follow-up of 31 months. Deformities were gradually corrected into a plantigrade foot over an average duration of 6 weeks. Union was achieved in all patients with a mean time of an additional 25 weeks, for a mean total frame time of 31 weeks. The mean preoperative tibiotalar angle was 151 degrees and was corrected to 115 degrees. FFI score improved from a mean of 87 to 24 and VAS from 8 to 2.

CONCLUSION

Posttraumatic rigid equinus can be treated effectively using gradual correction followed by integrated AAA in a safe and reproducible manner. Patients in this series had excellent functional, radiological, and satisfaction results.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Treatment of Relapsed and Neglected Pes Equinovarus with Binary Arthrodesis and Hexapodal Spider Frame

PURPOSE

The aim of this study was to assess the clinical and radiological outcomes of patients with recurrent or neglected pes equinovarus (PEV), who underwent talonavicular or calcaneocuboid arthrodesis with a hexapod spider frame.

METHODS

The study included 18 patients; a total of 25 feet were treated with dual arthrodesis and a hexapod spider frame. The International Club Foot Study Group (ICFSG) scoring system and visual analog scale (VAS) were used to assess preoperative status and postoperative outcomes. All functional, morphological and radiologic evaluations during the follow-up were done as described by Kling et al.

RESULTS

Patients were followed up for an average of 24.1 ± 11.8 months. The mean age of our cohort was 8.84 ± 2.83 years. The mean duration of correction was 3 weeks and the mean duration treatment length was 15.3 ± 1.9 weeks. Postoperative assessment revealed eight excellent, 13 good, and four poor outcomes, according to the ICFSG scoring system. There was a significant difference between preoperative and postoperative ICFSG scores, 12 feet showed an excellent outcome, 12 feet had good outcomes, and one foot was rated as a failure in the final assessment, based on the Kling criteria. There was also a significant difference between preoperative and postoperative VAS scores.

CONCLUSION

Dual arthrodesis plus a hexapod spider frame is a valuable option for patients with recurrent or neglected PEV. It can be offered safely to avoid secondary recurrences and potential complications in cases of rigid feet as well as challenging cases that are resistant to soft tissue manipulation.

Treatment of complex foot deformities with hexapod external fixator in growing children and young adult patients

BACKGROUND

Treatment of complex foot deformities in growing children and young adult patients is challenging. The traditional approach consists of extensive soft tissues releases, osteotomies and/or arthrodesis. More recently, distraction osteogenesis has been proposed as an alternative strategy. The aim of this study was to describe our treatment strategy and report clinical outcomes of the patients affected from complex foot deformities treated by distraction osteogenesis and hexapod external fixator.

MATERIALS AND METHODS

We retrospectively reviewed 10 consecutive patients with complex foot and ankle deformities treated from 2014 to 2016 at our unit. A TrueLok external fixator system was used in all patients. Final outcome was classified as good, fair and poor according to the criteria indicated by Paley and Ferreira. The results were also evaluated by the pre-operative and post operative American Orthopedic Foot and Ankle Score (AOFAS) and The Manchester-Oxford Foot Questionnaire (MOXFQ).

RESULTS

A plantigrade foot was obtained in eight patients at the end of treatment, while in two patients a recurrence of the deformity was noted. Result was classified as good in 6 patients, fair in 2 patients, and poor in 2 patients. The AOFAS score improved from 33.9±21.2 pre-operatively to 67.25±15.1 post-operatively (p=0.005). A statistically significant improvement was observed for the MOXFQ score as well (from 60.6±23.3 to 33.0±25.2, p=0.020).

CONCLUSIONS

Our study shows that the TrueLok hexapod external fixator is a safe and effective tool in treatment of complex rigid foot deformities. Nevertheless, deformity recurrence can be observed in some cases and treatment remains challenging. Distraction osteogenesis should be reserved as a salvage solution for particularly complex cases and should be performed at dedicated specialized centers.

Compact Two Degrees-of-Freedom External Fixator System for Correction of Persistent Clubfoot Deformity

Bone deformities are often complex three-dimensional (3D) deformities, and correcting them is difficult. To correct persistent clubfoot deformity in adolescents or adults, an external fixator is sometimes used to encourage tissue growth and preserve healthy tissues. However, it is difficult to set up, resulting in long surgeries and steep learning curves for surgeons. It is also bulky and obstructs patient mobility. In this paper, we introduce a new approach of defining clubfoot deformity correction as a six degrees-of-freedom (6DOF) correction, and then reducing it to just two degrees-of-freedom (2DOF) using the axis-angle representation. Therefore, only two physical trajectory joints are needed, which in turn enables a more compact fixator design. A computer planner was developed to minimize the bulk of the external fixator, and to optimize the distraction schedule to avoid overstretching the soft tissues. This reduces the learning curve for surgeons and shortens surgery time. To validate the system, a patient-specific clubfoot simulator was developed, and four experiments were performed on the clubfoot simulator. The accuracy of midfoot correction was 11 mm and 3.5 deg without loading, and 41 mm and 11.7 deg with loading. While the external fixator has to be more rigid to overcome resistance against correction, the surgical system itself was able to achieve accurate correction in less than 2 h. This is an improvement from the current method, which takes 2.5–4.5 h.

Effects of Taylor Spatial Frame on tumors and tumor-like lesions with pathological fractures of lower extremities

Objective:

We aimed to evaluate the clinical effects of Taylor spatial frame (TSF) on tumors and tumor-like lesions complicated with pathological fractures of the lower extremities.

Methods:

Eighty-two patients admitted from September 2013 to January 2015 were selected. Forty-two cases were included in Group-A to receive TSF fixation and forty were included in Group-B to receive locking plate fixation. The surgical time, intraoperative blood loss, postoperative healing rate of primary incision, incidence rate of complications, hospitalization stay length, and fracture healing time as well as rate of excellent and good Enneking scores one year after surgery were compared.

Results:

The intraoperative blood losses of Group-A and Group-B were (150.0±6.5) ml and (201.9±7.4) ml respectively (P<0.05). The surgical times were (77.3±8.9) minutes and (96.5±5.9) minutes respectively (P<0.05). The postoperative rates of complications in the two groups (4.76% vs. 10.00%) were similar (P>0.05). The primary incision healing rates of Group-A and Group-B were 97.62% and 82.50% respectively. The hospitalization stays were (15.7±0.9) days and (15.2±0.7) days respectively (P>0.05). The fracture healing times were (30.1±2.1) weeks and (32.4±2.2) weeks respectively (P<0.05). The rate of excellent and good Enneking scores one year after surgery was 97.61% in Group-A and 95.00% in Group-B (P>0.05).

Conclusions:

Tumors and tumor-like lesions complicated with pathological fractures of the lower extremities can be effectively treated by TSF.

Pediatric and adolescent applications of the Taylor Spatial Frame

Limb deformity can occur in the pediatric and adolescent populations from multiple etiologies: congenital, traumatic, posttraumatic sequelae, oncologic, and infection. Correcting these deformities is important for many reasons. Ilizarov popularized external fixation to accomplish this task. Taylor expanded on this by designing an external fixator in 1994 with 6 telescoping struts that can be sequentially manipulated to achieve multiaxial correction of deformity without the need for hinges or operative frame alterations. This frame can be used to correct deformities in children and has shown good anatomic correction with minimal morbidity. The nature of the construct and length of treatment affects psychosocial factors that the surgeon and family must be aware of prior to treatment. An understanding of applications of the Taylor Spatial Frame gives orthopedic surgeons an extra tool to correct simple and complex deformities in pediatric and adolescent patients.