Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator
Suhayl Tafazal
0
Sanjeev S. Madan
0
Farhan Ali
0
Manoj Padman
0
Simone Swift
0
Stanley Jones
0
James A. Fernandes
0
0
S. Tafazal (&) S. S. Madan F. Ali M. Padman S. Swift S. Jones J. A. Fernandes Department of Paediatric Orthopaedics, Sheffield Children's Hospital, Western Bank
, Sheffield S10 2TH,
UK
Background The use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management. Method A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment. The minimum follow-up was 24 months. Results Ten patients were treated with ICF between 2000 and 2005, while 15 patients have been treated with TSF since 2005. Two of the 10 treated with ICF and 5 of the 15 treated with TSF were open fractures. All patients went on to achieve complete union. Mean duration in the frame was 12.7 weeks for ICF and 14.8 weeks for the TSF group. Two patients in the TSF group had delayed union and required additional procedures including adjustment of fixator and bone grafting. There was one malunion in the TSF group that required osteotomy and reapplication of frame. There were seven and nine pin-site infections in the ICF and TSF groups, respectively, all of which responded to antibiotics. There were no refractures in either group. Conclusion In an appropriate patient, both types of circular fixator are equally effective but have different characteristics, with TSF allowing for postoperative deformity correction. Of concern are the two cases of delayed union in the TSF group, all in patients with high-energy injuries. We feel another larger study is required to provide further clarity in this matter. Level of evidence Level IIcomparative study.
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Tibial fractures are common in ambulatory children [1].
Many different methods of fixation have been used, each
with varying degrees of success [25].
External fixation has traditionally been favoured in
fractures with soft-tissue problems, those with unstable
fracture configurations and periarticular fractures [614].
Both monolateral and circular fixators can be used,
although the circular fixator is a more stable construct
biomechanically and may be more suitable for older
children and fractures with an unstable configuration [13].
Ilizarov pioneered the use of the circular fixator for fracture
treatment and deformity correction. The Taylor spatial
frame (TSF) is a more recent circular fixator that uses a
computer software programme for multiplanar correction
of limb deformities. This has the advantage of being
able to perform adjustments and fracture corrections
postoperatively.
We have used both types of circular fixator for the
treatment of tibial fractures. However, since 2005, the
TSF has been the fixator of choice. In this study, we
present our results relating to the treatment of tibial
fractures with either an Ilizarov circular fixator or Taylor
spatial frame.
Fig. 1 Preoperative radiograph of a segmental tibial fracture
We have retrospectively reviewed all consecutive acute
tibial fractures that were managed with circular fixators in
our institute from 2000 to 2008. All patients had a
minimum follow-up of 24 months. Ten patients were treated
with the Ilizarov circular fixator (ICF), which was used
until 2005. Fifteen further patients have since been
managed with the TSF. Our indications for the treatment of a
tibial fracture with a circular fixator were open fractures,
fractures with unstable configurations, and fractures that
displaced after initial treatment in a cast. Patients who
developed compartment syndrome also had stabilisation
with a circular fixator.
The patient details were obtained from the theatre
database. Clinical and demographic data were acquired
from the medical records. These included age, sex, mode of
injury, other concomitant injuries, initial treatment,
operative technique used, complications and duration of
treatment. Radiographs were reviewed for assessment of initial
injury, fracture reduction and alignment during the early
postoperative period and to determine fracture healing.
The surgical technique was similar for both types of
fixators. Surgery was performed in a laminar airflow
theatre, which was our units standard operating theatre used
for such cases. All patients received antibiotic prophylaxis
at induction of anaesthesia. Tourniquets were not used.
Fig. 3 Showing sound union at
the level of the original fracture
Fluoroscopy was used for fracture reduction as well as for
application of the fixator. The ring first technique was
used, where the first reference wire was introduced into the
segment for each ring, to which the r (...truncated)