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Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Distraction osteogenesis is a method of stimulating the growth of new bone tissue in order to lengthen the extremities or bridge resected bone defects. In addition to the now-established intramedullary procedures, two different fixator systems are in use. The present study investigated the classical Ilizarov ring fixator (IRF) and a hexapod to assess the precision of lower-leg lengthening and complications classified using the Paley criteria for problems, obstacles, and complications. The study also examined the follow-up results in functional tests to assess outcomes in terms of range of motion in adjacent joints, daily activities, and quality of life.

Patients and methods: A total of 43 patients (53 segments) who were treated over a period of 16 years were re-assessed. In 33 segments, treatment was carried out with the hexapod Taylor Spatial Frame (TSF); the conventional IRF was used in 20 segments. The patients’ mean age was 13.5 years (range 2–54 years). The follow-up examinations were carried out 2–15 years postoperatively and comprised measurement of a current leg axis view with the patient standing, calculation of a knee score, activity scores, ankle joint scores, and assessment of motor function and sensory function using appropriate scores in the lower leg and foot. The post-treatment health-related quality of life was assessed using the Short-Form Health Survey-36 questionnaire.

Results: Using the Paley criteria, far fewer problems occurred in the TSF group in comparison with the IRF (TSF 12.1%, IRF 50%). In the problems category, significant differences were observed with regard to axial deviation (TSF 0%, IRF 36.8%) and pin infections (TSF 9.1%, IRF 40%). Comparison of the obstacles and complications did not identify any significant differences between the two groups. Analysis of the scores for the knee, activity, and motor function/sensory function also did not show any marked discrepancies, apart from a major difference in mobility in the upper and lower ankle joints with poorer findings in the TSF group.

Conclusions: During treatment, the TSF ring fixator leads to fewer problems, fewer secondary axial translations, and fewer pin infections. However, with temporary transfixation of the ankle joints, the TSF system is also associated with postoperative deterioration in mobility in the upper and lower ankle joint.

No MeSH data available.


Typical assembly of the external fixators studied:, Ilizarov ring fixator (left) and Taylor Spatial Frame (right)
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Fig1: Typical assembly of the external fixators studied:, Ilizarov ring fixator (left) and Taylor Spatial Frame (right)

Mentions: Comparison of the SF-36 data collected showed a mean physical summary score of 43.15 points (range 24–59), with a mean of 42.18 (range 25–59) in the TSF group and mean of 44.05 (range 24–56) in the IRF group. The figures did not show any significant associations between the fixator procedures and the patients’ subjective state of health. Significant differences were noted in the individual subscales (Table 3) for physical function, physical role function, and social function in favor of the TSF group, with a much lower mean in comparison with the IRF group. The points for the eight individual components are listed in Table 3; the values are based on standard data for Germany (Fig. 1).Table 3


Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures
Typical assembly of the external fixators studied:, Ilizarov ring fixator (left) and Taylor Spatial Frame (right)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121109&req=5

Fig1: Typical assembly of the external fixators studied:, Ilizarov ring fixator (left) and Taylor Spatial Frame (right)
Mentions: Comparison of the SF-36 data collected showed a mean physical summary score of 43.15 points (range 24–59), with a mean of 42.18 (range 25–59) in the TSF group and mean of 44.05 (range 24–56) in the IRF group. The figures did not show any significant associations between the fixator procedures and the patients’ subjective state of health. Significant differences were noted in the individual subscales (Table 3) for physical function, physical role function, and social function in favor of the TSF group, with a much lower mean in comparison with the IRF group. The points for the eight individual components are listed in Table 3; the values are based on standard data for Germany (Fig. 1).Table 3

View Article: PubMed Central - PubMed

ABSTRACT

Objective: Distraction osteogenesis is a method of stimulating the growth of new bone tissue in order to lengthen the extremities or bridge resected bone defects. In addition to the now-established intramedullary procedures, two different fixator systems are in use. The present study investigated the classical Ilizarov ring fixator (IRF) and a hexapod to assess the precision of lower-leg lengthening and complications classified using the Paley criteria for problems, obstacles, and complications. The study also examined the follow-up results in functional tests to assess outcomes in terms of range of motion in adjacent joints, daily activities, and quality of life.

Patients and methods: A total of 43 patients (53 segments) who were treated over a period of 16 years were re-assessed. In 33 segments, treatment was carried out with the hexapod Taylor Spatial Frame (TSF); the conventional IRF was used in 20 segments. The patients’ mean age was 13.5 years (range 2–54 years). The follow-up examinations were carried out 2–15 years postoperatively and comprised measurement of a current leg axis view with the patient standing, calculation of a knee score, activity scores, ankle joint scores, and assessment of motor function and sensory function using appropriate scores in the lower leg and foot. The post-treatment health-related quality of life was assessed using the Short-Form Health Survey-36 questionnaire.

Results: Using the Paley criteria, far fewer problems occurred in the TSF group in comparison with the IRF (TSF 12.1%, IRF 50%). In the problems category, significant differences were observed with regard to axial deviation (TSF 0%, IRF 36.8%) and pin infections (TSF 9.1%, IRF 40%). Comparison of the obstacles and complications did not identify any significant differences between the two groups. Analysis of the scores for the knee, activity, and motor function/sensory function also did not show any marked discrepancies, apart from a major difference in mobility in the upper and lower ankle joints with poorer findings in the TSF group.

Conclusions: During treatment, the TSF ring fixator leads to fewer problems, fewer secondary axial translations, and fewer pin infections. However, with temporary transfixation of the ankle joints, the TSF system is also associated with postoperative deterioration in mobility in the upper and lower ankle joint.

No MeSH data available.