Strategies in Trauma and Limb Reconstruction

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VOLUME 19 , ISSUE 1 ( January-April, 2024 ) > List of Articles

ORIGINAL RESEARCH

The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture

Rahul Geetala, James Zhang, Daniel Maghsoudi, Amindu Madigasekara, Matija Krkovic

Keywords : Distraction osteogenesis, Ilizarov technique, Osteomyelitis, Taylor spatial frame

Citation Information : Geetala R, Zhang J, Maghsoudi D, Madigasekara A, Krkovic M. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. 2024; 19 (1):32-35.

DOI: 10.5005/jp-journals-10080-1613

License: CC BY-NC 4.0

Published Online: 06-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications. Materials and methods: Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union. Results: The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13–15.18], p = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant. Conclusion: Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union. Clinical significance: The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis.


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  1. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364(9431): 369–379. DOI: 10.1016/S0140-6736(04)16727-5.
  2. Costerton W, Veeh R, Shirtliff M, et al. The application of biofilm science to the study and control of chronic bacterial infections. J Clin Invest 2003;112(10):1466–1477. DOI: 10.1172/JCI20365.
  3. Hohmann E, Birkholtz F, Glatt V, et al. The “Road to Union” protocol for the reconstruction of isolated complex high-energy tibial trauma. Injury 2017;48(6):1211–1216. DOI: 10.1016/j.injury.2017.03.018.
  4. Naude J, Manjra M, Birkholtz FF, et al. Outcomes following treatment of complex tibial fractures with circular external fixation: A comparison between the Taylor spatial frame and true Lok-hex. Strategies Trauma Limb Reconstr 2019;14(3):142–147. DOI: 10.5005/jp-journals-10080-1443.
  5. Dammerer D, Kirschbichler K, Donnan L, et al. Clinical value of the Taylor spatial frame: A comparison with the Ilizarov and Orthofix fixators. J Child Orthop 2011;5(5):343–249. DOI: 10.1007/s11832-011-0361-3.
  6. Keshet D, Eidelman M. Clinical utility of the Taylor spatial frame for limb deformities. Orthop Res Rev 2017;9:51–61. DOI: 10.2147/ORR.S113420.
  7. Bose D, Kugan R, Stubbs D, et al. Management of infected nonunion of the long bones by a multidisciplinary team. Bone Joint J 2015; 97-B(6):814–817. DOI: 10.1302/0301-620X.97B6.33276.
  8. Sabaté Brescó M, Harris LG, Thompson K, et al. Pathogenic mechanisms and host interactions in staphylococcus epidermidis device-related infection. Front Microbiol 2017;8:1401. DOI: 10.3389/fmicb.2017.01401.
  9. Spiegelberg B, Parratt T, Dheerendra SK, et al. Ilizarov principles of deformity correction. Ann R Coll Surg Engl 2010;92(2):101–105. DOI: 10.1308/003588410X12518836439326.
  10. IBM Corp. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp; 2021. Available at: https://www.ibm.com/products/spss-statistics.
  11. Sachs BL, Shaffer JW. A staged Papineau protocol for chronic osteomyelitis. Clin Orthop Relat Res 1984;(184):256–263. PMID: 6368084.
  12. Collinge CA, Goll G, Seligson D, et al. Pin tract infections: Silver vs uncoated pins. Orthopedics 1994;17(5):445–448. DOI: 10.3928/0147-7447-19940501-11.
  13. Moroni A, Vannini F, Mosca M, et al. State of the art review: Techniques to avoid pin loosening and infection in external fixation. J Orthop Trauma 2002;16(3):189–195. DOI: 10.1097/00005131-200203000-00009.
  14. Parameswaran AD, Roberts CS, Seligson D, et al. Pin tract infection with contemporary external fixation: How much of a problem? J Orthop Trauma 2003;17(7):503–507. DOI: 10.1097/00005131-200308000-00005.
  15. Lee JJ, Patel R, Biermann JS, et al. The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am 2013;95(9):850–859. DOI: 10.2106/JBJS.L.00375.
  16. Tay WH, de Steiger R, Richardson M, et al. Health outcomes of delayed union and non-union of femoral and tibial shaft fractures. Injury 2014;45(10):1653–1658. DOI: 10.1016/j.injury.2014.06.025.
  17. Hasler CC, Krieg AH. Current concepts of leg lengthening. J Child Orthop 2012;6(2):89–104. DOI: 10.1007/s11832-012-0391-5.
  18. Ferreira N, Marais LC, Aldous C. Hexapod external fixator closed distraction in the management of stiff hypertrophic tibial nonunions. Bone Joint J 2015;97–B(10):1417–1422. DOI: 10.1302/0301-620X.97B10.35504.
  19. Hamada T, Matsubara H, Yoshida Y, et al. Comparison of treatment indices associated with the correction and lengthening of deformities along various lower limb frontal plane directions. J Clin Orthop Trauma 2019;10(Suppl 1):S57–S61. DOI: 10.1016/j.jcot.2019. 01.003.
  20. Manner HM, Huebl M, Radler C, et al. Accuracy of complex lower-limb deformity correction with external fixation: A comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop 2007;1(1):55–61. DOI: 10.1007/s11832-006-0005-1.
  21. Zhang X, Yang X, Chen Y, et al. Clinical study on orthopaedic treatment of chronic osteomyelitis with soft tissue defect in adults. Int Wound J 2022;19(6):1349–1356. DOI: 10.1111/iwj.13729.
  22. Siebenbürger G, Grabein B, Schenck T, et al. Eradication of Acinetobacter baumannii/Enterobacter cloacae complex in an open proximal tibial fracture and closed drop foot correction with a multidisciplinary approach using the Taylor Spatial Frame®: A case report. Eur J Med Res 2019;24(1):2. DOI: 10.1186/s40001-019- 0360-2.
  23. Tong K, Zhong Z, Peng Y, et al. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury 2017;48(7):1616–1622. DOI: 10.1016/j.injury.2017.03.042.
  24. Morris R, Hossain M, Evans A, et al. Induced membrane technique for treating tibial defects gives mixed results. Bone Joint J 2017;99-B(5):680–685. DOI: 10.1302/0301-620X.99B5.BJJ-2016-0694.R2.
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