Summary:
Purpose: The aim of this study is to examine the role of external fixation
system TSF (Taylor Spatial Frame) for the treatment of acquired and congenital
bone deformities in children. In particular, its purpose is to record problems,
obstacles and complications that may be present during treatment, classify and
systematize different risk factors leading to difficulties, and examine the
degree of their influence on the final therapeutic target.
Patients and methods: From January 2005 to December 2011, 86 children (103
lower limbs), 46 boys (53.48%) and 40 females (46.52%) with a mean age 11.15
years (range: 3-14y) underwent surgery. Patients were classified according to
their anatomical, dominant side and different type of acquired and/or
congenital bone deformation and the incidence of problems, obstacles and
complications between these groups were recorded. The mean follow-up was 54.2
months (range: 16-84 months). Accurate clinical and radiographic evaluation was
performed before the surgery. Then, data were inserted in the software Spatial
Frame Version 3.1 TM (Smith and Nephew). Distraction osteogenesis started
within seven days and gradual correction was performed according to the
personalized timetable provided by the software.
Results: Regarding the incidence of problems, obstacles and complications no
statistically significant difference was observed among different etiologies,
but only among years (p=0,047), with higher incidence for the years 2005 and
2007. Overall 37 problems, 11 obstacles and 4 complications were tracked. A
correlation between patient’s age and number of complications was observed.
Proximal tibia’s deformities as well as complex multilevel deformities had a
statistical significant increase of the incidence of problems and
complications. Statistical significant correlation was also observed between
obstacles and time of treatment (r = 0, 46) but not between problems and
treatment time (r = 0, 13), complications and treatment time (r = 0, 05) or
problems and BMI(r = 0, 03)
Conclusions: The TSF is well accepted by children, relatively safe and
confident during its use, offering full weight bearing to the operated limb.
Correction can be performed in all patients and eventually residual correction
can be obtained without any return to the operating room due to the use of the
TSF. Its use seems to be a valid method for the correction of acquired and
congenital bone deformities in children, especially in case of complex bone
deformities requiring the simultaneous correction of both sagittal and frontal
planes. Our study demonstrates that correction of different types of acquired
and congenital bones deformities in children by TSF is very challenging and a
learning curve is recommended.
Keywords:
Bone deformities, Fractures, External fixation TSF, Children
