An Introduction to the Taylor Spatial Frame for Foot and Ankle Applications

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The Taylor Spatial Frame (TSF; Smith & Nephew Memphis, TN) is an advanced orthopaedic modality that uses the Ilizarov priciples to correct deformities via an external hexapod. Typically, it is used to correct severe deformities that are not amenable to other methods of acute correction or fixation. Historically, these complex deformities have been corrected with the Ilizarov principles and components. Currently, advances in deformity planning, hardware, and software analysis have made correcting severe foot and ankle deformities much easier. This article gives an overview of the indications and contraindications of the TSF, it reinforces the basic principles of deformity planning, and it introduces the different designs of the TSF available.

Section snippets

History

The historical concept for how the TSF works can be attributed to the development of projective geometry, Chasles axis, and the technological advances of the Stewart platform. The field of projective geometry, as developed by Gerard Desarques, Blaise Pascal, and Phillipe de la Hire, laid the foundation for understanding the relationship between lines, planes, and points, which was later incorporated in several mathematical theories.3

The Mozzi-Chasles’ theorem states that “the most general rigid

Indications of TSF

The indications of the TSF for the foot and ankle are numerous but should be reserved for severe deformities that are not braceable. Some deformities are not amenable to acute correction secondary to patient’s current medical status, past surgical history, active infection, or poor skin quality. The TSF can be used for fracture reduction and stabilization. Primary ring position is not critical to the mounting of the external fixator. Reduction does not have to be performed during the operation

Principles of Deformity Correction

Ordering the appropriate radiographs is the first step in proper deformity evaluation. Standard radiographs that we order at our institution for evaluating foot and ankle deformities include full-length anterior–posterior (AP) and lateral standing radiographs, AP and lateral ankle to include tibia, long leg calcaneal axial, Saltzman view, and foot views (AP, lateral, oblique). It is important to assess the location of deformity, any mechanical axis deviation, misalignments, and/or

Contraindications

Some contraindications to using the TSF include lack of familiarity with deformity planning, inexperience with TSF fixator and/or software, patient noncompliance and/or psychiatric impairment, patient comorbidities prohibiting surgery or anesthesia, and lack of indication for external fixator.

Advantages

There are advantages and disadvantages with the use of external fixators. Likewise, there are reasons to choose the TSF instead of the Ilizarov and vice versa. The use of external fixation devices has the advantage over internal fixation in that it is generally less invasive. Percutaneous techniques used with this method of fixation offer reduced surgical morbidity because of less operative exposure. Extensive periosteal stripping, especially in cases of malunion and nonunion, can be avoided.

Disadvantages

In some practices and institutions, it is cost-prohibitive to use the TSF. The cost of circular external fixators significantly increases with the use of struts. Likewise, the prescription for deformity correction may necessitate additional strut changes, which also are an additional expense. One recommendation for reducing the number of strut changes is being able to assess your deformity and mounting parameters in the operating room. A prescription for correction can be generated at that time

Conclusion

The TSF is an advanced orthopaedic modality that permits accurate correction of severe foot and ankle deformities. As specialists in foot and ankle surgery, this new technology will add to our armamentarium in reconstructing difficult deformities. The utility of TSF frames, coupled with an increasing familiarity of deformity planning, will play a major role in limb preservation and salvage.

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