Date: Sat, 11 Sep 2004 13:27:25 -0500
Subject: Acute Trauma Experience with Taylor Spatial FrameFrom: Zeev Glozman
Hello
How many of you have acute trauma exp with Taylor Spatial Frame?
Has it ever been applied for trauma in the upper extremity ?
Zeev
Date: Fri, 10 Sep 2004 22:31:01 +0200
Date: Sat, 11 Sep 2004 20:50:07 -0400
From: Kevin Pugh
This is an extremely useful device for acute trauma. Courses are regularly offered.
kp
Kevin J. Pugh, MD
Date: Sun, 12 Sep 2004 12:03:17 +0600
From: Alexander Chelnokov
Hello Kevin,
KP> This is an extremely useful device for acute trauma. Courses are regularly offered.
Sorry my ignorance but could you add more details about its use in acute trauma? The courses are not available around. From available images and examples of its application it looks like a complicated way to do simple things.
Best regards,
Date: Sun, 12 Sep 2004 06:37:23 -0400
From: Kevin Pugh
My explanation would fill a book. I realize that courses in Europe have been few and far between, but my understanding is that this is going to be rectified. TSF is not going to replace the lag screw and plate for a fibula fracture or a both bones fracture, but is very useful for many complex trauma applications, mainly in the tibia.
The TSF is indicated for acute trauma (or reconstruction for that matter) any time you would consider using a wire frame. Thus, for all of those cases that you describe using the Ilizarov devcice, a TSF could be used. I use it as another "arrow in my quiver", and not for everything. It provides a solution to many difficult problems I find in my practice.
The Ilizarov and the TSF are both circular external fixators, capable of doing static fixation, gradual reduction, or distraction osteogenesis. The surgeon must respect biomechanical principles and build a stable construct. The difference is that the Ilizarov requires a unique frame for each case, thus requiring a time consuming pre-build. It can correct residual angulations, translations, and rotations, but these have to be done in a sequential fashion because the frame must be rebuilt for each type of correction. It is infinitely adjustable, but does require the continual modification of the frame. Patients can effect their own correction at home by following a prescription that consists of moving nuts each day in the direction of the arrow you draw on a piece of tape or with nail polish on a nut.
The same TSF frame can be used for a variety of problems. It can also correct all 6 axes of deformity, but unlike the Ilizarov, can do so either sequentially or simultaneously, and without frame modification. Because the hinge is virtual, the mounting is easier. The patient follows a prescription which is very well defined. They turn 6 struts a defined amount each day to change the orientation of the rings, and thus the bone. Mid-course adjustments do not require a frame change, just a new prescription.
Hopefully you can get to an educational forum at some point. Charlie Taylor's web site is a great place to start.
Regards
kp
Date: Tue, 23 Nov 2004 01:40:33 +0500
From: Alexander Chelnokov
Hello Kevin,
KP> fibula fracture or a both bones fracture, but is very useful for many complex trauma applications, mainly in the tibia.
What about acute trauma? Open tibial shaft fracture? Primary bone defect? Closed spiral fracture? Multifragmentary/segmental? What and where TSF is to be preferred in acute trauma? How about forearm fractures? The Ilizarov provides very precise technique for radius/ulna shaft fractures as well for periarticular.
KP> The TSF is indicated for acute trauma (or reconstruction for that matter) any time you would consider using a wire frame. Thus, for all of those cases that you describe using the Ilizarov devcice, a TSF could be
The Ilizarov device is widely used for instance for intra- and periarticular fractures of the prox/distal tibia. Is that true for TSF? In many places in Russia the Ilizarov is used for any tibial shaft fracture - what TSF can add if the fixator applied on admission and reduction is completed on the table?
KP> construct. The difference is that the Ilizarov requires a unique frame for each case, thus requiring a time consuming pre-build.
There is a lot of typical situations where pre-built frames could be applicable. But surgeons in many centers do not use pre-built frames and assemble all on the table. We used to apply pre-built 4 ring framesmany years ago. Of course it is more time consuming than a single bar and 4 half-pins - if all we need is preliminary fixation.
It seems to me the right way was found by Ilizarov - he dropped the idea of fixed-assembly apparatus and turned to the set of multi-purpose details for osteosynthesis according to his principles.
KP> It can correct residual angulations, translations, and rotations, but these have to be done in a sequential fashion because the frame must be rebuilt for each type of correction.
If one is uncomfortable with complex one-step correction he really may go step by step - sometimes it is more practical. Though the frame can be assembled for simultaneous multi-level lengthening, translations, rotations and angulations.
KP> It is infinitely adjustable, but does require the continual modification of the frame.
If one is planned this way. Or, for instance when bone transport is completed, some wires/half-pins can be inserted, and some unnecessary parts removed. Isn't that so about TSF?
KP> Patients can effect their own correction at home by following a
It is common for any device which provides gradual correction - here nobody except the patient or relatives can rotate nuts 4 times a day.
KP> correct all 6 axes of deformity, but unlike the Ilizarov, can do so either sequentially or simultaneously, and without frame modification.
The same can be said about any other external fixators not only the Ilizarov.
KP> Because the hinge is virtual, the mounting is easier.
Agree. But at the all images of TSF i've seen it looks ugly with its huge and skew rings. In the history of the Ilizarov the era when the tibia had to be placed in the center of the ring was 20 years ago.
KP> The patient follows a prescription which is very well defined. They turn 6 struts a defined amount each day to change the
In many cases of angular deformities all needed correction is being performed with rotation of only one nut in the Ilizarov.
KP> Hopefully you can get to an educational forum at some point. Charlie Taylor's web site is a great place to start.
Did Dr Taylor demonstrate the technique in Kurgan and what was opinion of local inhabitants there? It would be nice if they performed a comparative series TSF vs Ilizarov in all available variables.
Best regards,