Application of Taylor Spatial Frame for treating post-burn foot and ankle deformities in adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GU Jianming ¹ , WANG Shihao ² , DU Hui ³ ,  ZHOU Yixin ¹

1. Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;
2. Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;
3. Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;

Corresponding author：

ZHOU Yixin, Email: orthoyixin@yahoo.com

Keywords：

Taylor Spatial Frame; post-burn sequelae; cicatricial contracture deformity; foot and ankle deformity

DOI：

10.7507/1002-1892.202504123

Video：

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Objective To investigate the safety and effectiveness of using the Taylor Spatial Frame (TSF) based on the Ilizarov tension-stress principle for treatment of post-burn foot and ankle deformities in adults. Methods A retrospective analysis of clinical data from 6 patients with foot and ankle deformities treated between April 2019 and November 2023. There was 1 male and 5 females with an average age of 28.7 years (range, 20-49 years). There were 3 cases of simple ankle equinus, 2 cases of ankle equinus, midfoot rocker-bottom foot, and forefoot pronation, and 1 case of calcaneus foot combined with fore-midfoot pronation deformity. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 45.3±18.2, SF-12 Physical Component Summary (PCS) was 34.3±7.3 and Mental Component Summary (MCS) was 50.4±8.8. Imaging examination showed tibial-calcaneal angle of (79.8±31.5)°, calcaneus-first metatarsal angle of (154.5±45.3)°, talus-first metatarsal angle of (-19.3±35.0)°. Except for 1 case with severe deformity that could not be measured, the remaining 5 cases had talus-second metatarsal angle of (40.6±16.4)°. The deformities were fixed with TSF after soft tissue release and osteotomy. Then, the residual deformities were gradually corrected according to software-calculated prescriptions. TSF was removed after maximum deformity correction and osteotomy healing. External fixation time, brace wearing time after removing the TSF, and pin tract infection occurrence were recorded. Infection severity was evaluated based on Checketts-Otterburns grading. Joint function was evaluated using AOFAS score and SF-12 PCS and MCS scores. Patient satisfaction was assessed using Likert score. Imaging follow-up measured relevant indicators to evaluate the degree of deformity correction. Deformity recurrence was observed during follow-up. Results The external fixation time was 103-298 days (mean, 193.5 days). The mild pin tract infections occurred during external fixation in all patients, which healed after pin tract care and oral antibiotics. No serious complications such as osteomyelitis, fractures, neurovascular injury, or skin necrosis occurred. After external fixation removal, 3 cases did not wear braces, while the remaining 3 cases wore braces continuously for 6 weeks, 8 weeks, and 3 years, respectively. All patients were followed up 13.9-70.0 months, with an average of 41.7 months. During follow-up, none of the 6 patients had recurrence of foot deformity. At 1 year after operation, the AOFAS score was 70.0±18.1, SF-12 PCS and MCS were 48.9±4.5 and 58.8±6.4, respectively, all showing improvement compared to preoperative values (P<0.05). Imaging follow-up showed that all osteotomies healed, and all distraction cases achieved bony union at 6 months after stopping stretching. At 1 year after operation, tibial-calcaneal angle was (117.5±12.8)° and talus-first metatarsal angle was (-3.3±19.3)°, both showing improvement compared to preoperative values (P<0.05). Calcaneus-first metatarsal angle was (132.0±14.4)°, which also improved compared to preoperative values but without statistical significance (P>0.05). Except for 1 case with severe deformity that could not be measured, the remaining 5 cases had talus-second metatarsal angle of (18.0±6.4)°. And there was no significant difference (P>0.05) between pre-and post-operative data of 4 patients with complete data. At 1 year after operation, 1 patient was satisfied witheffectiveness and 5 patients were very satisfied. Conclusion The TSF, by applying the Ilizarov tension-stress principle for gradual distraction and multi-planar adjustment, combined with soft tissue release and osteotomy, can effectively correct foot and ankle deformities after burns, especially equinus deformity with contracture of the posterior soft tissues of the lower leg. There are still limitations in treating cases with tight, adherent scars on the dorsum of the foot that require long-distance distraction. If necessary, a multidisciplinary approach combined with microsurgical techniques can be utilized.

1.	Carmichael KD, Maxwell SC, Calhoun JH. Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation. J Pediatr Orthop, 2005, 25(4): 523-528.
2.	Saghieh S, El Bitar Y, Berjawi G, et al. Distraction histogenesis in ankle burn deformities. J Burn Care Res, 2011, 32(1): 160-165.
3.	Baindurashvili A, Afonichev K, Filippova O. Post-burn scar deformities of the foot: Peculiarities of clinical findings and treatment. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 2014, 2(1): 18-26.
4.	Grishkevich VM. Ankle dorsiflexion postburn scar contractures: anatomy and reconstructive techniques. Burns, 2012, 38(6): 882-888.
5.	安宝泉, 江海廷, 杨玉平, 等. Ilizarov张力-应力法则与VSD技术结合在筋膜高压症切开减压后对皮肤牵张作用的临床研究. 中国骨与关节损伤杂志, 2015, 30(9): 1000-1001.
6.	臧建成, 秦泗河. 从Wolff定律和Ilizarov张力-应力法则到骨科自然重建理念. 中国骨伤, 2013, 26(4): 287-290.
7.	Guan S, Du H, Wu Y, et al. The Ilizarov technique: A dynamic solution for orthopaedic challenges. Orthop Surg, 2024, 16(9): 2111-2114.
8.	郑学建, 秦泗河, 石磊, 等. Ilizarov技术治疗软骨发育不全下肢畸形早期临床研究. 中国修复重建外科杂志, 2023, 37(2): 157-161.
9.	Kumar G, Narayan B. The tension-stress effect on the genesis and growth of tissues: Part Ⅱ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989(239): 263-285.
10.	Calhoun JH, Evans EB, Herndon DN. Techniques for the management of burn contractures with the Ilizarov fixator. Clin Orthop Relat Res, 1992(280): 117-124.
11.	张子阳, 窦雪娇, 魏在荣. 应用Ilizarov技术治疗烧伤后膝关节屈曲挛缩畸形. 中国修复重建外科杂志, 2018, 32(10): 1271-1274.
12.	焦绍锋, 秦泗河, 王振军, 等. 单套Taylor外固定架联合双平面截骨矫正胫骨多平面畸形. 中国修复重建外科杂志, 2023, 37(7): 839-845.
13.	杜辉, 李兴, 李恒, 等. Miter构型泰勒空间外固定架治疗重度马蹄高弓足11例临床分析. 广西医科大学学报, 2024, 41(7): 1063-1069.
14.	Lu D, Wang T, Chen H, et al. Management of pin tract infection in pediatric supracondylar humerus fractures: a comparative study of three methods. Eur J Pediatr, 2017, 176(5): 615-620.
15.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
16.	Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care, 1996, 34(3): 220-233.
17.	许红生, 王振军, 郭悦, 等. 胫骨结节下截骨结合泰勒空间外固定器治疗成人特发性膝内翻. 中华骨与关节外科杂志, 2023, 16(9): 773-778.
18.	Emara KM, Allam MF, Elsayed MN, et al. Recurrence after correction of acquired ankle equinus deformity in children using Ilizarov technique. Strategies Trauma Limb Reconstr, 2008, 3(3): 105-108.
19.	沈余明, 黄雷, 胡骁骅, 等. 伊氏外固定架治疗烧伤后瘢痕挛缩性足下垂畸形. 中华烧伤杂志, 2008, 24(4): 287-289.
20.	张子阳, 臧建成, 秦泗河. Ilizarov 技术治疗烧伤后马蹄内翻足畸形. 中国修复重建外科杂志, 2018, 32(2): 178-181.
21.	袁凌, 何春念, 邵星. Ilizarov技术治疗足踝部深度烧伤后马蹄内翻足畸形的护理. 贵州医药, 2020, 44(7): 1160-1161.
22.	孙森韬, 王全, 曹卫红, 等. Ilizarov技术在儿童烧伤患者足踝畸形治疗中的应用. 中华损伤与修复杂志(电子版), 2018, 13(3): 223-225.
23.	杨敬, 王强, 朱伟, 等. 泰勒空间外架技术结合足部“U”形截骨治疗创伤后马蹄内翻足畸形. 骨科, 2021, 12(3): 200-205.
24.	Chen Y, Niu Z, Jiang W, et al. 3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator. J Zhejiang Univ Sci B, 2021, 22(10): 866-875.
25.	Steinwender G, Saraph V, Zwick EB, et al. Complex foot deformities associated with soft-tissue scarring in children. J Foot Ankle Surg, 2001, 40(1): 42-49.

1. Carmichael KD, Maxwell SC, Calhoun JH. Recurrence rates of burn contracture ankle equinus and other foot deformities in children treated with Ilizarov fixation. J Pediatr Orthop, 2005, 25(4): 523-528.
2. Saghieh S, El Bitar Y, Berjawi G, et al. Distraction histogenesis in ankle burn deformities. J Burn Care Res, 2011, 32(1): 160-165.
3. Baindurashvili A, Afonichev K, Filippova O. Post-burn scar deformities of the foot: Peculiarities of clinical findings and treatment. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery, 2014, 2(1): 18-26.
4. Grishkevich VM. Ankle dorsiflexion postburn scar contractures: anatomy and reconstructive techniques. Burns, 2012, 38(6): 882-888.
5. 安宝泉, 江海廷, 杨玉平, 等. Ilizarov张力-应力法则与VSD技术结合在筋膜高压症切开减压后对皮肤牵张作用的临床研究. 中国骨与关节损伤杂志, 2015, 30(9): 1000-1001.
6. 臧建成, 秦泗河. 从Wolff定律和Ilizarov张力-应力法则到骨科自然重建理念. 中国骨伤, 2013, 26(4): 287-290.
7. Guan S, Du H, Wu Y, et al. The Ilizarov technique: A dynamic solution for orthopaedic challenges. Orthop Surg, 2024, 16(9): 2111-2114.
8. 郑学建, 秦泗河, 石磊, 等. Ilizarov技术治疗软骨发育不全下肢畸形早期临床研究. 中国修复重建外科杂志, 2023, 37(2): 157-161.
9. Kumar G, Narayan B. The tension-stress effect on the genesis and growth of tissues: Part Ⅱ. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1989(239): 263-285.
10. Calhoun JH, Evans EB, Herndon DN. Techniques for the management of burn contractures with the Ilizarov fixator. Clin Orthop Relat Res, 1992(280): 117-124.
11. 张子阳, 窦雪娇, 魏在荣. 应用Ilizarov技术治疗烧伤后膝关节屈曲挛缩畸形. 中国修复重建外科杂志, 2018, 32(10): 1271-1274.
12. 焦绍锋, 秦泗河, 王振军, 等. 单套Taylor外固定架联合双平面截骨矫正胫骨多平面畸形. 中国修复重建外科杂志, 2023, 37(7): 839-845.
13. 杜辉, 李兴, 李恒, 等. Miter构型泰勒空间外固定架治疗重度马蹄高弓足11例临床分析. 广西医科大学学报, 2024, 41(7): 1063-1069.
14. Lu D, Wang T, Chen H, et al. Management of pin tract infection in pediatric supracondylar humerus fractures: a comparative study of three methods. Eur J Pediatr, 2017, 176(5): 615-620.
15. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
16. Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care, 1996, 34(3): 220-233.
17. 许红生, 王振军, 郭悦, 等. 胫骨结节下截骨结合泰勒空间外固定器治疗成人特发性膝内翻. 中华骨与关节外科杂志, 2023, 16(9): 773-778.
18. Emara KM, Allam MF, Elsayed MN, et al. Recurrence after correction of acquired ankle equinus deformity in children using Ilizarov technique. Strategies Trauma Limb Reconstr, 2008, 3(3): 105-108.
19. 沈余明, 黄雷, 胡骁骅, 等. 伊氏外固定架治疗烧伤后瘢痕挛缩性足下垂畸形. 中华烧伤杂志, 2008, 24(4): 287-289.
20. 张子阳, 臧建成, 秦泗河. Ilizarov 技术治疗烧伤后马蹄内翻足畸形. 中国修复重建外科杂志, 2018, 32(2): 178-181.
21. 袁凌, 何春念, 邵星. Ilizarov技术治疗足踝部深度烧伤后马蹄内翻足畸形的护理. 贵州医药, 2020, 44(7): 1160-1161.
22. 孙森韬, 王全, 曹卫红, 等. Ilizarov技术在儿童烧伤患者足踝畸形治疗中的应用. 中华损伤与修复杂志(电子版), 2018, 13(3): 223-225.
23. 杨敬, 王强, 朱伟, 等. 泰勒空间外架技术结合足部“U”形截骨治疗创伤后马蹄内翻足畸形. 骨科, 2021, 12(3): 200-205.
24. Chen Y, Niu Z, Jiang W, et al. 3D-printed models improve surgical planning for correction of severe postburn ankle contracture with an external fixator. J Zhejiang Univ Sci B, 2021, 22(10): 866-875.
25. Steinwender G, Saraph V, Zwick EB, et al. Complex foot deformities associated with soft-tissue scarring in children. J Foot Ankle Surg, 2001, 40(1): 42-49.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesApplication of Taylor Spatial Frame for treating post-burn foot and ankle deformities in adults

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