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. 2022 May;3(5):359-366.
doi: 10.1302/2633-1462.35.BJO-2021-0179.R1.

Is a staged reloading protocol effective to time the removal of circular frames? : a retrospective analysis

Vilas Sadekar  1 , Arun T Watts  1 , Elizabeth Moulder  1 , Panayiotis Souroullas  1 , Yvonne Hadland  1 , Elizabeth Barron  1 , Ross Muir  1 , Hemant K Sharma  1
Affiliations

Is a staged reloading protocol effective to time the removal of circular frames? : a retrospective analysis

Vilas Sadekar et al. Bone Jt Open. 2022 May.

Abstract

Aims: The timing of when to remove a circular frame is crucial; early removal results in refracture or deformity, while late removal increases the patient morbidity and delay in return to work. This study was designed to assess the effectiveness of a staged reloading protocol. We report the incidence of mechanical failure following both single-stage and two stage reloading protocols and analyze the associated risk factors.

Methods: We identified consecutive patients from our departmental database. Both trauma and elective cases were included, of all ages, frame types, and pathologies who underwent circular frame treatment. Our protocol is either a single-stage or two-stage process implemented by defunctioning the frame, in order to progressively increase the weightbearing load through the bone, and promote full loading prior to frame removal. Before progression, through the process we monitor patients for any increase in pain and assess radiographs for deformity or refracture.

Results: There were 244 frames (230 patients) included in the analyses, of which 90 were Ilizarov type frames and 154 were hexapods. There were 149 frames which underwent single-stage reloading and 95 frames which underwent a two-stage reloading protocol. Mechanical failure occurred after frame removal in 13 frames (5%), which suffered refracture. There were no cases of change in alignment. There was no difference between refracture patients who underwent single-stage or two-stage reloading protocols (p = 0.772). In all, 14 patients had failure prevented through identification with the reloading protocol.

Conclusion: Our reloading protocol is a simple and effective way to confirm the timing of frame removal and minimize the rate of mechanical failure. Similar failure rates occurred between patients undergoing single-stage and two-stage reloading protocols. If the surgeon is confident with clinical and radiological assessment, it may be possible to progress directly to stage two and decrease frame time and patient morbidity. Cite this article: Bone Jt Open 2022;3(5):359-366.

Keywords: CT scanning; Clinicians; Mechanical failure; Nonunion; Refracture; deformity; dynamization; failure; fracture sites; frame removal; hexapod; ilizarov; morbidity; nonunion; radiography; refracture; reloading; trauma.

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Conflict of interest statement

ICMJE COI statement: E. Moulder reports consulting fees, and participation on a data Safety monitoring board or advisory board, for Orthofix; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events, and support for attending meetings and/or travel from Orthofix and Smith & Nephew, all of which is unrelated to this work. H. K. Sharma declares research grants from B Braun and Orthofix; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, and equipment for research from Orthofix and Smith & Nephew; and being President Elect and past Treasurer of the British Limb Reconstruction Society, and chair of the Chair, limb reconstruction committee, of SICOT, all of which is also unrelated.

Figures

Fig. 1
Fig. 1
The protocol in standard scenarios. Stage one: the nuts are loosened at the end of each threaded rod to allow axial movement across the fracture site. Stage two: the rods are removed to allow free movement. The protocol can proceed directly to stage two in hexapod frames, with removal of the hexapod struts to allow free movement.
Fig. 2
Fig. 2
Schematic representation of our protocol. (Picture credit: Ms Savni Panandikar).
Fig. 3
Fig. 3
Flow diagram of patients who were included in the study.
See this image and copyright information in PMC

References

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