Bone Transport with the Taylor Spatial Frame Technique: A Case Series

Abstract

Aim: Bone transport is a beneficial reconstructive method for bone defects caused by infected non-unions or bone tumours. The Taylor Spatial Frame (TSF) is a three-dimensional corrective external fixator that can be used to achieve bone transport and correct any residual deformities easily at any time. This study reports the results of bone transport using TSF.

Materials and methods: This is a retrospective study of ten patients who underwent bone transport using the TSF. The mean age was 32.3 years; the femur was affected in one case and the lower leg in nine. Bone defects were due to infected non-unions in seven cases and bone tumours in three. The duration of external fixation, bone transport distance, distraction index (DI), alignment at the end of correction, leg length discrepancy, and complications were investigated.

Results: The average bone transport distance was 76.0 mm. The external fixation period averaged 367 days with the DI at 20.8 days/cm. Deformity at the docking site was assessed to have an average 2.6° deformity and 2.0 mm translation in the frontal view, as well as 3.3° deformity and 3.7 mm translation in the lateral view. The mean leg length discrepancy was 10.9 mm and the percentage of the mechanical axis (%MA) was 40.6%. Four patients underwent plate conversion after correction and two required additional surgery for non-union at the docking site. Bone union was achieved in all patients and there was no reaggravation of infection or tumour recurrence.

Conclusion: The TSF allowed for the correction of deformities and translations that occurred during bone transport giving excellent results. However, as with bone transport using this or other devices, additional procedures are often needed to obtain consolidation or docking site union.

How to cite this article: Shimokawa K, Matsubara H, Hikichi T, et al. Bone Transport with the Taylor Spatial Frame Technique: A Case Series. Strategies Trauma Limb Reconstr 2023;18(2):117-122.

Keywords: Bone transport; Bone tumour; Non-union; Plate conversion; Taylor Spatial Frame.

Fig. 1

Deformity and translation at the docking site after correction are shown in the graphs and tables underneath

Figs 2A to D

(A) A radiograph at the time of our referral: The defect was filled with a cement spacer; (B to D) Radiographs showing the bone transport course, performed with appropriate adjustments for deformity and translation

Figs 3A to D

(A to C) Radiographs at latest follow-up: The bone union has been achieved; %MA is 44%; almost passing through the knee centre; (D) Clinical photograph at last follow-up (6 years postoperatively): No recurrence of infection

Figs 4A to D

(A) The defect was filled with a cement spacer; (B) The segmental bone was transported from the distal to the proximal end; (C) A radiograph after plate conversion was performed; (D) Radiographs at latest follow-up (4 years postoperatively): The bone union has been achieved

Figs 5A to D

(A) Preoperative radiograph: the patient presents with osteosarcoma findings on the proximal metaphyseal end of the tibia; (B) Intraoperative clinical photograph: the resected tumour bone is shown in the lower right; (C) Postoperative X-ray: showing osteotomy at the distal side for bone transport; (D) The segmental bone was transported to the proximal end

Figs 6A to E

(A) After TSF was removed, nonunion of the docking site became apparent; (B) Additional bone grafting and plate fixation were performed, but the varus deformity remained; (C) Recorrection for varus deformity using TSF was performed; (D) Postoperative radiograph: Plate conversion was performed when TSF removal; (E) Radiographs at latest follow-up (15 years postoperatively): The bone union has been achieved, and the %MA was 29%