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[[File:Taylor Spatial Frame.jpg|thumb|A Taylor Spatial Frame on the left leg consisting of metal rings, pins and struts.]]
The '''Taylor Spatial Frame''' (TSF) is an [[external fixator]] used by [[podiatric]] and [[orthopaedic surgeon]]s to treat [[complex fracture]]s<ref>
{{cite journal | author = Eidelman, M |author2=Katzman, A. | title = Treatment of complex tibial fractures in children with the taylor spatial frame | journal = Orthopedics | date = October 2008 | pmid=19226013 | volume=31|issue=10 }}</ref> and [[bone deformity|bone deformities]]. The medical device shares a number of components and features of the [[Ilizarov apparatus]]. The Taylor Spatial Frame is a [[wiktionary:hexapod|hexapod]] device based on a [[Stewart platform]], and was invented by orthopaedic surgeon Charles Taylor. The device consists of two or more [[aluminum]] or [[carbon fibre]] rings connected by six [[strut]]s. Each strut can be independently lengthened or shortened to achieve the desired result, e.g. compression at the fracture site, lengthening, etc. Connected to a bone by wires or half pins, the attached bone can be manipulated in six axes ([[anterior]]/[[Posterior (anatomy)|posterior]], [[varus deformity|varus]]/[[valgus deformity|valgus]], lengthen/shorten.) Angular, translational, rotational, and length deformities can all be corrected simultaneously with the TSF.

The TSF is used in both adults and children. It is used for the treatment of acute [[fracture]]s, mal-unions, non-unions and [[congenital]] deformities. It can be used on both the upper and lower limbs. Specialised foot rings (as seen in the picture) are also available for the treatment of complex foot deformities.

== Post Operative procedure ==

=== Correcting deformities ===

Once the fixator is attached to the bone, the deformity is characterised by studying the postoperative [[x-ray]]s, or [[CT scans]]. The angular, [[translational]], [[rotational]], and length deformity values are then entered into specialised software, along with parameters such as the ring size and initial strut lengths. The software then produces a "prescription" of strut changes that the patient follows. The struts are adjusted daily by the patient until the correct alignment is achieved.

Correction of the bone deformity can typically take 3–4 weeks. For simpler fractures where no deformity is present the struts may still be adjusted post-surgery to achieve better bone alignment, but the correction takes less time. For individuals performing strut adjustment. a hand mirror may be useful to aid in reading the strut settings.

Once the deformity has been corrected, the frame is then left on the limb until the bone fully heals. This often takes 3–6 months, depending on the nature and degree of deformity.

=== Dynamisation ===

When the bone has sufficiently healed, the frame is dynamised. This is a process of gradually reducing the supportive role of the frame by loosening the struts one at a time. This causes force that was previously transmitted around the fracture site and through the struts to be transmitted through the bone.

=== Removal of frame ===

After a period of dynamisation, the frame can be removed. This is a relatively simple procedure often performed under [[gas and air]] analgesic.

The rings are removed by cutting the olive wires using wire cutters.

The wires are then removed by first sterilising them and then pulling them through the leg using pliers. The threaded half pins are simply unscrewed.

== Use for fractures ==

External fixation via TSFs tends to be less invasive than [[internal fixation]] and therefore has lower risks of infection associated with it. This is particularly relevant for [[open fractures]].

For open [[wikt:comminuted|comminuted]] fractures of the [[tibial plateau fracture|tibial plateau]] the use of circular frames (like TSF) has markedly reduced infection rates.<ref>{{cite journal|last1=Department of Surgery, St. Michael's Hospital and the University of Toronto, ON, Canada.|title=Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial.|date=Dec 2006|pages= 2613–23|pmid=17142411|doi=10.2106/JBJS.E.01416|volume=88|issue=12|journal=J Bone Joint Surg Am|url=http://www.ortopaedi.dk/fileadmin/kurser/2014/traume/download/Plates_vs_Ilizarov_2009.pdf}}</ref>

The time taken for bones to heal (time to union) varies depending on a number of factors. [[Open fractures]] take longer to heal, and infection will delay union. For tibial fractures union is generally achieved after between 3 and 6 months,<ref name="pmid23943063">{{cite journal|vauthors=Barron E, Rambani R, Bailey H, Sharma HK | title=Cost implications of the physiotherapy management of complex tibial fractures treated with circular frames. | journal=Strategies Trauma Limb Reconstr | year= 2013 | volume= 8 | issue= 3 | pages= 169–71 | pmid=23943063 | doi=10.1007/s11751-013-0173-8 | pmc=3800517 }}</ref> though time to union can be rather subjective,<ref name="pmid16798998">{{cite journal|vauthors=Patil S, Montgomery R | title=Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. | journal=J Bone Joint Surg Br | year= 2006 | volume= 88 | issue= 7 | pages= 928–32 | pmid=16798998 | doi=10.1302/0301-620X.88B7.17639 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16798998 }}</ref> and the dynamistion process combined with irregular appointments may interfere with these measures.

==Infection==

{{multiple image|caption_align=center|header_align=center
| align = right
| total_width = 400

| image1 = TSF pin site with a lot of dried exudate.jpg
| caption1 = Site with a lot of dried exudate that might merit dressing

| image2 = Taylor spatial frame pin site with weeping exudate.jpg
| caption2 = Site with "weeping" exudate that might merit dressing

| image3 = Taylor spatial frame pin site with crust.jpg
| caption3 = Site with crust and no exudate: some advice suggests maintaining crust

| footer = Pin sites in various states
}}

Infection of the pin sites (points where wires enter the skin) of the TSF is a common complication (estimates are that it affects 20% percent of patients). In extreme cases this can result in [[osteomylitis]] which is difficult to treat. However, pin site infections are normally successfully treated with a combination of oral antibiotics, [[intravenous]] antibiotics, or removal of the affected pin.

Pin sites are classified as [[percutaneous]] wounds

Best practice for maintenance of pin sites is unclear and requires more study.<ref>{{cite web|last1=Timms, Vincent, Santy-Tomlinson, Hertz|title=Guidance on pin site care|url=http://www.rcn.org.uk/__data/assets/pdf_file/0009/413982/004137.pdf|website=Royal College of Nursing|publisher=Royal College of nursing|accessdate=15 November 2015}}</ref> Common practice involves the regular cleaning of the pin sites with [[chlorhexidine gluconate]] solution (advice varies from every day to every week), regular showering, and dressing of sites that exude liquid with non-woven gauze soaked in chlorhexidine gluconate. This dressing can be held in place with bungs or makeshift clips or by twisting around the wire.

Advice varies as to whether scab tissue or any "crust" surrounding a pin site should be maintained. With some literature arguing that this acts as a barrier to entry, while other literature argues this may increase the risk of infection.

==Cost of treatment==

The taylor spatial frame is a general tool for fixating and moving bone fragments in a gradual way. This means that costs can vary dramatically.

The cost of a frame itself was around 2,500 pounds sterling in 2006
<ref name="pmid16798998 cost breakdown">{{cite journal|vauthors=Patil S, Montgomery R | title=Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. | journal=J Bone Joint Surg Br | year= 2006 | volume= 88 | issue= 7 | pages= 928–32 | pmid=16798998 | doi=10.1302/0301-620X.88B7.17639 | pmc= | url=http://m.bjj.boneandjoint.org.uk/content/88-B/7/928/T5.expansion.html }}</ref> though this cost will vary depending on the number of components in the frame.

Cases involving treatment of nonunion of fracture are complicated and time-consuming with costs of around 30,000 pounds sterling in 2006
<ref name="pmid16798998"/>
and treatment can take between 1 and 2 years. Of these costs about 23,000 pound sterling reflect follow-up outpatient treatment and cost for hospital stays, which can vary dramatically between patients.

==See also==
* [[Distraction osteogenesis]]
* [[Bone fracture]]
* [[Trauma surgery]]
* [[Traumatology]]
* [[External fixation]]

==References==
{{reflist}}
== Further reading ==
* {{cite book|ref=harv|title=Textbook of orthopedics and trauma|editor1-first=G.S.|editor1-last=Kulkarni|edition=2nd|publisher=Jaypee Brothers Publishers|year=2008|isbn=9788184482423|first=Milind|last=Choudhuri|chapter=Taylor Spatial Frame}}
* {{cite patent
| country = US
| number = 6129727A
| status = Active
| title = Orthopaedic spatial frame apparatus
| pubdate = 2000-10-10
| fdate = 1999-03-02
| pridate = 1999-03-02
| invent1 = Ed Austin
| invent2= Anthony James
| invent3 = James E. Orsak
| assign1 = Smith and Nephew Inc

}}.

== External links ==
* [http://www.bonefixator.com/fracture_fixation/taylor_spatial_frame_1.html Information on Taylor Spatial Frame (TSF), design, geometry, advantages and limitations]
* [http://www.smartcorrection.com Smart Correction Application for Hexapod Fixator with Radiographic Navigation Software]

[[Category:Orthopedic surgical procedures]]
[[Category:Orthopaedic instruments]]
{{dictionary-stub1}}

Taylor Spatial Frame - Revision history

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