A Comparative Study of Taylor Spatial Frame and Monolateral External Fixator for Treating Infected Tibial Defects With Concomitant Soft Tissue Loss.

OBJECTIVE

The management of infectious tibial defects with concomitant soft tissue loss (ITD-STL) continues to pose substantial clinical challenges in orthopedic practice. This study aimed to compare the clinical efficacy of the Taylor Spatial Frame (TSF) versus the Monolateral External Fixator (MEF) in achieving bone and soft tissue reconstruction for ITD-STL.

METHODS

A retrospective cohort study was performed on 49 consecutive patients with ITD-STL admitted between July 2010 and September 2022. The dataset included 25 patients who received treatment with the TSF, whereas 24 patients underwent treatment with the MEF. Demographic information, wound healing time, bone healing index, external fixation index, cost of hospitalization, and complications were recorded and compared between the two groups. Bone healing and functional recovery were assessed at the last follow-up (mean 18.8 months postoperatively; range 12-24 months) using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) score. Then, statistical analysis such as independent samples t tests or chi-Square test was performed.

RESULTS

The wound healing time was (89.5 ± 30.6 days) in the TSF group and (86.2 ± 31.8 days) in the MEF group (p > 0.05). The bone healing index was (45.49 ± 11.99 d/cm) in the TSF group and (48.20 ± 13.01 d/cm) in the MEF group (p > 0.05). The external fixation index of the TSF group (52.4 ± 7.2 d/cm) was significantly lower than the MEF group (58.6 ± 10.3 d/cm) (p < 0.05). The total hospitalization cost was significantly higher in the TSF group compared to the MEF group (67.16 ± 2.46 thousand RMB vs. 42.67 ± 2.35 thousand RMB; p < 0.05). The overall complication rate was significantly lower in the TSF group (56%) than in the MEF group (75%). At the final follow-up, no significant differences in the ASAMI scores were observed between the two groups (p > 0.05).

CONCLUSION

The use of TSF and MEF for ITD-STL can achieve bone reconstruction and soft tissue repair via bone transport, yielding a positive therapeutic effect. However, TSF treatment is a superior method, characterized by better biomechanical properties and fewer complications, particularly in the correction of postoperative tibial axial deviation. However, these benefits might be offset by the economic costs they could entail.