The Computer-aided Parallel External Fixator for Complex Lower Limb Deformity Correction

Overview

Journal Int J Comput Assist Radiol Surg

Publisher Springer

Specialties General Surgery
Radiology

Date 2017 Aug 9

PMID 28785959

Citations 7

Authors

Mengting Wei

Jianwen Chen

Yue Guo

Hao Sun

Affiliations

Soon will be listed here.

Abstract

Purpose: Since parameters of the parallel external fixator are difficult to measure and calculate in real applications, this study developed computer software that can help the doctor measure parameters using digital technology and generate an electronic prescription for deformity correction.

Methods: According to Paley's deformity measurement method, we provided digital measurement techniques. In addition, we proposed an deformity correction algorithm to calculate the elongations of the six struts and developed a electronic prescription software. At the same time, a three-dimensional simulation of the parallel external fixator and deformed fragment was made using virtual reality modeling language technology. From 2013 to 2015, fifteen patients with complex lower limb deformity were treated with parallel external fixators and the self-developed computer software. All of the cases had unilateral limb deformity. The deformities were caused by old osteomyelitis in nine cases and traumatic sequelae in six cases. A doctor measured the related angulation, displacement and rotation on postoperative radiographs using the digital measurement techniques. Measurement data were input into the electronic prescription software to calculate the daily adjustment elongations of the struts. Daily strut adjustments were conducted according to the data calculated. The frame was removed when expected results were achieved. Patients lived independently during the adjustment.

Results: The mean follow-up was 15 months (range 10-22 months). The duration of frame fixation from the time of application to the time of removal averaged 8.4 months (range 2.5-13.1 months). All patients were satisfied with the corrected limb alignment. No cases of wound infections or complications occurred.

Conclusions: Using the computer-aided parallel external fixator for the correction of lower limb deformities can achieve satisfactory outcomes. The correction process can be simplified and is precise and digitized, which will greatly improve the treatment in a clinical application.

Citing Articles

Complications after cosmetic limb lengthening, a specialized center experience.

Al Ramlawi A, Over D, Assayag M, McClure P J Orthop. 2025; 61:7-11.

PMID: 40051788 PMC: 11882336. DOI: 10.1016/j.jor.2024.09.011.

Measurement of the dynamic axial load-share ratio in vivo could indicate sufficient callus healing in external fixators.

Fu X, Liu S, Wang N, Ji Y, Lu L, Chen T BMC Musculoskelet Disord. 2025; 26(1):139.

PMID: 39940030 PMC: 11817624. DOI: 10.1186/s12891-025-08353-0.

Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation.

Li J, Wang W, Yang H, Li B, Liu L Orthop Surg. 2022; 14(10):2447-2454.

PMID: 36001696 PMC: 9531104. DOI: 10.1111/os.13399.

Retrospective clinical outcomes in the definitive treatment of high-energy tibial diaphyseal fractures using hexapod external fixator versus monolateral external fixator.

Liu Y, Liu K, Cai F, Zhang X, Li H, Zhang T BMC Musculoskelet Disord. 2022; 23(1):330.

PMID: 35395846 PMC: 8991465. DOI: 10.1186/s12891-022-05257-1.

Intraoperative acute correction versus postoperative gradual correction for tibial shaft fractures with multiplanar posttraumatic deformities using the hexapod external fixator.

Liu Y, Cai F, Liu K, Zhang X, Li H, Fu X BMC Musculoskelet Disord. 2021; 22(1):803.

PMID: 34537029 PMC: 8449448. DOI: 10.1186/s12891-021-04505-0.

References

Dahl M, Gulli B, Berg T . Complications of limb lengthening. A learning curve. Clin Orthop Relat Res. 1994; (301):10-8. View

Seide K, Faschingbauer M, Wenzl M, Weinrich N, Juergens C . A hexapod robot external fixator for computer assisted fracture reduction and deformity correction. Int J Med Robot. 2007; 1(1):64-9. DOI: 10.1002/rcs.6. View

Manner H, Huebl M, Radler C, Ganger R, Petje G, Grill F . Accuracy of complex lower-limb deformity correction with external fixation: a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop. 2009; 1(1):55-61. PMC: 2656701. DOI: 10.1007/s11832-006-0005-1. View

Schiedel F, Vogt B, Wacker S, Popping J, Bosch K, Rodl R . Walking ability of children with a hexapod external ring fixator (TSF®) and foot plate mounting at the lower leg. Gait Posture. 2012; 36(3):500-5. DOI: 10.1016/j.gaitpost.2012.05.006. View

El Barbary H, Ghani H, Misbah H, Salem K . Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Int Orthop. 2005; 29(3):182-5. PMC: 3456886. DOI: 10.1007/s00264-005-0638-6. View

MONTICELLI G, Spinelli R . Limb lengthening by epiphyseal distraction. Int Orthop. 1981; 5(2):85-90. DOI: 10.1007/BF00267837. View

Gubin A, Borzunov D, Malkova T . The Ilizarov paradigm: thirty years with the Ilizarov method, current concerns and future research. Int Orthop. 2013; 37(8):1533-9. PMC: 3728395. DOI: 10.1007/s00264-013-1935-0. View

Stanitski D, Dahl M, Louie K, Grayhack J . Management of late-onset tibia vara in the obese patient by using circular external fixation. J Pediatr Orthop. 1998; 17(5):691-4. DOI: 10.1097/00004694-199709000-00021. View

Coogan P, Fox J, Fitch R . Treatment of adolescent Blount disease with the circular external fixation device and distraction osteogenesis. J Pediatr Orthop. 1996; 16(4):450-4. DOI: 10.1097/00004694-199607000-00006. View

10.

Rodl R, Leidinger B, Bohm A, Winkelmann W . [Correction of deformities with conventional and hexapod frames--comparison of methods]. Z Orthop Ihre Grenzgeb. 2003; 141(1):92-8. DOI: 10.1055/s-2003-37296. View

11.

Raskolnikov D, Slover J, Egol K . The use of a multiplanar, multi-axis external fixator to achieve knee arthrodesis in a worst case scenario: a case series. Iowa Orthop J. 2013; 33:19-24. PMC: 3748878. View

12.

Paley D, Herzenberg J, Tetsworth K, McKie J, Bhave A . Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am. 1994; 25(3):425-65. View

13.

Dammerer D, Kirschbichler K, Donnan L, Kaufmann G, Krismer M, Biedermann R . Clinical value of the Taylor Spatial Frame: a comparison with the Ilizarov and Orthofix fixators. J Child Orthop. 2012; 5(5):343-9. PMC: 3179531. DOI: 10.1007/s11832-011-0361-3. View

14.

Kuchenmeister J . Three-dimensional adaptive coordinate transformations for the Fourier modal method. Opt Express. 2014; 22(2):1342-9. DOI: 10.1364/OE.22.001342. View

15.

Paley D, Tetsworth K . Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia. Clin Orthop Relat Res. 1992; (280):65-71. View

16.

Ganger R, Radler C, Speigner B, Grill F . Correction of post-traumatic lower limb deformities using the Taylor spatial frame. Int Orthop. 2009; 34(5):723-30. PMC: 2903157. DOI: 10.1007/s00264-009-0839-5. View

17.

Takata M, Vilensky V, Tsuchiya H, Solomin L . Foot deformity correction with hexapod external fixator, the Ortho-SUV Frame™. J Foot Ankle Surg. 2013; 52(3):324-30. DOI: 10.1053/j.jfas.2013.01.013. View

18.

Gunes T, Erdem M, Bostan B, Yeniel K, Sen C . Quality of life in patients with varus gonarthrosis treated with high tibial osteotomy using the circular external fixator. Knee Surg Sports Traumatol Arthrosc. 2008; 16(3):311-6. DOI: 10.1007/s00167-007-0473-y. View

19.

BIANCHI MAIOCCHI A . Historical review of the method according to Ilizarov. 15 years after its worldwide application. Bull Hosp Jt Dis. 1997; 56(1):16-8. View

20.

Blondel B, Launay F, Glard Y, Jacopin S, Jouve J, Bollini G . Hexapodal external fixation in the management of children tibial fractures. J Pediatr Orthop B. 2010; 19(6):487-91. DOI: 10.1097/BPB.0b013e32833dec5d. View