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

Area of Science:

• Orthopedic surgery
• Biomechanical engineering
• Trauma care

Background:

• Circular frames are essential for treating complex fractures and deformities.
• The timing of frame removal is critical to prevent refracture and minimize patient morbidity.
• Assessing the bone's healing and load-bearing capacity before frame removal is challenging.

Purpose of the Study:

• To evaluate the effectiveness of a staged reloading protocol in minimizing mechanical failure after circular frame removal.
• To compare the incidence of mechanical failure between single-stage and two-stage reloading protocols.
• To identify risk factors associated with mechanical failure.

Main Methods:

• A retrospective analysis of 244 circular frames (Ilizarov and hexapod) from 230 patients undergoing trauma or elective treatment.
• Implementation of either a single-stage or two-stage reloading protocol involving progressive weight-bearing before frame removal.
• Monitoring patients for increased pain and assessing radiographs for deformity or refracture before protocol progression.

Main Results:

• Overall mechanical failure (refracture) occurred in 5% of frames (13/244) after removal.
• No significant difference in refracture rates was observed between single-stage (149 frames) and two-stage (95 frames) reloading protocols (p = 0.772).
• The reloading protocol successfully identified and prevented failure in 14 patients prior to frame removal.

Conclusions:

• The staged reloading protocol is a simple and effective method for optimizing circular frame removal timing and reducing mechanical failure rates.
• Both single-stage and two-stage reloading protocols demonstrated similar low rates of mechanical failure.
• Surgeons may consider advancing to the second stage directly if clinical and radiological assessments are confidently favorable, potentially reducing treatment duration and patient morbidity.