[Comparison between Taylor spatial frame and Ilizarov circular frame in treatment of large-segment tibial bone...

To compare the effectiveness of bone transport using the Taylor spatial frame (TSF) versus the Ilizarov circular frame (ICF) in the treatment of long-segment tibial bone defects.

A retrospective analysis was performed on the clinical data of 44 patients with large-segment tibial bone defects who met the selection criteria and received surgical treatment between January 2011 and December 2024. The patients were divided into the TSF group (25 cases) and the ICF group (19 cases) according to different external fixation methods. There was no significant difference in baseline data including gender, age, bone defect length, defect etiology, and number of previous operations between the two groups ( P>0.05). The operation time, external fixation duration, external fixation index, and postoperative complications were recorded and compared between the two groups. At last follow-up, the medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) were measured. The Hospital for Special Surgery (HSS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and the bone and functional evaluation criteria of the Association for the Study and Application of the Method of Ilizarov (ASAMI) were adopted to evaluate the affected limb function, and the range of motion of the knee and ankle joints.

All patients in both groups successfully completed the operation. The TSF group had a significantly shorter operation time than the ICF group ( P<0.05), while there was no significant difference in external fixation duration, or external fixation index between the two groups ( P>0.05). All patients were followed up 12-36 months, with an average of 18.5 months. At last follow-up, the MPTA and PPTA in the TSF group returned to the normal range, whereas those in the ICF group deviated from the normal values, and the differences between the two groups were significant ( P<0.05). No significant difference was observed between the two groups in HSS score, AOFAS score, maximum knee flexion range of motion, and maximum ankle plantarflexion and dorsiflexion range of motion ( P>0.05). The TSF group achieved superior ASAMI bone evaluation results compared with the ICF group ( P<0.05), while no significant difference was found in ASAMI functional evaluation between the two groups ( P>0.05). No severe intraoperative neurovascular injury occurred in either group. Superficial pin tract infection occurred in 9 patients in the TSF group and 8 patients in the ICF group, which was controlled after conservative treatment. One patient in the ICF group developed deep pin tract infection and recovered after surgical debridement. Axial deviation was found in 3 cases in the ICF group. Delayed union of the docking site occurred in 2 cases in the TSF group and 3 cases in the ICF group. Refracture after frame removal was observed in 1 case in the TSF group. Ankle stiffness occurred in 2 cases in the TSF group and 3 cases in the ICF group, and all patients recovered after corresponding symptomatic treatment. There was a significant difference in the overall incidence of complications between the two groups (TSF group 36.0% vs ISF group 68.4%, P<0.05).

Both TSF and ICF bone transport techniques can effectively repair large-segment tibial bone defects and achieve reliable bone healing and limb functional recovery. Compared with ICF, TSF has the advantages of shorter operation time, higher postoperative three-dimensional orthopedic accuracy, and better recovery of limb alignment.