Medical Professional Publications

Another Viable Option for Multiplanar Corrections of Tibial Deformities

Columbus, OH — July 2017

The TruLok Hexapod (TL Hex) external fixator effectively corrected angular abnormalities, lengthened the lower leg after surgery and restored mechanical axis, surgeons from Nationwide Children's Hospital and Timone Children's Hospital, Aix-Marseille University, have found.

Their retrospective study of 31 patient tibias corrected with the device shows the outcomes are comparable to those of the Taylor Spatial Frame fixator, which has been on the market nearly two decades longer, and other fixators.

"The true meaning of the study is we have an additional sophisticated way to correct tibial deformities in children, and this and other devices allow us to do complex surgeries safely and reliably," says Christopher Iobst, MD, director of the new Center for Limb Lengthening and Reconstruction within the Department of Orthopaedics at Nationwide Children's and a study author.

Fixators encircle the lower leg with a metal frame connected to bone with percutaneous wires or half-pins. The rings of the frame are attached to telescoping struts that surgeons manipulate to make multiplanar corrections of a child's bone deformities. The study is in the journal Orthopaedics & Traumatology: Surgery & Research.

The researchers reviewed the medical records of 15 boys and 11 girls whose mean age at surgery was 12 years old. Their tibial deformities were due to congenital defects, Blount's disease, pseudo-achondroplasia and other causes. Eleven children had undergone prior surgery for their tibial conditions.

For all tibias, mechanical axis deviation and limb length discrepancy goals were achieved. For tibias managed with proximal osteotomy, mean medial proximal tibial angle improved from 80.6 degrees to 88.5 degrees.

Following surgery, the device remained on the lower leg from 90 to 241 days. Children could bear full weight on the leg after an average of 45 days.

Complications included fractures in two cases, superficial pin tract infections in 16, and deep-seated infection in one case. All were considered mild to moderate complications.

Dr. Iobst, who is also a clinical associate professor of Orthopaedic Surgery at The Ohio State University College of Medicine, is an educational consultant for makers of both the TruLok and Taylor devices and teaches other surgeons how to use their respective products.

"I try to learn about each device that comes on the market, so I can choose what's best for my patient," Dr. Iobst says. 

Surgeons used to the Taylor system will find many similarities with the TruLok, and it appears outcomes are likely to be the same for most people, Iobst says.

"The advantage may be TruLok's software, which is a little more sophisticated."

Reference:
Presenti S, Iobst CA, Launay F. Evaluation of the external fixator TrueLok Hexapod System for tibial deformity correction in children. Orthopaedics & Traumatology: Surgery & Research. 2017 Apr 17. [Epub ahead of print]

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