scholarly journals Bone Defects in Tibia Managed by the Bifocal Versus Trifocal Bone Transport Technique

2021 ◽  
Author(s):  
Alimujiang Abulaiti ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Kai Liu ◽  
Abulaiti Abula ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Demographic Data ◽  
Bone Defects ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Tibial Bone ◽  
Operation Duration ◽  
Transport Technique

Abstract Background: The purpose of this study was to evaluate the clinical effectiveness and determine the differences, if any, between trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8±12.4 years (range 19 to 65 years). 32 patients were treated by bifocal bone transport (BFT) technique, and the other 21 patients were managed by trifocal bone transport (TFT) technique. The demographic data, operation duration, docking time, external fixation time, and external fixation index were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in demographic data and both ASAMI bone and functional scores (P>0.05). The mean defect size and operation duration in TFT (9.4±1.5 cm, 161.9±8.9 minutes) were larger than that in BFT (7.8±1.8 cm, 122.5±11.2 minutes) (P<0.05). The mean docking time, external fixation time, and external fixation index in TFT (65.9±10.8 days, 328.0±57.2 days, 34.8±2.1 days/cm) were all less than those in BFT (96.8±22.6 days, 474.5±103.2 days, 60.8±1.9 days/cm) (P<0.05). Difficulties and complications were more prevalent in the BFT group, while less in the TFT group (P<0.05). Conclusions: Both the trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator achieve satisfactory clinical outcomes. The trifocal bone transport technique can significantly decrease the docking time, external fixation time, external fixation index, difficulties, and complications compared with the bifocal bone transport technique.

scholarly journals Reconstruction of Long Segmental Tibial Bone Defects Caused by Infection using the Bifocal or Trifocal Bone Transport Technique with Monolateral Rail External Fixator

2021 ◽  
Author(s):  
Alimujiang Abulaiti ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Kai Liu ◽  
Abulaiti Abula ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Demographic Data ◽  
Bone Defects ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Tibial Bone ◽  
Operation Duration ◽  
Transport Technique

Abstract Background: The purpose of this study was to evaluate the clinical effectiveness and determine the differences, if any, between trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8±12.4 years (range 19 to 65 years). 32 patients were treated by bifocal bone transport (BFT) technique, and the other 21 patients were managed by trifocal bone transport (TFT) technique. The demographic data, operation duration, docking time, external fixation time, and external fixation index were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in demographic data and both ASAMI bone and functional scores (P>0.05). The mean defect size and operation duration in TFT (9.4±1.5 cm, 161.9±8.9 minutes) were larger than that in BFT (7.8±1.8 cm, 122.5±11.2 minutes) (P<0.05). The mean docking time, external fixation time, and external fixation index in TFT (65.9±10.8 days, 328.0±57.2 days, 34.8±2.1 days/cm) were all less than those in BFT (96.8±22.6 days, 474.5±103.2 days, 60.8±1.9 days/cm) (P<0.05). Difficulties and complications were more prevalent in the BFT group, while less in the TFT group (P<0.05). Conclusions: Both the trifocal and bifocal bone transport technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator achieve satisfactory clinical outcomes. The trifocal bone transport technique can significantly decrease the docking time, external fixation time, external fixation index, difficulties, and complications compared with the bifocal bone transport technique.

scholarly journals Reconstruction of Long Segmental Tibial Bone Defect Using the Bone Transport Compared to Acute Shortening and Re-lengthening : A Retrospective Study

2021 ◽  
Author(s):  
Feiyu Cai ◽  
Yanshi Liu ◽  
Kai Liu ◽  
Chenchen Fan ◽  
Xiayimaierdan Maimaiti ◽  
...  
Keyword(s):  
External Fixation ◽  
Bone Defect ◽  
Demographic Data ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Acute Shortening

Abstract Background: Ilizarov technique has been widely used to salvage bone defects. However, treating large bone defects remains a challenge for surgeons. The aim of this study was to compare bone transport with acute shortening/re-lengthening in a series of large tibial segmental defects.Method: A total of 39 patients (29 males, 10 females) with large tibial segmental defects were treated with the Ilizarov technique (Group A: bone transport in 23 cases; Group B: acute shortening/re-lengthening 16 in cases) from March 2010 to December 2018. The mean age was 38.7 years (range24 years to 55 years). The average bone defect size was 8.82 cm (range from 6 cm to 12 cm). The demographic data, operation duration, docking time, external fixation time, and external fixation index were retrospectively documented and analyzed. Complications that occur during the treatment were classified. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Result: There were no statistically significant differences (P>0.05) in the demographic data of the two groups. There was no significant difference in operation duration between the two groups. The docking time in group A was longer than that in group B (93.26±19.52 days, 58.44±14.23 days, P<0.001). No statistical significance was obversed for the external fixation time in the two groups (330.87±88.52 days in group A, 321.25±56.67 days in group B,P=0.704). A higher external fixation index was presented in group A (38.32±5.39 days/cm) than group B (35.17±2.14 days/cm) (P=0.033). There was no significant difference between the two groups in ASAMI bone results and functional results (Table 4). Complications were more prevalent in group A (28 complications of 23 patients), while less in group B (7 complications of 16 patients) (P<0.05).Conclusion: Both bone transport and acute shortening/re-lengthening technique can achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defect caused by infection using a monolateral rail external fixator. The acute shortening/re-lengthening can significantly decrease the docking time, external fixation index, and complications compared with bone transport.

scholarly journals Utility of Ipsilateral Medial Fibular Transport Using the Ilizarov Frame in the Treatment for Non-elderly Patients Sustaining Massive Tibial Bone Defects as a Sequela of Trauma and Infection: A Systematic Review

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Patricio E. Dumlao III ◽  
Gracia Cielo E. Balce
Keyword(s):  
Systematic Review ◽  
External Fixation ◽  
Bone Defect ◽  
External Fixator ◽  
Bone Defects ◽  
Fixation Index ◽  
Tibial Bone ◽  
Ilizarov Frame ◽  
Vascularized Fibula ◽  
The Mean

Introduction and Objectives. Segmental tibial bone loss from tumor, trauma, or infection is a debilitating, limb-threatening scenario where treatment principles involve aggressive resection of infected tissues usually leading to large defects requiring reconstruction. A systematic review was conducted to determine the best available evidence related to the ipsilateral medial fibular transport using the Ilizarov frame in the management of these massive tibial bone defects. Methods. Multiple medical online database search for articles containing the keywords: ipsilateral medial fibular transport, medial fibula transport, medialization of the fibula using the Ilizarov fixator, ring external fixator, vascularized free fibula, vascularized fibula transfer, and other related MeSH terms was done. Data was summarized to describethe mean age, bone defect, external fixator time, external fixator index, and bone and functional results using the ASAMI criteria. Results. Eight studies with a total of 43 patients with massive tibial bone defects treated by fibular transport using the Ilizarov methods were identified. The mean age was 25.27 years (6.5-44.4) with a mean bone defect of 13.57 cm (9.52-17). The mean length of follow-up was 37.67 months (18-70.2). The bone union rate was 100%. Mean external fixation time was 9.59 months (8.31-10.88) and external fixation index was 0.61 months/cm (0.52-0.70). The majority of patients have an excellent bone (84%) and functional (52%) results. The average rate of complication was determined at 0.74/patient (95% CI, 0.60-0.89). The most common complications include pin-tract infection (37%), residual loss of motion/stiffness of knee and ankle (35%), and pain on the transport site (21%). Conclusion. Ipsilateral medial fibular transport using the Ilizarov frame provides a viable alternative treatment option for the treatment of massive tibial bone defects.

scholarly journals Efficacy of trifocal versus bifocal bone transport on large tibial bone defect: a systematic review and meta-analysis

2021 ◽  
Vol 9 (7) ◽  
pp. 2084
Author(s):  
I. Wayan Subawa ◽  
Putu Astawa ◽  
Priza Razunip ◽  
Anak A. G. D. Maha Putra ◽  
Gede M. Putra ◽  
...  
Keyword(s):  
Bone Loss ◽  
External Fixation ◽  
Bone Defect ◽  
Meta Analysis ◽  
Bone Transport ◽  
Fixation Index ◽  
Cochrane Library ◽  
Tibial Bone ◽  
Segmental Bone ◽  
Transport Technique

One of the most common long-term complication of chronic osteomyelitis of tibia is segmental bone loss. One of the methods to manage the segmental bone loss in osteomyelitis is bone transport technique, which is able to reconstruct a defect of more than 6 cm. This paper aims to systematically review and analyze the outcome of bifocal and trifocal bone distraction technique on the tibial bony defect. A comprehensive literature search was performed using PubMed, Google Scholar, and Cochrane library. The inclusion criteria were any studies about comparison between bifocal bone transports with trifocal bone transport in management of large tibial bone defect. The outcomes assessed includes external fixation index, duration of regenerate consolidation, lengthening speed, bone transport distance, and operating time. Two studies reported shorter external fixation index in total of 57 fractures in the trifocal group and 61 fractures in the bifocal group. The meta-analysis showed significant difference in external fixation index between the two groups (Figure 1; RR=-44.37; 95% CI 73.73-15.01; p<0.0001) with significant heterogeneity (Chi square=11.38, p=0.0007); I2: 91%. Although only two studies were compared, both studies had almost similar subjects, and shown that trifocal bone transport technique had faster external fixator index compared to the bifocal bone transport group in the setting of severe bone loss in tibial fracture.

scholarly journals Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052092040
Author(s):  
Yao Lu ◽  
Teng Ma ◽  
Cheng Ren ◽  
Zhong Li ◽  
Liang Sun ◽  
...  
Keyword(s):  
External Fixation ◽  
Locking Plate ◽  
Short Form ◽  
Clinical Results ◽  
Bone Transport ◽  
Fixation Index ◽  
Fixation Time ◽  
Sf 36 ◽  
Health Related ◽  
The Mean

Objective To evaluate the effectiveness of bone transport involving circular external fixation and locking plate application for the treatment of segmental tibial defects. Methods A retrospective review of 12 patients with segmental tibial defects who underwent bone transport with circular external fixation and locking plate application. We evaluated external fixation time, external fixation index, time to achieve union, and complications. Clinical results were assessed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) score. Generic health-related outcome was assessed using the 36-Item Short-Form Health Survey questionnaire (SF-36). Results The mean follow-up was 25.8 months, and the mean defect size was 6.7 cm. All of the patients achieved union at the distraction callus and docking site. The average external fixation time was 299.5 days. The mean external fixation index was 16.5 days/cm, and the mean healing index was 44.9 days/cm. The functional outcomes were excellent in eight cases and good in four. The average SF-36 score was 92. Conclusion Bone transport with external fixation and locking plate application may be a promising method for the treatment of segmental tibial defects.

scholarly journals Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

scholarly journals Treatment options for infected bone defects in the lower extremities: free vascularized fibular graft or Ilizarov bone transport?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Gao-hong Ren ◽  
Runguang Li ◽  
Yanjun Hu ◽  
Yirong Chen ◽  
Chaojie Chen ◽  
...  
Keyword(s):  
External Fixation ◽  
Lower Extremities ◽  
Bone Defects ◽  
Bone Transport ◽  
Fixation Time ◽  
Fibular Graft ◽  
Treatment Groups ◽  
Free Vascularized Fibular Graft ◽  
Ilizarov Bone Transport ◽  
The Times

Abstract Objective The objective was to explore the relative indications of free vascularized fibular graft (FVFG) and Ilizarov bone transport (IBT) in the treatment of infected bone defects of lower extremities via comparative analysis on the clinical characteristics and efficacies. Methods The clinical data of 66 cases with post-traumatic infected bone defects of the lower extremities who underwent FVFG (n = 23) or IBT (n = 43) from July 2014 to June 2018 were retrieved and retrospectively analyzed. Clinical characteristics, operation time, and intraoperative blood loss were statistically compared between two groups. Specifically, the clinical efficacies of two methods were statistically evaluated according to the external fixation time/index, recurrence rate of deep infection, incidence of complications, the times of reoperation, and final functional score of the affected extremities. Results Gender, age, cause of injury, Gustilo grade of initial injury, proportion of complicated injuries in other parts of the affected extremities, and numbers of femoral/tibial defect cases did not differ significantly between treatment groups, while infection site distribution after debridement (shaft/metaphysis) differed moderately, with metaphysis infection little more frequent in the FVFG group (P = 0.068). Femoral/tibial defect length was longer in the FVFG group (9.96 ± 2.27 vs. 8.74 ± 2.52 cm, P = 0.014). More patients in the FVFG group presented with moderate or complex wounds with soft-tissue defects. FVFG treatment required a longer surgical time (6.60 ± 1.34 vs. 3.12 ± 0.99 h) and resulted in greater intraoperative blood loss (873.91 ± 183.94 vs. 386.08 ± 131.98 ml; both P < 0.05) than the IBT group, while average follow-up time, recurrence rate of postoperative osteomyelitis, degree of bony union, and final functional scores did not differ between treatment groups. However, FVFG required a shorter external fixation time (7.04 ± 1.72 vs. 13.16 ± 2.92 months), yielded a lower external fixation index (0.73 ± 0.28 vs. 1.55 ± 0.28), and resulted in a lower incidence of postoperative complications (0.87 ± 0.76 vs. 2.21±1.78, times/case, P < 0.05). The times of reoperation in the two groups did not differ (0.78 ± 0.60 vs. 0.98 ± 0.99 times/case, P = 0.615). Conclusion Both FVFG and IBT are effective methods for repairing and reconstructing infected bone defects of the lower extremities, with unique advantages and limitations. Generally, FVFG is recommended for patients with soft tissue defects, bone defects adjacent to joints, large bone defects (particularly monocortical defects), and those who can tolerate microsurgery.

scholarly journals Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Tao Zhang ◽  
Aihemaitijiang Yusufu
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
Demographic Data ◽  
Deformity Correction ◽  
Parameter Measurement ◽  
Fixation Time ◽  
Trauma Patients ◽  
Group I ◽  
Outcomes Evaluation

Abstract Background It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. Methods We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group I) and 34 patients under the control of foot ring during the radiographic process (Group II). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner–Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. Results Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.3 days) (P < 0.05). Conclusions The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

scholarly journals Bone transport versus acute shortening for the management of infected tibial bone defects: A meta-analysis

2020 ◽  
Author(s):  
Hongjie Wen ◽  
Shouyan Zhu ◽  
Canzhang Li ◽  
Yongqing Xu
Keyword(s):  
Bone Grafting ◽  
Meta Analysis ◽  
Functional Results ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Union ◽  
Fixation Index ◽  
Cochrane Library ◽  
Tibial Bone ◽  
Acute Shortening

Abstract Background: The treatment for infected tibial bone defects can be a great challenge for the orthopaedic surgeon. This meta-analysis was conducted to compare the efficacy and safety between bone transport (BT) and the acute shortening technique (AST) in the treatment of infected tibial bone defects.Methods: A literature survey was conducted by searching the PubMed, Web of Science, Cochrane Library, and Embase databases together with the China National Knowledge Infrastructure (CNKI) and the Wanfang database for articles published up to 9 August 2019. The Newcastle-Ottawa scale (NOS) was adapted to evaluate the bias and risks in each eligible study. The data of the external fixation index (EFI), bone grafting, bone and functional results, complications, bone union time and characteristics of participants were extracted. RevMan v.5.3 was used to perform relevant statistical analyses. Relative risk (RR) was used for the binary variables and standard mean difference (SMD) for continuous variables. Each variable included its 95% confidence interval (CI).Results: Five studies, including a total of 199 patients, were included in the meta-analysis. Statistical significance was observed in the EFI (SMD = 0.63, 95% CI: 0.25, 1.01, P = 0.001) and bone grafting (RR = 0.26, 95%CI: 0.15, 0.46, P <0.00001); however, no significance was observed in bone union time (SMD = –0.02, 95% CI: –0.39, 0.35, P = 0.92), bone results (RR = 0.97, 95% CI: 0.91, 1.04, P = 0.41), functional results (RR = 0.96, 95% CI: 0.86, 1.08, P = 0.50) and complications (RR = 0.76, 95% CI: 0.41, 1.39, P = 0.37).Conclusions: AST is preferred from the aspect of minimising the treatment period, whereas BT is superior to AST for reducing bone grafting. Due to the limited number of trials, the meaning of this conclusion should be taken with caution for infected tibial bone defects.Trial registration: PROSPERO CRD42019133659

scholarly journals Improving Postoperative Radiographs for the Correction Planning of Hexapod External Fixator Using an Additional Foot Ring

2021 ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Xingpeng Zhang ◽  
Hong Li ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Demographic Data ◽  
Deformity Correction ◽  
Radiological Examination ◽  
Fixation Time ◽  
Trauma Patients ◽  
X Rays ◽  
Examination Time ◽  
Mean Time

Abstract Background: It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the correction planning of hexapod external fixator.Methods: We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for fracture reduction planning were obtained under the control of an additional foot ring. In this simple way, the radiologist and the patient himself can easily control the rotation position of the limb while taking the radiographs, and the two X-rays are orthogonal to each other. The final data consisted of 47 patients in traditional radiographs (Group Ⅰ) and 34 patients under the control of foot ring during the radiographic process (Group Ⅱ). The demographic data, original postoperative deformities, number of repeated radiographs after the first postoperative radiological examination, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed.Results: Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, and external fixation time (P>0.05). The mean number of repeated radiographs after the first postoperative radiological examination (1.2 times) and mean time to the satisfactory reduction achieved (3.0 days) in patients with an additional foot ring used were all less than that (2.1 times, 5.3 days) in patients without foot ring (P<0.05).Conclusions: The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the correction planning of hexapod external fixator. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

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