Skip to main content
Log in

Improving the accuracy of patient positioning for long-leg radiographs using a Taylor Spatial Frame mounted rotation rod

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Long-leg radiographs are used to plan and supervise the correction of bone deformity in patients treated with the Taylor Spatial Frame (TSF). Often radiographs are performed with malpositioning of the limb leading to wrong alignment measurements. The aim of this retrospective study was to show the usefulness of a simple device which might enhance the reproducibility of limb rotation on long-leg radiographs.

Materials and methods

We included 20 consecutive patients with TSF treatment and at least three long-leg radiographs (4.9 ± 1.3). Eight out of 20 patients received radiographs with the help of a rotation rod (device with two clamps and a carbon tube). It is placed at the most frontal tab of the reference ring while conducting the radiograph. By this means, limb rotation can be controlled. To show the usefulness of this device, two observers measured the relation of the distances between the middle of the reference ring to the medial and lateral fourth hole on the reference ring (TSF-RR). The standard deviation and range of the TSF-RR of all radiographs for each patient was calculated and compared between patients without and with the rotation rod.

Results

The standard deviations of TSF-RR in patients without the rotation rod was significantly higher compared to patients with rotation rod (observer 1: p = 0.0228, observer 2: p = 0.0038). Also, the range of the TSF-RR within one patient is significant higher (observer 1: p = 0.0279, observer 2: p = 0.0038) in patients without the rotation rod compared to patients with the rotation rod.

Conclusions

The variability of rotation on radiographs was lower with the rotation rod. Therefore, more reproducible and better comparable radiographs can be conducted. Radiologic exposure might be reduced as repetition of wrongly positioned limbs on radiographs are less frequent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Fadel M, Hosny G (2005) The Taylor spatial frame for deformity correction in the lower limbs. Int Orthop 29(2):125–129. https://doi.org/10.1007/s00264-004-0611-9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Leiva-Gea A, Delgado-Rufino FB, Queipo-de-Llano A, Mariscal-Lara J, Lombardo-Torre M, Luna-Gonzalez F (2020) Staged upper and lower limb lengthening performing bilateral simultaneous surgery of the femur and tibia in achondroplastic patients. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03360-3

    Article  PubMed  Google Scholar 

  3. Sadek AF, Laklok MA, Fouly EH, Elshafie M (2016) Two stage reconstruction versus bone transport in management of resistant infected tibial diaphyseal nonunion with a gap. Arch Orthop Trauma Surg 136(9):1233–1241. https://doi.org/10.1007/s00402-016-2523-8

    Article  PubMed  Google Scholar 

  4. Meselhy MA, Singer MS, Halawa AM, Hosny GA, Adawy AH, Essawy OM (2018) Gradual fibular transfer by ilizarov external fixator in post-traumatic and post-infection large tibial bone defects. Arch Orthop Trauma Surg 138(5):653–660. https://doi.org/10.1007/s00402-018-2895-z

    Article  PubMed  Google Scholar 

  5. Bezstarosti H, Van Lieshout EMM, Voskamp LW, Kortram K, Obremskey W, McNally MA, Metsemakers WJ, Verhofstad MHJ (2019) Insights into treatment and outcome of fracture-related infection: a systematic literature review. Arch Orthop Trauma Surg 139(1):61–72. https://doi.org/10.1007/s00402-018-3048-0

    Article  CAS  PubMed  Google Scholar 

  6. Rödl R, Leidinger B, Böhm A, Winkelmann W (2003) Correction of deformities with conventional and hexapod frames–comparison of methods. Z Orthop Ihre Grenzgeb 141(1):92–98

    Article  Google Scholar 

  7. Manner HM, Huebl M, Radler C, Ganger R, Petje G, Grill F (2007) 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 1(1):55–61. https://doi.org/10.1007/s11832-006-0005-1

    Article  PubMed  Google Scholar 

  8. Feldman DS, Shin SS, Madan S, Koval KJ (2003) Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor spatial frame. J Orthop Trauma 17(8):549–554. https://doi.org/10.1097/00005131-200309000-00002

    Article  PubMed  Google Scholar 

  9. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25(3):425–465

    CAS  PubMed  Google Scholar 

  10. van Heerwaarden R, Spruijt S, Niemeyer P, Freiling D, Schröter S (2012) Osteotomy: the basics. In: ESSKA instructional course lecture book. Springer, pp 151–162

  11. Paley D, Herzenberg J (2005) Radiographic assessment of lower limb deformities. In: Principles of Deformity Correction, vol 3. Springer, Berlin, Heidelberg, New York, pp 31–60. https://doi.org/10.1007/978-3-642-59373-4_3

  12. Wright JG, Treble N, Feinstein AR (1991) Measurement of lower-limb alignment using long radiographs. J Bone Joint Surg Br 73(5):721–723

    Article  CAS  Google Scholar 

  13. Swanson KE, Stocks GW, Warren PD, Hazel MR, Janssen HF (2000) Does axial limb rotation affect the alignment measurements in deformed limbs? Clin Orthop Relat Res 371:246–252

    Article  Google Scholar 

  14. Lonner JH, Laird MT, Stuchin SA (1996) Effect of rotation and knee flexion on radiographic alignment in total knee arthroplasties. Clin Orthop Relat Res 331(331):102–106. https://doi.org/10.1097/00003086-199610000-00014

    Article  Google Scholar 

  15. Hunt MA, Fowler PJ, Birmingham TB, Jenkyn TR, Giffin JR (2006) Foot rotational effects on radiographic measures of lower limb alignment. Can J Surg 49(6):401–406

    PubMed  PubMed Central  Google Scholar 

  16. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420

    Article  CAS  Google Scholar 

  17. Lee YS, Lee BK, Lee SH, Park HG, Jun DS, Moon DH (2013) Effect of foot rotation on the mechanical axis and correlation between knee and whole leg radiographs. Knee Surg Sports Traumatol Arthrosc 21(11):2542–2547. https://doi.org/10.1007/s00167-013-2419-x

    Article  PubMed  Google Scholar 

  18. Jamali AA, Meehan JP, Moroski NM, Anderson MJ, Lamba R, Parise C (2017) Do small changes in rotation affect measurements of lower extremity limb alignment? J Orthop Surg Res 12(1):77. https://doi.org/10.1186/s13018-017-0571-6

    Article  PubMed  PubMed Central  Google Scholar 

  19. Maderbacher G, Schaumburger J, Baier C, Zeman F, Springorum HR, Dornia C, Grifka J, Keshmiri A (2014) Predicting knee rotation by the projection overlap of the proximal fibula and tibia in long-leg radiographs. Knee Surg Sports Traumatol Arthrosc 22(12):2982–2988. https://doi.org/10.1007/s00167-014-3327-4

    Article  PubMed  Google Scholar 

  20. Radtke K, Becher C, Noll Y, Ostermeier S (2010) Effect of limb rotation on radiographic alignment in total knee arthroplasties. Arch Orthop Trauma Surg 130(4):451–457. https://doi.org/10.1007/s00402-009-0999-1

    Article  PubMed  Google Scholar 

  21. Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RMD, Reijman M, Pols HAP, Bierma-Zeinstra SMA (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204–1211. https://doi.org/10.1002/art.22515

    Article  CAS  PubMed  Google Scholar 

  22. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286(2):188–195. https://doi.org/10.1001/jama.286.2.188

    Article  CAS  PubMed  Google Scholar 

  23. Cooke D, Scudamore A, Li J, Wyss U, Bryant T, Costigan P (1997) Axial lower-limb alignment: comparison of knee geometry in normal volunteers and osteoarthritis patients. Osteoarthritis Cartilage 5(1):39–47. https://doi.org/10.1016/s1063-4584(97)80030-1

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors are not compensated and there are no other institutional subsidies, corporate affiliations, or funding sources supporting this work.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marc-Daniel Ahrend.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest relevant to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahrend, MD., Finger, F., Grünwald, L. et al. Improving the accuracy of patient positioning for long-leg radiographs using a Taylor Spatial Frame mounted rotation rod. Arch Orthop Trauma Surg 141, 55–61 (2021). https://doi.org/10.1007/s00402-020-03460-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03460-0

Keywords

Navigation