Outcome of correction of complex femoral rotational deformities using Taylor Spatial Frame in skeletally immature patients: a retrospective case series

Background: Although the incidence of rotational lower-limb deformity caused by malunited femoral fractures is low, it can alter the force transition across lower limb joints. The aim of the current study was to evaluate the effectiveness of the Taylor Spatial Frame (TSF) in the treatment of severe rotational lower-limb deformities that were caused by neglected malunited femoral fractures in pediatric and adolescent patients. Methods: Fifteen skeletally immature patients, six boys and nine girls with mean age of 10.17 yr (range: 7 to 14 yr), who had rotational deformities of the lower limbs and had osteotomies and application of TSF from March 2012 to February 2016 underwent clinical and radiographic assessments. Results: The osteotomy site was at the middle third of the femur in 12 patients and at the supracondylar region in three patients. The mean correction time for the femoral rotational deformity was 19.6 days (range: 15 to 28 days). The mean time for fixator removal after full correction of rotational deformity and lengthening was 172.67 days (range: 150 to 180 days). The mean preoperative leg-length discrepancy (LLD) was 4.31 cm (range: 2 to 10 cm), and the mean postoperative LLD was 0.27 cm (range: 0 to 2 cm; P<0.001). Femoral torsion was internal in 10 patients and external in five patients. The mean preoperative rotational deformity was 81 degrees (range: 60 to 180 degrees); the mean postoperative rotational deformity decreased significantly to 3.53 degrees (range: 0 to 7 degrees; P<0.001). Conclusions: TSF was effective in treating severe rotational deformities of the lower limbs that were caused by neglected malunited femoral fractures in pediatric and adolescent patients.