SLR - July 2019 - Matthew B. Engelthaler

Two-Stage Correction Using the Taylor Spatial Frame for Severe Hindfoot Deformity in A Patient with Marfan Syndrome: A Case Report

Reference: Ohashi S, Ikoma K, Kido M, Oka Y, Kim W and Kubo T. Two-Stage Correction Using the Taylor Spatial Frame for Severe Hindfoot Deformity in A Patient with Marfan Syndrome: A Case Report. Journal of Orthopaedic Science. 2019 Jan 01, 24(1), 178-183

Scientific Literature Review

Reviewed By: Matthew B. Engelthaler, DPM
Residency Program: Metrowest Medical Center – Framingham, MA

Podiatric Relevance: The Taylor Spatial Frame (TSF) is one of the more popular external fixation devices being used to treat fractures, malunions, non-unions, and complex deformities as well. With this comes the opportunity of not only limb salvage but even functional gait in patients that otherwise might be non-ambulatory or need proximal amputation.

Method:
A seventy-four-year-old female with history of Marfan syndrome and recurrent inversion injuries of her right ankle at a young age was seen initially in the clinic with a 20-year history of pain and noticeable deformity. The ankle joint had no joint space and was ankylosed. The subtalar joint was also noted to have joint narrowing and subluxation. The hindfoot had 3 degrees of plantar flexion, 50 degrees of inversion, and 42 degrees of internal rotation, when compared to the tibial axis. The decision was made that a two stage corrective procedure would be in the patient’s best interest. First to reduce the deformity with a TSF and then go on for arthrodesis with a TTC nail. A Tibial ring and a foot plate would be used as the subtalar joint was the only deformity requiring correction. The varus was corrected by 30 degrees at the time of surgery and after a three-day wait period, the foot was corrected in 20 days at a rate of 1 mm per day. Once the deformity was corrected (0 degrees of plantar flexion, 0 degrees of inversion, and 28 degrees of internal rotation), arthrodesis of the Talonavicular, subtalar, and ankle joints were done.

Results:
At eight weeks after the surgery, partial weight bearing was allowed and at 12 weeks there was confirmed fusion by radiographs. At this time full weight-bearing was allowed and at 15 months after the surgery the patient could walk with a plantigrade foot with no pain.

Conclusions:
In the recent past the Taylor Spatial Frame has been one of the more popular external fixation devices used in podiatric and orthopedic surgery. This was one example of a case of a patient with marfan syndrome and a severe degree of deformity at the subtalar joint which was corrected and had a positive outcome. This study clearly is limited due to the case report nature as well as a 15 month follow up. It does however show that the TSF is an option in a two stage procedure in which deformity correction needs to be made.

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