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At the Forefront of Orthopaedic Computer-assisted Surgery


Patients of all ages, with a wide range of foot, ankle, and leg conditions, including new fractures, non-healing bones, infected bones, diabetic leg complications, joint contractures, and congenital deformities are receiving successful treatment at Georgetown University Hospital with surgery that combines an advanced external fixation device called the Taylor Spatial Frame and computer-assisted surgery (Spatial CAD).

The Frame consists of two rings connected by six struts, each of which can be independently lengthened or shortened. It can be used to correct angulation, translation, rotation, and/or length discrepancy. Francis Xavier McGuigan, MD, professor of orthopaedic surgery at Georgetown, says: “For many patients with deformities, you cannot get the degree of correction attainable using this device with traditional orthopaedic hardware and methods.”

“I adapt the Frame to the patient and the problem,” says McGuigan, who has experience in the military as a lower extremity trauma specialist treating Marines who had suffered blast injuries in Iraq and Afghanistan. “After the Frame is on, I use the Spatial CAD to analyze the deformity. This process will precisely calculate what the deformities are in three planes, within a degree and less than a few millimeters. Then I load these data onto a special Web site, along with the parameters of the Frame. On the basis of the two sets of information, the program creates a ‘prescription’ for that specific individual. The patient adjusts the struts daily, according to this prescription, until the deformity is corrected.”

McGuigan enumerates the procedure’s numerous benefits, beyond unparalleled precision: “It is minimally invasive. There is no interruption of the body’s natural healing, no compromise of other structures like the knee, and no metal left in the body after treatment is completed. The patient is soon able to bear weight on the operated leg and can shower while wearing the Frame.” Additionally, he points out, unlike traditional treatments, the Frame allows for adjustments after the initial surgery to ensure that the correction is perfect.

Within the spectrum of limb salvage, the Frame plays a large role. “We see patients for whom traditional treatment has either failed or for whom it is not applicable. They may present with infections and rods, plates, and screws in their limb, asking if we can help,” says McGuigan. “In such situations, we put together a team of physicians.” For example, plastic/reconstructive limb surgeons Christopher Attinger, MD, and John Steinberg, DPM, use advanced techniques to heal any wounds and ulcers that may accompany the injury. Ivica Ducic, MD, PhD, specializes in covering wounds with muscle flaps to help fight infection and increase blood supply to the injury zone. If the leg or foot lacks adequate circulation, Richard Neville, MD, uses the latest vascular surgical techniques to restore the blood flow needed for healing.

The Frame is about ten years old, yet despite its effectiveness, it is not, McGuigan says, in wide use. “In terms of depth of experience with the Frame and its various applications, Georgetown is a leader in the metropolitan area. We are the only area hospital using the Spatial CAD to assist in correcting the deformity,” says McGuigan.

By Eve Katz, PhD, excerpted from the Summer 2009 issue of Georgetown Physician Update

(Published April 07, 2010)