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Guide for users - Ortho-SUV - Art of Deformity Correction

1. reduction Step 13 the program gives an obviously Incorrect result for example 17 days for a 5 mm distraction During deformity correction the struts begin to press on the soft tissues or on the outstanding ends of the half pins In a maximal distraction during correction of the deformity the threaded rod Fig 7 has completely dislocated itself from the strut length changing unit Fig 9 disconnection of the unit and the threaded rod has occurred thus destabilizing the external fixation frame On the control X ray image an exact deformity correction not shown the location of the distal fragment does not fully correlate with that of the red bone contour program considers the default settings for these structures which cannot be applicable to the target case Incorrect initial assembly of the external fixation frame There is no thread on one of the ends of the threaded rods packed in the Ortho SUV Frame set which precludes disconnection of the strut length changing unit and the threaded rod If this complication has occurred the rods being used in the external fixation frame assembly do not belong to the Ortho SUV set 1 The location of the distal fragment was set by the user in Step 11 therefore at maximal magnification examine the location of the red bone contour relative to the basic proximal fragment During surgery planning it is essent
2. Strut length change Rate of correction 1 mm day Calculate Recommended number of days once a day twice a day four times a day M wp f Back Show Print Clean Fig 76 Ortho SUV program window in Step 13 choice of rate of correction The deformity correction rate has been entered 1 mm day Next click the Calculate button the program will calculate the number of days required for the deformity correction at the given rate Result of calculation appears in a field Recommended number of days Fig 77 Calculated by software number of days provides daily moving any of SAR not more than by value chosen for example 1 mm day Note that the user has a possibility to ignore the number of days calculated by the program Just remove it and enter the number of days required There is another possibility to change number of days for deformity correction For this purpose it is necessary to change value in the field Rate of correction for example 2 5 mm day and again do not forget it to press the button Calculate SUV Software vr 1 0 D INFA_DISK_C BACKUP tpasmatonorna SUV 2607201 f File Edit Window Help Calculate Recommended number of days gt SUV Software vr 1 0 D INFA_DISK_C BACKUP rpaematonorua SUV 2607201248 NH f File Edit Window Help DG SEO eC Lc Rate of correction 25 mm day Calculate Recommended number of days C once a day
3. random fixation If a distance between rings is too small strut fixation is possible not only to the basic and the mobile supports but to the stabilizing support as well If the distance between supports is too much length of strut can be increased by means of additional threaded or telescopic rods Fig 17 www ortho suv org 24 Fig 17 Abilities of Ortho SUV Frame assembling a standard configuration struts are fixed directly to the basic and mobile supports b distance between supports is not enough for strut fixation directly or using straight plates Therefore Z shaped plates are used c distance between support is not enough for strut fixation by means of Z shaped plates Therefore some struts are fixed to stabilizing support d increasing strut length with the help of telescopic rod NB At any mentioned variant of frame assembly two rules must be observed Logo rule and Watch rule 1 Logo rule A logotype SUV marked on the struts must be always directed externally to the side opposite the bone Fig 18 www ortho suv org 25 Fig 18 Logo rule a b logotype SUV marked on struts must be always directed externally to the side opposite the bone 2 Watch rule The strut 1 must be always located on the left from the strut 2 At connection of the strut 2 to the strut 1 logo rule must be observed The strut 1 is symbolized by the left arm wearing a watch The str
4. 55 centre of the beam Fig 31 and press the left button of the mouse In the field of the cursor a dark blue dagger with the red centre will appear Fig 46 T SUV Software vp 120903 DINFA_DISK_C BACKUP rpasmaronorma SUV 260 f File E Window Hel dit p D cu SEO c GE Ss Fig 46 Ortho SUV software window in Step 6 The focal distance has been entered 760 mm and the X ray beam center marked An arrow points to the marker of the beam center The next stage involves marking the strut and joint projections on the AP view Figs 47 and 48 NB The strut and joint numbers indicated in the program must be the same as the strut and joint numbers used in the external fixation device calculations Arbitrary designation of the numbers is not allowed The simplest way to identify strut numbers on the roentgenograms is to use the X ray positive markers of the strut numbers section 5 2 Fig 32 NB If the projection of any strut or joint is doubtful or invisible outside the roentgenogram or is covered by other details of the frame this strut or joint can be ignored The software does not demand a designation of all struts and Joints As a rule it is enough to note three struts and two not connected with them joints But if AP and lateral view were made not perpendicularly each other it is necessary to mark all struts and joints that can be seen In order to mark the strut projection click in the fie
5. Ortho SUV Frame reminds Stewart platform from outside This device was made on the basis of Solomin Utekhin Vilensky platform SUV Platform featuring unique construction and kinematics Only 3 struts connect to each ring The other 3 struts connect to the side of another strut The information about the distance between the sides of the triangle formed at each ring by the strut connection is fed into the computer Because only 3 struts connect to each ring thus forming a triangle between the connection points the computer identifies a plane for each triangle using only the strut lengths and the length of the sides of the 2 triangles The beauty of this frame is that for the first time it is independent of the size 9 and shape of the rings and the math is much easier This is by far the most modular of all the 6 axis correction frames Paley D 2011 Due to improvements Ortho SUV Frame succeeds its analogs by a number of design features its reductive potential and rigidity of the osteosynthesis Additionally Ortho SUV Frame is equipped with advanced software Indications for application of Ortho SUV Frame Fractures except intra articular Closed fractures Open fractures Open fractures in conjunction with soft tissue damage such as burns soft tissue extensional defects Consequences of the fractures non unions malunions posttraumatic deformities osteomyelitis including bone defects L
6. 7 2 Day 6 149 25 145 25 179 25 138 75 173 75 133 50 8AM 4 1 10 2 7 2 8PM 4 2 2 7 3 Day 7 151 25 144 50 184 00 139 75 177 25 132 25 www ortho suv org 107 Name age Smith 24 y o Diagnosis R Lower leg deformity Case history 2412 Date 04 03 2010 Mode Four times a day 45 45 Note In this mode strut length is controlled using 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software calculates number of turns from line to line at 8AM 12AM 4PM and 8PM recommended time for changing strut length For example 2 means two lines i e 0 5 mm for strut lengthening 0 25 mm 0 25 mm Mode Four times a day Day SUr Str2 Str3 Str4 Str5 Str6 Day 0 137 00 150 00 151 00 133 00 153 00 140 00 SAM 2 1 5 1 3 1 12AM 2 1 4 1 4 1 4PM 2 0 5 1 3 1 8PM 2 1 5 1 4 1 Day 1 139 00 149 25 155 75 134 00 156 50 139 00 8AM 2 1 5 1 3 1 12AM 2 1 4 1 4 2 4PM 2 0 5 1 3 1 8PM 2 1 5 1 4 1 Day 2 141 00 148 50 160 50 135 00 160 00 137 75 8AM 2 1 1 3 1 12AM 3 1 5 1 3 1 4PM 2 1 5 1 4 1 8PM 2 0 5 1 3 1 Day 3 143 25 147 75 165 25 136 00 163 25
7. Also it is necessary to take into consideration that axes mid lines of bone contours Step 9 must be drawn 2 3 cm out of bone contours border Therefore the distal border of bone contour must be over 3 cm above the distal border of the roentgenogram field To make a bone contour place the cursor on a cortex of mobile fragment Press the left button of the mouse and than release it Yellow point will appears on the screen Move the cursor on other point of the cortex and press the left button of the mouse again A line connecting the new point with the previous one will appear By successive drawing of necessary number of lines make outline of bone fragment Fig 53 If the last fragment of the line is drawn incorrectly use the button Erase the last line Note that in the Step 8 in the panel of tools there is a button of moving of fields of roentgenograms Fig 53 This button is used when it is necessary to move a field of x ray picture on the screen and to increase or reduce in a combination with the button zoom in zoom out the roentgenogram Use the button as follows pressing left mouse in field of this button results in appearance of a tick It means that the function of moving is switched on and drawing the bone contour is blocked Moving x ray picture and its reduction magnification should be done in the same way as it was described in Step 4 After required action has been done moving of a x ray picture or its reduction ma
8. Incorrectly entered lengths of the struts and sides of the triangles or entry of the values in cm Step 1 3 Incorrect scaling Steps 4 5 the length of the known section is 80 mm and or the length of the known section was entered in cm 4 Incorrectly entered focal distance Steps 6 7 or the focal distance was entered in cm 5 Incorrectly marked numbers of the struts and or joints i e lack of correspondence to the assembly of the external fixation frame Steps 6 7 6 Coincidence of the red lines with the projections of the struts depends on the exact and correct completion of Steps 1 7 1 Different lengths of the bone contours Step 8 of the mobile bone fragment on the the external fixation frame 2 Exactly entered values of the lengths of the struts and sides of the triangles in mm 3 Exact value of the known section length entered in mm 4 Exact value of the focal distance entered in mm 5 Marking the numbers of the struts numbers and or joints according to the assembly of the external fixation frame by using the strut markers when obtaining an X ray image Fig 32 6 Control of whether the values have been entered correctly in the completion of Steps 1 7 If the AP and lateral roentgenograms were not taken in orthogonal projections then on Steps 6 and 7 the maximal possible number of struts and joints must be marked 1 The lengths of the bone con
9. away from the strut length changing unit Fixing screws 1 are loosened using the hexahedral screwdriver Fig 22a The connector nuts are moved behind the lock nuts Fig 22b The next step is a reduction implemented by manually moving the rings relative to one another Fig 22c The connector nuts are then moved along the threaded rods until each one locks with its respective strut length changing unit Fixing screws 1 are tightened Fig 22d Finally each strut length changing units must be fixed by lock nuts 31 Fig 22 Fracture reduction in fast strut mode a fixing screws 1 of all the struts are loosened b the connector nuts are moved along the threaded rods c acute reduction d the connector nuts are moved along the threaded rods until each one locks with its own strut length changing unit the fixing screws 1 are tightened 4 2 Deformity correction mode This mode is applicable when there are indications both for gradual deformity correction and fracture reduction The computer program calculates which of struts is to be lengthened or shortened The strut length changing unit is equipped with a scale For a strut to be lengthened the strut length indicator is set in its extreme minus position For a strut intended for shortening the indicator is set in its extreme plus position Procedure on moving the indicator in necessary position is named Strut adjustment or Reverse To
10. by Software based Ortho SUV Frame User Manual Available at http ortho suv org Accessed on March 12 2013 20 Taylor J C 1997 A new look at deformity correction Distraction The Newsletter of ASAMI North America 5 1 144 Appendix 1 Steps to be followed before you start using the Ortho SUV Frame Software Step No 1 Create a folder named Ortho SUV on your Laptop Desktop on which you want to run the program Step No 2 Insert the Ortho SUV Frame Software CD supplied to you in the disk drive of your Laptop Desktop Copy the folder SUV Software on the software CD into the Ortho SUV Folder created by you Step No 3 Click on the Hasp folder then click on the folder Sentinel LDK Run time setup 2011 amp click again on HaspUserSetup exe file Install the Hasp program following the steps as prompted Step No 4 Before working in the program it s necessary to create the folder for the clinical case In this folder AP and lateral x ray images of the patients in jpeg or bmp format should be placed In the same folder the file made later by Ortho SUV program for the subject case should be also saved Step No 5 Attach the Hasp key to the USB drive of your laptop amp then double click SUV Software exe file Program window will appear Press the New document button Save your case folder allocating a file name to it amp then follow the steps as prompted by the software Note 1 Immediately after the new docu
11. is between joints 4 and 6 and C2 Mobile is between joints 6 and 2 All measurements are made using the special measuring tool Fig 27 www ortho suv o rE 38 B1 base 227 LY N O e T U D R REY D DF Cc V L G AN Koen f aW NOS 44 y Ue P3209 C2 mobile www ortho suv org 39 Fig 27 Measuring sides of triangles a sides of triangles are measured between the centers of nuts that fix the joints to rings or to plates b measurement using special tool triangular measurement device Note that one of strut is fixed directly to ring and the second with the help of plate c measurement using a laser range finder d in this case distance between the centres of nuts fixing plates to ring is measured It is a mistake e in this case the distance between the centre of nut fixing plate of strut 1 and the centre of nut fixing joint 3 to plate is measured This is wrong measurement www ortho suv org 40 5 2 2 Parameters measured on X ray When roentgenograms are intended for the finding of the above noted parameters not only the standard rules Paley D 2005 Solomin L 2013 but also the following must be observed 1 The image field has to cover as many joints and struts as possible Therefore film cassette lt 30 cm in width are inappropriate Fig 28 The image field should contain only the helpful information Edges of roentgenograms which do not have the
12. it is necessary to press the right button of the mouse It results in appearance of the pop up menu In the pop up menu it is necessary to chose Visibility of bone fragment contours and to press the left button of the mouse In addition using this pop up menu is possible to make markers of bone fragments green and violet trees visible or on the contrary invisible For this purpose the button Visibility of bone fragment markers should be used Fig 65 f SUV Software vr 130131 DAINFA DISK CBACKUPVpaewaronorwa SUV Cosonosckas CosoHOBcKas s f File Edit Window Help D cx SB ITI e Angle 110 7 Angle 2 5 9 ot Visibility of bone fragment markers Visibility of bone fragment contours Visibility of the frame AT n p 1 Pa K m Translation z a Axial WO Down AP fae Disi Left Lett o ly Right Right mo Rotation BASE BASE d SS Back Fwd 4 A Fig 65 Ortho SUV program window in Step 11 There are bone fragment markers trees and yellow and red bone contours in field of roentgenograms Yellow bone contours are initial position of mobile fragment red bone contours are final mobile oe C a gt 82 fragment position Pressing of right button of the mouse leads pop up menu appearance pointed by arrow When the software user is satisfied with position of mobile fragment position of red bone contours he may pass to the following Step 12 When red bone contours have
13. sc c JAnged ea 90 85 95 E 1 lue angle of base fragment marker Di Fig 62 Finding mechanical axis of EE T orta gane wit femoral bone in frontal plane with help of blue angle a diagram of mechanical angle b centrator with blue angle is placed on joint line and vertex of blue angle coincides with centre of femoral head Due 78 value of blue angle 90 deg is inserted It leads to that axial line of tree takes position of mechanical axis of bone fragment Note that yellow point is placed on distal border of proximal fragment The Ortho SUV software window in Step 10 at finding of mechanical axes of femoral fragments in frontal plane with the use of blue angle is shown in Fig 63 SUV Software vr 121029 DAINFA_DISK_C BACKUP rpasmaronorua SUV Cosonoscxas bedro suv File Edit Window Help D c ft PSB D c m 7 771 T SUV Software vr 121029 DAINFA_DISK_C BACKUP tpasmaronorna SUV Co File Edit Window Help D c il e S250 Angle 1 5 Angle Z 13 1 7 1421A21A4 Yr fin Oy 1 Y WWW Ortho suv org OQO 79 SUV Software vr 121029 D INFA_DISK_C BACKUP rpasmaronorva SUV Cosonoscxaa bedro suv gt File Edit Window Help D c N SB D lt Angle is Angle 2 eee hey a La Back Fwd y A Fig 63 The Ortho SUV software window in Step 10 at finding of mechanical axes of femoral fragments in frontal
14. using button Print should be printed out and used in daily control for deformity correction The printed table contains the help Fig 80 www ortho suv org 105 Name age Smith 24 y o Diagnosis R Lower leg deformity Case history 2412 Date 04 03 2010 Mode Once a day y 45 Note In this mode strut length is controlled using B longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software calculates number of turns from line to ling at 12AM recommended time for changing strut length For example 2 means hao lines 16 0 5 mm for strut lengthening Mode Once a day Day Stri Str Stra Str4 Stro Stro Day 0 137 00 150 00 151 00 133 00 153 00 140 00 12AM T8 3 19 4 14 E Day 1 139 00 149 25 155 75 134 00 156 50 139 00 12AM T8 3 19 4 14 5 Day 2 141 00 148 50 160 50 135 00 160 00 137 73 12AM 9 3 19 13 E Day 3 143 25 147 75 165 25 136 00 163 25 136 5 12AM 8 3 18 4 14 3 Day 4 145 29 147 00 169 73 137 00 166 73 135 90 12AM 8 3 19 3 14 E Day 5 147 25 146 25 174 50 137 75 170 25 134 50 12AM 8 4 19 4 14 m Day 6 149 25 145 25 179 25 138 75 173 73 133 50 12AM 8 3 19 14 3 Dayi 7 151 25 144 50 164 00 139 795
15. www ortho suv Org 17 Fig 10 Body of strut length changing unit a the screw 1 is loose connector nut is moved away from the body b connector nut is moved into the body screw 1 and lock nut are fixed 1 screw 1 2 screw 2 3 connector nut 4 lock nut The clutch of strut length changing unit Fig 11 consists of two right threaded cylinders external and internal The external cylinder has a scale with a division value of 2 mm In addition there are arrows and and eight longitudinal lines The internal cylinder has a strut length change indicator It moves inside the scale of the external cylinder There is a longitudinal line on the internal cylinder as well External end of internal cylinder is pivotally connected to the joint of previous strut The logo SUV is applied here Fig 11 18 Fig 11 Clutch of strut length changing unit a view in coronal plane lock nut is moved away from external cylinder b view in sagittal plane lock nut fixes the external cylinder 1 the external cylinder with the scale arrows and and eight longitudinal lines 2 internal cylinder 3 longitudinal line of internal cylinder 4 lock nut 5 SUV logo 19 2 2 External supports Supports from any circular external fixation devise may be used to assemble an Ortho SUV Frame Fig 12a d g Additionally supports comprising 1 2 2 3 and 5 8 of a ring Fig 12b e are possible to use as w
16. E Fie Soe Wi rel res Hep D wM aan or y SAR 2 Z S I Sotwore sp 121205 HMHE ASK OBAT RLE paa veo ocn SUV 1516 Coe itt mne p Structure at risk SAR 2 Dalam lm eurem NIL aD Back Fwd y A Step 13 Sut longis Cage Mode Four times a day In this mode strut length is controlled using Rate of correction 1 mm day 8 longitudinal lines on external cylinder Calculat and one line on internal cylinder culate Turn from one line to the next one corresponds Recommended number of days 22 to change of strut length by 0 25 mm for lengthening and for shortening once a day twice a day 45 45 four times a day 0 25 mm 0 25 mm y Back Show v Print Clean Re Name age Egorov LM 47 y o af Diagnosis Lower leg deformity Case history 5078 Date 16 11 2009 Mode Four time a day Day Str1 Str2 Str3 Str strs Str Day 0 137 00 150 00 151 00 133 00 153 00 140 00 8AM 1 0 1 1 12AM 2 0 1 Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm 1 The software will calculate number of turns 4PM E 1 1 1 4 from line to line at 8AM 12AM 4PM and 8PM BPM 1 ui 1 recommended time for changing strut length 116 Fig 83 Photographs and roentgenograms of patient E before during and after the treatment www ortho suv org 117 6 2 2 Femur shaft deformity correction 28 y o patient K was hospital
17. Left Left o Right Right o Rotation E o E T SUV Software vr 130131 D INFA_DISK_C BACKUP rpasmaronorua SUV CosoHoEc File Edit Window Help D c k SS ITI eU me Angle 118 4 Angle 25 9 e E T t Step 11 Translation Axial WPO j Down Lett Lert o Right Right BO Rotation i S d 90 f File Edit Window Help D cx ll e ES ITI c Angeiio4 Angle 25 9 Eao Translation Axial ue 0 bom AP Ager y diis Left Left 0 a Right T Right 9 Rotation o rA Fig 69 Ortho SUV program window in Step 11 red bone contour angulation a cursor is placed at one red points any can be used of proximal bone fragment marker green tree pointed by arrow b while pressing left button of the mouse chosen red point is being moved It leads to angulation of red bone contour c by experimentally changing red points necessary position for red bone contour is being achieved Rotation To rotate the mobile bone fragment red bone contour it is necessary to insert necessary value of rotation into appropriate window After that it is necessary using the left button of the mouse to tick in the field Rotation to the left or Rotation to the right Fig 70 lt gt SUV Software vr 130131 D INFA_DISK_C BACKUP rpa fF File Edit Window Help D cy d SEO c Angei i1o4 Angle 2 5 9 Eu Translation Axial U 0 Down AP view Lat view left
18. Rotation o xi C Fig 68 Ortho SUV program window in Step 11 free plane parallel moving of red bone contour a button plane parallel moving is ticked The cursor is placed at one of red points any can be used of proximal fragment marker green tree pointed by arrow b while pressing left button of mouse red contour is moved to necessary position c tick in the button plane parallel moving is being removed Red bone contour angulation In Step 11 the fields Angle 1 and Angle 2 show the angles between the axial lines of the basic and mobile bone fragments markers Angle 1 for the AP view and Angle 2 for the lateral view These values can be used as reference points for necessary turn angulation of red bone contour 89 For red bone contour angulation any of red points of the proximal bone fragment marker green tree can be used It is most convenient to use the red points which are placed on the axial line of green tree Place the cursor at any of these points and while keeping the left button of the mouse pressed move the cursor on the screen Red bone contour will move with the cursor together Fig 69 By experimentally changing points achieve necessary position of red bone contour Note that red contours change the position on both roentgenograms File Edit Window Help D cr kl SEO c cfAngledio7 jAngle2 s9 4 4 Translation Axial Up O pom ii iaa m
19. Software vp 120903 D INFA_DISK_C BACKUP tpaemaronc f2 File Edit Window Help D c asm SUV Software vp 120903 D INFA_DISK_C BACKUP rpaematono f2 File Edit Window Help D E asm K SB Structure at risk SAR 1 SAR 2 Distance between SAR 00 Back Fwd y A C Fig 75 Ortho SUV program window in Step 12 identification of structures at risk SAR a SAR 1 on AP and Lat view is marked by the tool green cross It must be the same point After that button SAR 1 is being pressed b SAR 2 on AP and Lat view is marked by the tool green cross It must be the same point After that button SAR 2 is being pressed In window Distance between SAR figure 44 9 has appeared It is distance between SAR in mm c it was decided to ignore SAR 2 For this purpose after designation of SAR 1 button SAR 2 should immediately be pressed After that in the window Distance between SAR digit 0 has appeared For the program it means SAR 1 and SAR 2 coincide 100 Step 13 Strut Length Change To define the rate of deformity correction fracture reduction a value in mm day is entered in the Rate of correction field Fig 76 The default value is 1 mm day but the user can enter any other value the minimal value is 0 1 mm day gt SUV Software vr 1 0 D INFA_DISK_C BACKUP rpasmatonorna SUV 26072012 ana JIH case 2 calculation ca File Edit Window Help D c SEO
20. Ue 7 Down AP an pe Left Left o P Right Right 9 Rotation I oo E SUV Software vp 121029 DNINFA DISK CBACKUPVrpaewaronorws SUV Cosonoscxas soza File Edit Window Help D c N SB D c e nges Angle 2 11 e x Translation Axial Up 12 J Down dree wens Left Lett Right Right ESO Rotation s 0 P P 1 IE Back Fwd y A 131 Fig 86 Photographs and photoroentgenograms of patient Z before during and after the treatment www ortho suv org 132 6 5 Application of Ortho SUV Frame in Treatment of Knee Joint Stiffness 48 y o women P was hospitalized with the diagnosis consolidated fracture of left femur severe extension stiffness of left knee joint 15 0 0 Fig 87a Judet procedure was performed followed by Ortho SUV Frame application Fig 87b Il 10 90 1V 8 90 II 3 9 VII 8 90 Ortho SUV Ill 4 10 IV 1 80 VIII 8 2 8 2 VIII 4 10 While performing program calculations to identify the motion curve of the joint end of tibia relatively to femur the Iwaki s knee joint motions kinematics was used lwaki H 2000 Proceeding from these calculations knee joint flexion up to 90 degrees was completed in 12 days Fig 87c d The cycle 90 deg flexion knee zero position was then performed using Ortho SUV Frame twice a day during the following 5 days ten cycles in all Then struts were removed and the patient performed
21. active motions in knee joint Fig 87e After that the external fixation device was removed In remote period the ROM in knee joint was 90 0 0 Fig 871 www ortho suv org 133 WWW ortho suv org 134 www ortho suv org 135 Fig 87 Photographs and photoroentgenograms of patient P before during and after the treatment Note the correct interrelations in the knee joint during flexion using Ortho SUV Frame 7 Tips and Tricks for Using the Ortho SUV Frame Table 1 lists the possible specific difficulties that can occur while working with the Ortho SUV Frame as well as tips for their avoidance and elimination As the table makes clear almost all possible complications are the result of incorrect use of the hardware and or software However if despite consultation of the table the cause cannot be determined and difficulties in working with the program are experienced the operator is advised to archive the case folder AP Lat view and suv file and e mail it to orthosuv gmail com The cover letter should include a detailed explanation of the nature of the problem encountered This is one reason why it is essential to save the file after each step of the program Table 1 Complications occurring with use of Ortho SUV Frame Complications Maincauses Prophylaxis 1 During The initial Arrange the struts as Prior to the assembly assembly of the arrangement of the shown in Fig 14a b of the e
22. assembling NB For simplification of strut connection they should be preassembled as it is shown in Figs 5b and 14a A preassembled strut consists of a joint a threaded rod and attached to the joint strut length changing unit of the next Strut 21 All the six preassembled struts are interconnected as it is shown in Fig 14b Special dismountable strut number labels clips are used for designation of number of each of struts Figs 5d and 14a Fig 14 Set of struts for Ortho SUV Frame a full set with arrows pointing the clips indicating strut number b interconnected struts otruts can be fixed to the ring directly and by means of straight or Z shaped plates as well Fig 15 www ortho suv Org C Fig 15 Variants of strut fixation to support a directly to ring b by means of straight plate c by means of Z shaped plate otruts are fixed to the basic and the mobile rings at three points Struts 1 3 and 5 are fixed to the proximal basic ring Struts 2 4 and 6 are fixed to the distal mobile support The standard of frame assembly is the joint of strut 1 located at any point of the front semicircle of the basic ring www ortho suv org 23 Its better to make equal distance between the points of strut fixation to the ring to form equilateral triangle But this requirement is not obligatory Fig 16 Fig 16 Fixation of struts to support a making equilateral triangle b
23. be send to Prof Leonid N Solomin Vreden Russian Research Institute of Traumatology and Orthopedics solomin leonid 2gmail com http rniito org solomin 8 3 Where to acquire All information can be taken at web sites of Ortho SUV Ltd and S H Pitkar Orthotools Pvt Ltd x oF DEFO Q RECTM9 ORTHOTOOLS PVT LTD s H PITKAR S H PITKAR ORTHOTOOILS PVT LTD Office amp Works EL 32 Block MIDC Bhosari Pune 411 026 India Tel 91 20 40706464 Fax 91 20 46768107 Email info pitkar com ISO 9001 ISO13485 and Indian FDA approved company tkar com 4 http pitkar com http ortho suv org 142 9 References 1 Bonev 2003 The true origins of parallel robots copyright http www parallemic org Reviews Review007p html Accessed on Aug 25 2005 2 Dammerer D Kirschbichler K Donnan L Kaufmann G Krismer M Biedermann H Clinical value of the Taylor Spatial Frame a comparison with the llizarov and Orthofix fixators J Child Orthop 2011 5 343 349 3 Iwaki H Pinskerova FMAR 2000 Tibiofemoral movement 1 the shapes and relative movements of the femur and tibia in the unloaded cadaver knee J Bone Joint Surg 82 B 1189 1195 4 Marangoz S Feldman D S Sala D A Hyman J E Vitale M G Femoral deformity correction in children and young adults using Taylor spatial frame Clin Orthop Relat Res 2008 466 12 3018 3024 5 Method of Unified Designation of External Fi
24. c Ange foa Angle 2 0 1 Ee amp x WWW ortho suv org 93 SUV Software vr 130131 D INFA_DISK_C BACKUP tpasmatonorua SUV SU File Edit Window Help D cr E SB TI Angeii3 4 Angle2 6 Tux Left Left o Right Right Eo Rotation o x Fig 71 Software calculates moving of mobile fragment on the shortest trajectory directly a moving on the shortest trajectory fragments will be linked and reduction becomes impossible b at fragments overlapping it is necessary at first stage to perform distraction to achieve 3 4 mm gap between fragments c after gap has appeared total residual correction can be done NB Before Step 12 position of the red bone contour must be controlled using maximal magnification A little residual displacement or possibility of linking of bone fragments can not be noticed at small magnification If options Plane parallel moving and or Angulation have been used the command to confirm moving in the accepted slang to click the pointer must be done before going to Step 12 To do this it is necessary to place the cursor at the red point connected to the yellow point index of border of proximal bone fragment in a lateral view and press the left button of the mouse After that confirm moving of mobile fragment by clicking the pointer Fig 72 f SUV Software vr 130131 DAINFA_DISK_C BACKOP Tpa f File Ed
25. calculation Fig 85i After deformity correction struts were replaced for Ilizarov hinges Fig 85j The second stage was bone grafting of non union site and corticotomy for lower leg lengthening at level II Fig 85k The frame was removed in 207 days after bone grafting Fig 85l 123 www ortho suv org 124 T Wy Step 10 Mark axis of bone Mark axis of bone on AP view on Lat view T SUV Software vp 121029 DAINFA_DISK_C BACKUP File Edit Window Help nog HT c L 5 TTT Angle 2 29 8 125 gt SUV Software vp 121029 D INFA_DISK_C BACKUP rpasmatonorma SUV Co30Ho eckaa sozon 3110 12 suv f File Edit Window Help cr SB D CEE Le gt SUV Software vp 121029 D INFA_DISK_C BACKUP tpaematonorua SUV CosoHosckaa sozon 311012 suv lt gt File Edit Window Help Dg 250 c CE 6 lt gt SUV Software vp 121029 DAINFA amp File Edit Window Help D c S B60 T Step 13 ___ Rate of correction 1 mm day Calculate Recommended number of days 15 once a day with dickers twice a day without clickers four time a day yf Back Show s Print Clean Name age Kuznetsova A 27 y o Diagnosis Lower leg deformity Case history 1006 2009 Date 12 10 2009 Mode Once a day Day Str1 Str2 Str3 Str4 Str5 Str6 Day 0 132 00 145 00 156 00 138 00 153 00 136 00 12AM 2 1 5 7 2 1 Day 1 132 50 145 25 157 25 139 75 153 50 136 25 12A
26. directly on the film cassette the general rule works But when the film cassette is placed into the radiological table holder and the ruler is positioned on the surface of the X ray table the distance from anode to the ruler is taken as a focal distance It is a mistake to measure the distance from anode to the center of a bone and placing the ruler on the bone level 42 OE Fig 30 Measuring focal distance two parameters for AP and Lateral views 4 X ray beam center must be indicated on the roentgenogram For this purpose a small about of a cent coin in size usually cross shaped marker is placed on film cassette where is the center of X ray beam Fig 31 While X ray examining make sure that this beam center marker did not overlap with any radiopaque parts of the frame such as struts or rings Fig 31 Beam center identification a self adhesive X ray positive mark to visualize the beam center b this mark points the beam center on the film 5 To facilitate the strut number identification special radiopaque markers with bar codes are used Fig 32 www ortho suv org 43 a b C Strut 1 Strut 2 Strut 3 Fig 32 Strut markers a f markers of struts 1 6 schemes and image of bar codes on roentgenogram g strut markers are fixed on struts h x ray image of strut markers pointed by arrows 6 In some cases it is impossible to make AP and lateral views in tangential projec
27. e B60 Angle 10 7 Angle2 9 Ee Translation Axial Ue 0 Down Lat view Ge Cah C Left n AS Right a Right_5 86 f SUV Software vr 130131 DNINFA DISK CABACKUPVrp f File Edit Window Help D c N SS T lt Angle 110 7 Angle 25 9 a d ene een up T V Down C i er Left v o E Right f SUV Software vr 130131 DNINFA DISK CVBACKUPVrpasvaronorvs JACosoHo5c File Edit Window Help D ck SS IT Anglet10 7 Angle 2 s 9 Ket EN Ww N ae ADS SUDAN Tm r3 Translation Axial Up 0 Dow Ye S S Right Fig 67 Ortho SUV program window in Step 11 horizontal moving translation of red bone contour a necessary value 11 mm of translation is inserted into field AP view b button Left is clicked It has led to moving of red bone contour to the left on AP view Note that to the left in this case means inwards c necessary value 14 mm of horizontal moving is inserted into field Lat view d button Right is clicked It has led to moving of red bone contour to the right on Lat view Note that to the right in this case means back 87 NB If X ray examination have been made not strictly in tangential projections i e not at an angle of 90 deg to each other transversal moving of red bone contour in one plane for example in AP view will lead to some displacement of red contour in the second pla
28. execute reverse procedure it is needed to do the following 1 Loosen the lock nuts 2 Using the screwdriver loosen fixing screw 2 Fig 23a 3 By opposing hand motions rotate the body and the external cylinder of clutch of strut length changing unit in opposite directions Fig 23b If the struts length is minimal the body of strut length changing unit is rotated clockwise if it is maximal rotation is counter clockwise 4 Tighten fixing screw 2 and the lock nuts NB While reverse procedure the strut length does not change and the bone fragments are not displaced 32 loosen the fixing screw 2 fasten the fixing screw 2 Fig 23 Adjustment of a strut reverse procedure a scale before the procedure the indicator is set in its extreme position b loosening fixing screw 2 c the body and the external cylinder of clutch of strut length changing unit are counter rotating d fixing screw 2 is tightened e the scale after the procedure indicator is in its extreme position The strut length has not been changed As it was already specified the tightening of the screw 2 fixes the body to the clutch of strut length changing unit owing to what they rotate together To change strut length lock nuts are loosened and the body with fix to it clutch are rotated Fig 24 As it was already mentioned there are www ortho suv org 33 arrows and on the external cylinder of the clu
29. necessary information should be to cut off using any graphic editor Fig 28 Image field a when a narrow film is used the number of struts and joints visualized will be insufficient to measure necessary parameters b image field encompassing most of the struts and joints 2 For an opportunity of scaling software steps 4 and 5 in the image field the ruler Fig 29 should be placed It is placed directly on the film cassette not in a projection of the centre of a bone If the film is placed into film cassette holder the ruler should be placed on a surface of a radiological table For maintenance of necessary accuracy of scaling the length of a ruler should not be less than 80 mm Instead of the ruler it is possible to use any roentgen visible subject of known not less than 80 mm lengths 41 Fig 29 For an opportunity of scaling the image field must contain roentgen visible ruler with length not less than 80 mm Ruler should be placed directly on the film cassette or if film cassette holder is used on a surface of a radiological table 3 Focal distance must be measured Focal distance is a distance in millimeters between anode of the X ray tube and the film cassette X ray equipment often has focal distance sensors or measuring tape Fig 30 NB When a radiopaque ruler is used for scaling step 4 in the program a focal distance is measured between anode and the ruler Therefore if the ruler is placed
30. not the proper position it is possible to correct it The software options have capabilities to move red bone contours by necessary value upwards and downwards to the left and to the right angulate and rotate them as well Vertical and horizontal axial movings To move red bone contours upwards it is necessary to insert the value of moving in mm and tick the window Up After that the red bone contours on both roentgenograms will move upwards by the given value To move the red bone contours downwards it is necessary to insert the value of moving in mm and tick the window Down After that red bone contours on both roentgenograms will move down by the given value Fig 66 NB The axial moving up and down will take place along the axial lines of the basic bone fragments markers axial lines of green trees lt gt SUV Software vr 130131 D INFA_DISK_C BACKUP rpa f File Edit Window Help Dag SS cr c Angle 110 7 Angle 2 5 9 4 E Translation Axial Up 11 Z Down AP view u Left Left m C o s Right Right Eo Rotation ei o 83 SUV Software vr 130131 DAINFA D f File Edit Window Help D c N e SEO Angle d10 7 Angle 2 5 9 Ee Translation Axial isa p view Left Left Right Right o Rotation o BASE ssi 2 gt SUV Software vr 130131 D INFA_DISK_C BACKUP tpasmatonorna SUV Co Y File Edit Window He
31. the anatomic axis the cursor is placed in the center of the bone contours of the mobile bone fragment 2 3 centimeters above its proximal end Pressing the left button of the mouse make points which the program connects in a line If there are bends of bone fragment line must replicate them because it must be mid diaphyseal line of the bone contour Axis of bone contour must be done both on AP and Lat view Fig 54 66 If the last fragment of the line is drawn incorrectly use the button Erase the last line After drawing blue lines on AP and Lat view press button Fwd If the note Precise the anatomical axes sizes appears it is necessary to remove axes of bone contours and draw the new one which exceeds more proximal and distal ends of bone contour NB The anatomic axes of the bone contour must exceed its proximal and distal ends by 2 3 centimeters If the X ray image is short and it is impossible to draw the blue line above the distal end of the bone contour the operator must return to Step 8 remove the bone contour and draw a new shorter one File Edit Window Help D cr N SB T 67 21029 NC zz File Edit Window Help D zc SB D s HD Fig 54 Ortho SUV program window after completion of Step 9 a on AP and Lat view anatomical axes of yellow bone contours are drawn b if there are bends of bone fragment axes should replicate them because it must be mid diaphys
32. window in Step 10 the features of yellow points setting in presence of gap between bone fragments a yellow point of proximal 75 fragment marker is placed on distal border of basic fragment Yellow point of distal fragment marker is placed at the same level with yellow point of the proximal fragment marker b scheme Setting of fragment markers according to mechanical axes The blue angle is used for finding of mechanical axis of bone fragment It is located on one of centrators Fig 55 In this case centrator without the blue angle must be ignored It should be using its central red point moved out of borders of bone fragment On default the blue angle settles down to the left of an axial line If necessary it can be placed to the right of an axial line For this purpose overlap the cursor with left point of centrator and press the left button of the mouse While left clicking the mouse move this point left to right As result blue angle meets the right position Fig 60 T SUV Software vr 121029 DAINFA_DISK_C BACKUP tpaemaronc File Edit Window Help D c SB D e Angl 5 TH Angle 26 4 SUV Software vr 121029 DNINFA DISK C BACKUP rp File Edit Window Help D c SB D T L 1 Angle 2 Fig 60 Indicator of angle of axial line positioning blue angle a centrator without blue angle must be moved out of bone fragment borders so it is ignored b if necessary blue angle can be arrang
33. 1029 D INFA_DISK_C BACKUP File Edit Window Help Dc eaan CEA 36 SUV Software vp 121029 DNINFA DISK CBACK P par 7 MW warovea File Edit Window Help lt lel Oe wmm INE C SUV Software vr 121029 DNNFA DISK C BACKU File Edit Window Help lt Lel D lt N L BE e r T f 1 Structure at risk SAR 1 SAR 2 Distance between SAR Back Fwd L File tdt Window Help RTI Dc E n S60 SAR 2 WWW ortho suv org 120 www ortho suv org 121 Fig 84 Photographs and roentgenograms of patient E Before during and after treatment 6 3 Application of Ortho SUV Frame in metaphyseal deformity 19 y o women K was hospitalized with the diagnosis distal metaepiphyseal nonunion of the right tibia Four component three planar www ortho suv org 122 deformity of the right lower leg Fig 85a United left femur fracture treated by external fixation device As the first stage external fixation using Ortho SUV Frame was done Fig 85 b c 9 3 14 10 1190 IV 10 4 V 2 90 _ Ortho SUV _ VII 8 2 8 2 VIII A4 10 calc 8 2 calc 4 10 m tars V m tars 150 horseshoe shaped support While working with computer program basic fragment markers using centrators were drawn in projection of anatomical axes of proximal fragment on AP and lateral views It was not difficult because of large size of this fragme
34. 136 75 8AM 2 1 1 1 12AM 2 1 5 1 3 1 4PM 2 1 5 1 4 1 8PM 2 0 1 3 2 Day 4 145 25 147 00 169 75 137 00 166 75 135 50 C Fig 80 Printed table of deformity correction protocol a c examples of tables calculated for different rates of strut lengths change www ortho suv org 108 At end of work with the program as well as after each Step the file must be saved using the standard button of the panel of tools It is always possible to return to this file for control and recalculation The file opens from the Step at which the program was closed NB At acute deformity correction sizes of those struts to be extended must be firstly changed Only after that the struts recommended by software should be shortened Fig 81 It allows avoiding possible interengage of bone fragments f File Edit Window Help D cy al e asm Rate of correction ao mm day Recommended number of days n lonce a dav C twice a day four times a day T SUV Software vr 1 0 D INFA_DISK_C BACKUP tpasmaronorma SUV 260720 File Edit Window Help D lt SEO ea Step 13 Strut length change Rate of correction n mm day Calculate Recommended number of days 1 Y once a day C twice a day C four times a day Back l i Print Clean Name age Smith S 24 y o Diagnosis R lower leg deformity Case history 1012 2010 Date 04 03 2010 Mode Once a day Day Stri Str2 Str4 Str
35. 177 25 132 25 12AM 9 3 19 13 m Day 8 153 20 143 5 188 73 140 73 180 50 131 29 www ortho suv org 106 Name age Smith 24 y o Diagnosis R Lower leg deformity Case history 2412 Date 04 03 2010 Mode Twice a day 45 45 0 25 T mm d gt Mode Twice a day Note In this mode strut length is controlled using 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software calculates number of turns from line to line at 8AM and 8PM recommended time for changing strut length For example 2 means two lines i e 0 5 mm for strut lengthening Day Stri Str2 Str3 Str4 Str5 Str6 Day 0 137 00 150 00 151 00 133 00 153 00 140 00 8AM 4 2 2 7 2 8PM 4 1 10 2 7 2 Day 1 139 00 149 25 155 75 134 00 156 50 139 00 8AM 4 2 gt 2 7 3 8PM 4 1 10 2 7 2 Day 2 141 00 148 50 160 50 135 00 160 00 137 75 8AM 5 2 2 2 6 2 8PM 4 1 10 2 7 2 Day 3 143 25 147 75 165 25 136 00 163 25 136 75 8AM 4 2 9 2 7 2 8PM 4 1 2 7 3 Day 4 145 25 147 00 169 75 137 00 166 75 135 50 8AM 4 2 10 2 7 2 8PM 4 1 9 1 7 2 Day 5 147 25 146 25 174 50 137 75 170 25 134 50 8AM 2 10 2 7 2 8PM 4 2 9 2
36. 3 choice of number of strut change lengths a day Possible variants of choice and the helps given by the program are shown After that number of days and rate of correction have been identified the button Show must be pressed After calculations the program will show the table of values of daily change of strut lengths Fig 79 The first column of the table shows number of days of deformity correction Six next columns show lengths each of struts Rows of days are divided by rows of time recommended for changing strut lengths 104 Mode Four times a day In this mode strut length is controlled using 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening y 4 45 0 25 mm 0 25 mm _ _ 0 Name age Smith S 24 y o Diagnosis R lower leg deformity Case history 1012 2010 Date 04 03 2010 Four times a day Stri Str2 Str3 Str4 Str5 Str 137 00 150 00 151 00 133 00 153 00 140 00 Eight turns from line to line 360 deg 2 mm 1 2 0 2 0 1 2 0 1 0 The software will calculate number of turns 1 1 1 2 1 from line to line at 8AM 12AM 4PM and 8PM i E 2 40 MM 40 recommended time for changing strut length Turn from line to line 45 deg 0 25 mm Fig 79 Ortho SUV program window in Step 13 table of deformity correction protocol The table
37. 5 Str6 Day 0 137 00 150 00 151 00 133 00 153 00 140 00 12AM 29 102 88 40 78 50 Day 1 144 25 124 50 173 00 123 00 172 50 127 50 Fig 81 Ortho SUV program window in Step 13 at acute deformity correction a number 1 is entered into window Recommended number of days b there are three rows in table initial strut length row Day 0 final strut length row Day 1 and between them row 12AM number of clicks needed for change of strut length First length of struts 1 3 and 5 should be changed because they are lengthened Only after that it is necessary to shorten struts 2 4 and 6 NB If for some reason difficulties have occurred usually associated with incorrect usage save the file archive the case folder AP Lat view and suv file and send it to the following email address orthosuv gmail com In the accompanying message explain in detail the problem that has been encountered To resume working it is usually enough to re start the program and obviously avoid one s previous mistakes 6 Application of Ortho SUV Frame Clinical Cases 6 1 Application of Ortho SUV Frame in fracture treatment 22 y o patient B was hospitalized with the diagnose malunited midshaft fracture of the left tibia with shortening translation and angulation of bone fragments Fig 82a 110 External fixation of left lower leg using an Ortho SUV Frame has been performed Wires were inserted in a way tha
38. Left o la Right Rit Rotation BASE BASE SWZ A 91 77 SUV Software vr 130131 DAINFA_DISK CB ACE File Edit Window Help D c SB D c Angle 110 4 Angle2 9 Ee x b uo Step 11 Translation Axial ueo Down AP view Tos visae Lett o ly Right mH Rotation BASE N Fig 70 Ortho SUV program window in Step 11 rotation of mobile fragment a value of necessary rotation 20 deg is being entered into field Rotation specified by arrow b field rotation to the left is being ticked It has resulted to that the form and the sizes of both red bone contours changed NNB It is necessary to take into consideration that the program calculates moving of mobile bone fragment from an initial position to final one using the shortest trajectory directly from point A to point B Therefore at overlapping of bone fragments it is necessary to execute reduction in two stages The first stage is distraction to achieve 3 4 mm gap between fragments The second stage is residual deformity correction If not to do it fragments will be linked and reduction becomes impossible Fig 71 92 p gt SUV Software vr 130131 D NFA_DISK_C BACKUP tpasmatonorua SUV S eaosEMagom suv p File Edit Window Help e x Duk 9 EI cr 6 Angle 125 6 Angle 28 4 dear SUV Software vr 130131 DNNNFA DISK C File Edit Window Help Dag 9 Bao
39. M 2 2 5 7 3 0 Day 2 133 00 145 75 158 50 141 50 154 25 136 25 126 Mode Once a day In this mode strut length is controlled using 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening 45 45 0 25 T mm 4 gt Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software will calculate number of turns from line to line at 12AM recommended time for changing strut length www ortho suv org 127 Fig 85 Photographs and photoroentgenograms of patient K a before treatment b c after Ortho SUV Frame applying d arrows point at dialog box fields where values of epimetaphyseal anatomic angles have been entered e arrows point at blue angles Because due value of blue angles were entered axial lines of bone fragment markers are located precisely in projection of anatomic axes of distal fragment in frontal and sagittal planes f g identification of structures at risk SAR 1 and SAR 2 h results of software calculation i k result of correction result of treatment 6 4 Application of Ortho SUV Frame in Foot Deformity Correction 19 y o women Z was hospitalized with the diagnosis complex deformity of right foot with 5 cm shortening Fig 86a At firs
40. N 1 3 M y T LA 74 1 IVa WWW Ortho suv org 98 There is a special tool for SAR designation two intercrossing lines of green color green cross Place the cursor at the centre of the green cross on AP view Than press the left button of the mouse and move the green cross to the projection of SAR 1 The same way SAR 1 must be marked on the lateral view After that press the button SAR 1 Next step is marking of SAR 2 To do this move the green cross in projection of SAR 2 sequentially on AP and Lat view Finally press the button SAR 2 After that in the window Distance between SAR distance between SAR in mm can be seen Fig 75 When the orthopedic surgeon is convinced that the stretching of main vessels and nerves can be ignored SAR 2 should not be designated For example at segment lengthening the stretching of vessels nerves and length of regenerate will be equal The other example is femur valgus deformity correction because the length of regenerate will exceed a stretching of vessels and nerves In similar cases after designation of SAR 1 the button SAR 2 must immediately be pressed After that in the window Distance between SAR digit 0 will appear For the program it means that SAR 1 and SAR 2 coincide After SAR designation button Fwd must be pressed File Edit Window Help D c N SB mn Step 1 Structure at risk SAR 1 SAR 2 M I Back Fwd y A 99 SUV
41. UV software window in Step 7 Indicating the joint and strut projection on lateral view a in field Joint 1 put tick opposite to joint number which is going to be designated This results in that around of a point designating the joint end of the strut line a small circle with a small line appeared b cursor is brought to red point of cardan line marked by arrow c while left clicking mouse line in projection of the centre of joint 1 is drawn d all well seen cardan joints are marked NB Button Fwd changed color black for green that allows making the following step After the forward button has been clicked on the program analyses all the data entered at all previous steps This takes depending on computer power 10 sec to 2 min When the calculation has been completed red lines will appear on both images six on the AP view and six on the lateral view These lines have to exactly match the projections of all strut axes Permissible deviation is limited by a strut width as it appears on the image The congruency between red lines and struts serves as a criterion of 62 correct data input Fig 52 If this congruency is present for all the struts click Yes and continue to the next step NNB If even a single red line does not match a strut seen on the roentgenogram click No to return to Step 7 Then it is necessary to return to all previous steps and consistently check all data input Only when congruency
42. Vreden Russian Research Institute of Traumatology and Orthopedics Ortho SUV Ltd Leonid Solomin Alexander Utekhin Victor Vilensky Deformity Correction and Fracture Treatment by Software based Ortho SUV Frame User Manual For SUV Software vp 1 0 and vr 1 0 Saint Petersburg 2013 www ortho suv org www ortho suv org Contents Ne Chapter Hae Indications for application of Ortho SUV Frame 2 Design of Ortho SUV Frame 9 Logonle 4 Wathrmle O 2 7 25 Deformity correction mode Step 1 Input of Strut Lengths and Those of the Sides of the Triangles 47 2 otep Uploading the AP Roentgenogram U 1 oloading the Lateral profile Roentgenogram otrut and Joint Projections on the AP View Indicating the Focal Distance and Beam Center and the Strut 59 and Joint Projections on the Lateral View Step 8 Drawing the Bone Contours Step 9 Marking the Anatomic Axes of the Bone Contours on the AP 65 and Lateral Views Setting of fragment markers according to anatomic axes 69 Setting of fragment markers according to mechanical axes 75 Finding anatomic axes with the help of blue angle 1 79 Vertical and horizontal axial movings 1 82 Redbonecontouanguation 1 1 11 1 88 Roaonn 0 X2 AJ 90 100 Rotation Step 12 Designation of Structures at Ris
43. asic proximal reference support 2 mobile distal corresponding support 3 struts 4 stabilizing support Ortho SUV Frame s standard set Fig 5 includes six standard medium size struts six ring connection plates straight three ring connection plates Z type labels of strut numbers set of 6 X ray markers of struts set of 6 two spanners 12 mm two spanners 8 mm triangular measurement device Allen key hasp key Fig 25 www ortho suv Org 11 N www ortho suv org 12 g lt g Ra N X N f Fig 5 A standard Ortho SUV Frame s set a the full set b struts c plates straight and Z shaped d strut number clips and X ray positive strut number markers e wrenches and a screwdriver f triangular measurement device strut length changing units of short and long sizes a set of threaded rods of various lengths Fig 6 can be taken additionally www ortho suv org 12 Fig 6 Additional equipment threaded rods of different lengths 2 1 Design of strut of Ortho SUV Frame A strut consists of three main elements a joint a threaded rod M6 and a strut length changing unit Fig 7 Threaded rod Fig 7 Strut s of an Ortho SUV Frame design Joint Fig 8 is fixed to a ring of the frame or to plate by means of a nut Other end of joint with the help of coupling is connected to threaded www ortho suv org 14
44. between all red lines and all strut projections is achieved one may continue to the next step x SUV Software vr 120717 DAINFA DISK BACKL ATO asmatTonorna SUV 26072012 gaa N H Sozonovskaja ia cozonovskaia cuv N i i m E f2 File Edit Window Help D cr SB D c CEA Lr SUV Software vp 121015 DINFA DISK CABACKUP File Edit Window Help D c SB ITI Do the lines match the strut projections Fig 52 Ortho SUV software window in Step 7 after the program has analysed all data input a all red lines match strut projections Button Yes must be pressed b some lines do not coincide with strut projection It is necessary to press button No and to check up ALL data which were input at each previous steps 63 Step 8 Drawing the Bone Contours The contour of the mobile bone fragment is outlined with a yellow line on the AP and lateral views For accurate matching yellow lines to a contour of a bone fragment it must be made at the maximal magnification Note that length of bone contour has no principle importance for the software Therefore it is not necessary to draw contours of all distal fragment from the proximal end up to joint line Length of bone contour 1 2 cm is permitable But in this case in the Step 11 it will be very difficult to understand what final position of distal fragments is recommended by the software Therefore recommended length of bone contour must not be less than 3 4 cm Fig 53
45. companying message explain in detail the problem that has been encountered To resume working it is usually enough to re start the program and obviously avoid one s previous mistakes Step 1 Input of Strut Lengths and Those of the Sides of the Triangles Fill in the window Patient data by typing in the patients surname name age and diagnosis as well as the modeling date Fig 37 Fill in the fields Strut 1 Strut 6 Fig 37 by inserting the lengths of the corresponding struts as measured according to the rules described in Sect 5 1 Fig 26 Fill in the fields Triangles A1 Base B1 Base C1 Base A2 Mobile B2 Mobile C2 Mobile by typing in the respective sizes of the sides of the triangles whose apexes are the centers of the nuts fixing the strut joints to supports or to plates The rules for measuring the sides of the triangles are provided in Sect 5 1 Fig 27 There are scheme prompt at this step window After completion of these fields and saving the file click on the Forward button and continue to the next step SUV Software vp 120903 D INFA_DISK_C BACKUP rpasmaronc lt gt File Edit Window Help D cx N SB ITI Cl base a c wi L TaM E ON Ti DEES a as 0 fy NC S a YA Casehistonys 2412 Date Strut lengths Triangles Strut 1 137 A1 Base 156_ Strut 2 150 BA Base 183 C2 mobile Fig 37 Data input in St
46. deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software will calculate number of turns from line to line at 12AM recommended time for changing strut length Mode Twice a day In this mode strut length is controlled using 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening 45 45 0 25 T mm 4 amp Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software will calculate number of turns from line to line at 8AM and 8PM recommended time for changing strut length www ortho suv org 103 Step 13 Strut length change Mode Four times a day In this mode strut length is controlled using Rate of correction mm day 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds Recommended number of days 19 to change of strut length by 0 25 mm for lengthening and for shortening C once a day C twice a day four times a day Turn from line to line 45 deg 0 25 mm Eight turns from line to line 360 deg 2 mm The software will calculate number of turns from line to line at BAM 12AM 4PM and 8PM recommended time for changing strut length Fig 78 Ortho SUV program window in Step 1
47. e 13 5 Ange2 54 Back Fwd c A C Fig 58 Ortho SUV software window in Step 10 at positioning of distal bone fragment marker on Lat view a field Base fragment marker is ticked After that in top down direction green tree is drawn With use of centrators axial line has positioned according to mid diaphysial line anatomic axis of fragment Yellow point is placed on distal border of basic fragment b field Mobile fragment marker is ticked After that in top down direction violet tree is drawn With use of centrators axial line has positioned according mid diaphysial line anatomic axis of fragment Yellow point is placed on proximal border of mobile fragment c diagram As there is only angular deformity no translation yellow points of proximal and distal fragments coincide 74 The above mentioned method of setting the yellow points of the fragment markers should be used only in cases when there is no gap between bone fragments In the presence of distraction regenerate yellow point of the proximal bone fragment must be set at the distal border of the proximal fragment as it is described above Yellow dot pointer distal fragment should be set at the same level with the yellow point of proximal bone fragment marker Fig 2 9 59 gt File Edit Window Help D cy e P mIT Ange 121 9 Angle 2 13 7 AR KaR 4i E OL v AN gt d N 7 Fig 59 Ortho SUV software
48. eal line of bone contour The anatomic axes of the bone contour must exceed its proximal and distal ends by 2 3 centimeters Step 10 Marking the Bone Fragment Axes Special tools are used to mark the axes of both the basic and the mobile bone fragments the bone fragment markers trees The basic fragment marker is colored green and the mobile fragment marker is violet So we have a green tree and a violet tree Fragment markers consist of Fig 55 the axial line 1 two centrators 2 and 3 the indicator of an angle of axial line positioning blue angle 4 Blue angle is placed on one of the centrators the pointer of bone fragment border yellow point 5 The yellow point is connected to the red point 6 68 Fig 99 Bone fragment markers a proximal and b distal in Ortho SUV software green tree and violet tree 1 axial line 2 first centrator 3 second centrator 4 indicator of an angle of axial line positioning blue angle 5 pointer of bone fragment border yellow point 6 red point providing moving of yellow point 5 along axial line 1 During work with the software axial lines of trees are placed according to anatomic mid diaphysial lines or mechanical axes of bone fragments It depends on what axes anatomic or mechanical are used for planning of deformity correction 69 Setting of fragment markers according to anatomic axes At firs
49. eam center Lat view v Beam center Fig 49 Ortho SUV software window in Step 7 for lateral view The focal distance has been entered 760 mm and the X ray beam center marked An arrow points to the marker of the beam center 60 SUV Software vp 121015 DAINFA_DISK_ ABACKUP vrpaswarononis SUV 26 ovskajasozonovskaja suv e SUV Software vp 121015 D AINFA DISK CUBACK P p f File Edit Window Help File Edit Window Help Dc B Ben Dc B BID File Edit Window Help Dc 260 Fig 50 Ortho SUV software window in Step 7 Indicating the strut projection on Lat view a in a field Strut 1 the tick is put The cursor is brought to area joint 1 pointed by arrow b while pressing left button of the mouse line in projection of the centre of strut 1 is drawn c all well seen struts are marked 61 SUV Software vp 121015 D INFA_DISK_C BACKUP rpasmatonor 6072012 aaa JIH Sozonovskaja sozonovskaja suv SUV Software vp 121015 DAINFA_DISK_C BACKUP tpaematonorwi fl File Edit Window Help File Edit Window Help D z E SS D Oe SB D Focal Lat view 760 Beam center Lat view Beam center SUV Software vp 121015 DINFA DISK CBACKUP je SUV 26072012 Vana N Sozonovskaja sozonovskaja su SUV Software vp 121015 D INFA_DISK_C BACKUP rpas File Edit Window Help File Edit Window Help Dc a SB D lt N SEO Fig 51 Ortho S
50. ed to the right of axial line For this purpose overlap cursor with left point of centrator and press the left button of the mouse While left clicking mouse move this point left to right As result blue angle meets the right position The mechanical axis as well as an anatomic axis is known to cross a joint line in the certain point at the certain angle Localization of crossing and value of an angle are specific for proximal and distal joints of each long bone in frontal and sagittal planes Paley D 2003 Solomin L N 2008 2013 With reference to Ortho SUV software centrator with blue angle is a joint line Thus to find a mechanical axis of a bone fragment the centrator with blue angle must be placed in a projection of joint line At the same time the vertex of the blue angle must be placed at a due point of crossing of the mechanical axis and the joint line For this purpose red points of the centrator is moved in a necessary direction After that necessary value of blue angle must be set For this purpose there are fields Blue angles on AP view and Blue angles on Lat view in Step 10 For example it is known that the proximal tibial mechanical angle in frontal plane is 87 deg and the mechanical axis should cross the joint line in its centre Moving with the help of the left mouse extreme red points of the centrator place the centrator to coincide with joint line and the vertex of the blue angle must be located in the centre o
51. ell as supports of any shape triangular oval or rectangular Fig 12 c f h Fig 12 In the assembly of an Ortho SUV Frame supports of various shapes and types can be used a d g supports from a range of circular external fixation devices b e 1 2 2 3 5 8 rings c f h oval triangular and polygonal shaped supports WWW ortho suv org 20 3 Ortho SUV Frame Assembly The number of supports in frame modules as well as the number and type of transosseous elements to insert in each case are chosen on the basis of knowledge in the biomechanics of external fixation and following principles of a method of external fixation frame assembly Solomin L N 2008 2013 NB Each bone fragment must be strongly fixed to rings Rigidity of fixing of each bone fragment to a ring should exclude errors of correction of deformation due to displacement of the bone fragment inside the ring For example it happens because of insufficient number of wires and half pins and or their incorrect spatial orientation 3 1 Supports Assembly Any angle of support assembling is possible Bone fragments can be located both in the external support centre and off the ring centre Fig 13 Fig 13 At Ortho SUV Frame assembling rings can be placed both perpendicular to an axis of bone segment and at any random angle bone fragments can be located in the centre of rings and off the ring centre as well a AP view b Lateral view 3 2 Strut
52. en executed Fig 72 To calculate the number of days required for the deformity correction or fracture reduction the program always uses the structures at risk points Figs 73 74 and 75 If these have not been set the 2 The anatomic axes must exceed the margins of the bone contours by 20 30 mm Any numerical value of rotation must be entered into the field of value of rotation In addition either window indicating a direction of mobile fragment rotation must be ticked If rotation is not required O zero and any direction of rotation must be entered If options Plane parallel moving and Or Angulation have been used the command to confirm moving click pointers must be done before going to Step 12 Fig 68 The button plane parallel moving must not be clicked Fig 72 Do not forget to exactly locate both structures at risk points Step 12 138 2 f it is impossible to draw the anatomic axis above the distal end of the bone contour short X ray image return to otep 8 erase the bone contour and draw a new one which must be shorter than the initial bone contour It is necessary to enter value of rotation and its direction Switch off the button plane parallel moving Fig 68 and execute the command to confirm moving click pointers Fig 72 Return to Step 11 and exactly set the structures at risk points Figs 73 74 and 75
53. ep 1 1 patient data 2 strut lengths 3 triangle side lengths 4 scheme prompt 48 Step 2 Uploading the AP Roentgenogram A movable panel appears with a button to load the AP roentgenogram AP view Fig 38 lt gt SUV Software vp 120903 D INFA_DISK_C BACKUP tpasmatonorua gt File Edit Window Help D c SS IT Fig 38 Ortho SUV program window in Step 2 Uploading the AP view To upload the AP roentgenogram click on the button AP view A drop down menu appears Using the browse function choose the previously prepared AP roentgenogram Click on the button Open At this point the operator is returned to Step 2 Note that the AP view itself does not appear Click on the Forward button and continue to the next step Step 3 Uploading the Lateral profile Roentgenogram To upload the lateral digital roentgenogram click on the button Lateral Fig 39 A drop down menu appears Using the browse function choose the previously prepared lateral roentgenogram Click on the Open button Two radiographic images will appear in the document window the AP view to the left and the lateral view to the right Fig 40 After these two views appear save the file click on the Forward button and continue to the next step 49 T SUV Software vp 120903 D INFA_DISK_C BACKUP File Edit Window Help Oe SB IT Step 2 Lateral Fig 39 Ortho SUV software window after St
54. ep 3 SUV Software vp 120903 NONAME2 lt gt File Edit Window Help D c SB D Lateral Fig 40 Ortho SUV software window after Step 3 in which the AP and lateral views appear Step 4 Scaling of the AP View At the step 4 in a window of the program appear earlier uploaded AP view the button zoom in zoom out and the special tool so called dumbbell Fig 41 Having pressed by the button the user chooses 50 what he wants to make with the roentgenogram magnification or reduce the image Thus near or appears an appropriate dot index After that double click of the left button of the mouse in the field of the roentgenogram the user enlarges or reduces the image The picture is enlarged reduced around of the cursor It lets make the centre for magnification demagnification any point of the roentgenogram Moving of the roentgenogram along the screen is carried out as follows having pressed on the left button of the mouse in a field of the roentgenogram and not releasing the mouse button the user moves the cursor in that direction where he wants to move the picture T SUV Software vp 120903 D INFA_DISK_C BACKUP rpasmaronorna SUV 26072012 aaa JIH Sozonovskaja lt gt File Edit Window Help Step 4 Interval between AP view Pl LY f Fig 41 Ortho SUV software window in Step 4 1 AP view 2 Zoom in zoom out button 3 tool dumbbel
55. f AP view a prior to scaling Dumbbell is outside of field of roentgenogram b dumbbell is moved to ruler one of its ends is overlapped with ruler c after scaling Both ends of dumbbell are overlapped with ruler Field Interval between is filled in according length of ruler 80 mm If for the program the analog roentgenogram was photographed for scaling the size of the roentgenogram can be used its width or length Fig 43 52 T SUV Software vr 120717 D INFA_DISK_C BACKUP tpasmatonorua SUV 26072012 SUV Software vr 120717 Mauix fJ File Edit Window Help BE D f gt SUV Software vr 120717 D 2 File Edit Window lt Dc Fig 43 Ortho SUV software window in Step 4 Scaling of AP view analog roentgenogram was the initial source a prior to scaling Dumbbell is outside of field of roentgenogram b after scaling Both ends of dumbbell are overlapped with ends of the roentgenogram Field Interval between is filled according to width of the analog roentgenogram 298 mm 53 Step 5 Scaling of the Lateral View Lateral view scaling is implemented in the same way as described for the AP view Figs 44 and 45 Click on the Forward button to continue to the next step f File Edit Window Help Dc S260 eE Sr LE lt gt SUV Software f file Edit Window Help Dci mI 6 mc Fig 44 Ortho SUV sof
56. f the joint line After that in the field Blue angle of base fragment marker insert 87 and press the button Blue angle of base fragment marker The axial line will be placed at an angle of 87 deg to the centrator joint line designating the mechanical axis of the proximal fragment Fig 61 77 pu le 87 85 90 Fig 61 Finding mechanical axis of proximal tibial bone in frontal plane with help of blue angle a diagram of mechanical angle b centrator with blue angle is placed on joint line and vertex of blue angle coincides with centre of joint line Due value of blue angle 87 deg is inserted It leads to that axial line of green tree takes position of mechanical axis of bone fragment Note that yellow point is placed on distal border of proximal fragment It is known that the proximal femoral mechanical angle in frontal plane is 90 deg and the mechanical axis should cross the joint line in the centre of femoral head Moving with the help of the left mouse extreme red points of the centrator place the centrator to coincide with Joint line and the vertex of the blue angle must be placed in the centre of femoral head After that in the field Blue angle of base fragment marker insert 90 and press the button on Blue angle of base fragment marker The axial line placed at an angle of 90 deg to the centrator Joint line designating the mechanical axis of proximal fragment Fig 62 ma v
57. gnification you must switch this button off After that drawing bone contour can be continued NB Lengths of bone contours on AP and Lat view must be of equal length Once the bone contours have been drawn on the AP and lateral views click the Fwd button 64 T SUV Software vp 120903 D INFA_DISK_C BACKUP rpaematonorua SUV 26072012 aaa JIH Sozonovskaja sozonovskaja suv File Edit Window Help SEO gt SUV Software vp 120903 DAINFA_DISK_C BACKUP rpae aro orua SUV 26072012 ana JIH Sozonovskaja sozonovskaja suv lt gt File Edit Window Help D cr eaea e EN EX P ecd e tet f 7 4 P 3 WUU RNrrnn CUly Oro WWW OlLITO SUV OI d 65 SUV Software vr 121029 D INFA_DISK_C BACKUP rpasmaronorna SUV 26072012 ana IH Sozonc f File Edit Window Help his e Reo SUV Software vr 121029 D INFA_DISK_C BACKUP rpasmarono File Edit Window Help D lt N SB D exo oc ENS Fig 53 Ortho SUV software window in Step 8 a arrow points the button of moving of fields of roentgenograms On AP view arrow indicates the yellow point made by cursor b yellow line in projection of cortex of distal fragment AP view is drawn c yellow bone contours on AP and Lat view are done Note that bone contours are of equal length d e possible variants of bone contours of mobile fragment Step 9 Marking the Anatomic Axes of the Bone Contours on the AP and Lateral Views To mark
58. ial to consider the direction in which the distal main support and struts will be moved 1 Use only the threaded rods packed in the Ortho SUV set 2 The threaded bush of the strut length changing unit Fig 9 has a slot It can be used to control the position of the peripheral end of the threaded rod 1 The yellow bone contour Step 8 must exactly coincide with the contours of the mobile bone fragment In completing deformity correction or fracture reduction planning Step 11 the location of the red bone contour of the 139 Partial re assembly of the external fixation frame Partial re assembly of the external fixation frame replacing the threaded rod by a longer one 1 Additional program calculation and elimination of the residual displacement The control X ray image shows that the fragments have interconnected which prevents fracture reduction or deformity correction Thus further changes in strut length will result in the deformation of not only the bone fragments but of the whole external fixation as well After the work is complete the program does not shut down frame 2 Unstable fixation of the bone fragments by the proximal and or distal external fixation unit As a rule the bone fragment relating to the support becomes displaced due to the deformity of the transosseous elements 3 X ray projections taken before and after the deformity correction do n
59. it Window Help D c bl m ET c Angeiioe Angle 2 5 9 Ee AP view Lat view Left Left Oo y Right Right Rotation 20 A fX SUV Software vr 130131 D INFA_DISK_C BACKUP tpasmatonorualSUV Co f File Edit Window Help D c g 1 FE ITI e eoe jAde2so 4 AP view Lat view Left Left o y Right Right Rotation S 20 Vr Fig 72 Ortho SUV program window in Step 11 performance of command to confirm moving click pointer a after having placed cursor at red point connected with pointer of proximal fragment border yellow point specified by arrow left button of the mouse must be pressed b the same click pointer procedure must be done for mobile fragment pointed by arrow NB Do not forget to execute the command to confirm moving click pointer If you are convinced of correct position of the mobile bone fragment i e red bone contour press button Fwd If after pressing button Fwd 95 an icon Click the pointer will appear it is necessary to repeat procedure to confirm moving Fig 72 using pointers not only in lateral view but also in AP view Step 12 Designation of Structures at Risk Performance of Step 12 allows the program to obtain the data for calculation of necessary rate of deformity correction The parameters given are Structures at Risk SAR The first structure at risk SAR 1 is a point located on pr
60. ized with the diagnosis Posttraumatic complex two level deformation of the right femur with shortening 4 cm Fig 84a The patient was operated two level osteotomy with applying two Ortho SUV Frames Fig 84b 110 90 1 8 90 11 9 90 11 10 90 O SUV 1V 9 90 V 10 90 O SUM VII 9 90 VIII 3 9 VIII 8 90 VIII 4 90 Uo T lt 0 2 289509 SU RRIT pT MEC CM E In calculation bone fragment markers were drawn in a projection of anatomic axes of bone fragments Calculations were made separately for each of levels of deformation Fig 84c To find time necessary for deformity correction Structures at Hisk SAR were designated in Step 12 Deformity correction was performed and the correct position of mechanical axis of femur restored according to the software calculations Fig 84f After deformity correction struts were replaced for llizarov hinges Fig 840 In 2 months after the beginning of the fixation period module transformation of the device was executed Fig 84h In 130 days after the beginning of the fixation period the frame was removed Fig 84i www ortho suv org Reduction of fracture Deformity correction translation al M e Back Fwd y A Angle Z 16 3 tiated Step 11 Reduction of fracture Deformity correction I BASE BASE ww Rotation we 7 vR p s Axial translation Tolengthen R fi t N 118 www ortho suv org 119 C SUV Software vp 12
61. k 100 6 Application of Ortho SUV Frame Clinical Cases 109 6 5 Application of Ortho SUV Frame in Treatment of Knee Joint Stiffness Tios and Tricks for Using the Ortho SUV Frame 8 Instead of the conclusion 1 0 Ortho SUV Frame training courses and workshops 9 References References o O cJAppndx o O 1 Introduction In the correction of complex multi component and multiplanar deformities http Awww ortho suv org images stories deform class2 pg using the Ilizarov frame unified reduction nodes have to be replaced three to five times Fig 1 Every frame re assembly involves a change in the reductional units and is a highly laborious process in which there is additional patient exposure to radiation Sometimes due to the peculiarities of frame assembly external supports are not oriented at a right angle to the axes of the bone fragments a bone is not at the center of a support the support for some reason is not closed etc correction of one component can lead to the secondary translation of other s These secondary translations will in turn require correction and therefore additional frame re assembly Solomin L N et al 2009 www ortho suv o rE Fig 1 To correct a multi component deformity the Ilizarov frame has to be reassembled three to five times a lengthening b correction of an angular deformity and translation in the frontal plane c correction of an angu
62. l For scaling the AP view extreme points of the dumbbell must be overlapped with roentgen visible ruler which is on the roentgenogram Fig 29 To move the dumbbell place the cursor directly on its center visible as a small circle and while left clicking the mouse move the ruler around the display to roentgen visible ruler After that one of the ends of the dumbbell should be overlapped with one of the ends of the ruler For this purpose direct the cursor on one of the ends of the dumbbell and while left clicking the mouse drag it on screen before it coincides to the end of the ruler Due to this the dumbbell is increased in length Similarly overlap other end of the dumbbell with the opposite end of the ruler After the length and position of the dumbbell have been set fill in the field Interval 51 between AP view by typing in the length of the Known interval in mm Fig 42 then click on the Forward button to continue to the next step C SUV Software vp 120903 DNINFA DISK C BACKUP rpaswaronorna SUV 26072012 4na MH Sozonovskaja sozonovskaja T SUV Software vp 121015 DAINFA DISK CBACK PNrpaemaro won SUV File Edit Window Help File Edit Window Help Da asm AP view Back Fwd y A SUV Software vp 120903 DAINFA_DISK_C BACKUP Tp File Edit Window Help Da a aan cE e Fig 42 Ortho SUV software window in Step 4 Scaling o
63. lar deformity and translation in the sagittal plane d correction of a rotation Certainly the problem of the directed accurate moving of object in three dimensional space demands the decision not only in orthopedic Surgery but also in many branches of technique One of perspective directions in the given area is application of hexapods Hexapods structurally consist of two basic and mobile platforms to be connected by six telescopic rods of a special design so called struts The ways in which the struts connect to each other and to the platforms differ and depend upon the authors approach Fig 2 The number of struts is not connected with the number of planes and the degrees of freedom that the platforms must have relative to each other when five struts are used the system loses its stability while seven struts Causes overstraining The first hexapod was proposed by Gough in 1947 Bonev l 2003 for testing wheels exposed to combined forces Fig 2a Ceppel in 1962 unaware of Gough s invention created a similar mechanism while developing a vibration device Fig 2b Stewart in 1965 Bonev I 2003 proposed a platform on the basis of the original hexapod Fig 2c www ortho suv org Fig 2 Hexapods a Gough s system b Ceppel s system c Stewart s platform Bonev I 2003 Initial length of each of struts corresponds to initial position of a mobile platform final length of each of strut agrees with needed posi
64. lateral view The second structure at risk SAR 2 is a point in a projection of main vessels and nerves which during deformity correction or reduction of fracture will be maximally stretched Localization of this point must be identified using basic knowledge of topographic anatomy and long bone deformity correction For example there are valgus and shortening of proximal tibia In this case peroneal nerve will be most stretched during deformity correction Therefore the projection of peroneal nerve is SAR 2 Fig 74 SAR 2 should be marked on the lateral view too It must be the same point which has been determined for AP view 97 A B a tibialis n peroneus a tibialis v saphena v saphena posterior superficialis anterior magna parva v tibialis n peroneus v tibialis Saphenus n cutaneus posterior profundus anterior surae n tibialis medialis V NLA y is Fig 74 Identification of SAR 2 i e point in projection of main vessels and nerves which during deformity correction or reduction of fracture will be maximally stretched a there are valgus and shortening b during deformity correction peroneal nerve will be stretched much more than other vessels and nerves of lower leg Thus projection of peroneal nerve is SAR 2 c projection of SAR 2 on the lateral view is shown It must be the same point which has been identified on AP d SAR 2 is marked by the tool green cross on AP and lateral view 7 LAI
65. ld of the strut appropriate number Then bring the cursor to the centre of joint the same number Then while left clicking the mouse drag the line along the 56 projection of this strut onto the X ray image Fig 47 The line should be drawn strictly along the strut centre For correction of position of the line bring the cursor to any of its ends press the left button of the mouse and move the line in a necessary direction If the centre of joint is invisible draw the line in a projection of a seen part of strut NB As joints of struts 1 3 and 5 are fixed to the proximal ring lines for these struts must be drawn top down As joints of struts ZZ 2 4 and 6 are fixed to the distal ring lines for these struts must be drawn bottom up SUV Software vp 121015 DAINFA_DISK_C BACKUP tpasmaronorvalKypc KHMFa MeTOAMMKA PyCcK 2 Fite Edit Window Help t File D lt N SUV Software vp 121015 DAINFA_DISK_C BACKUP tpaemaronorven SUV 260 Edit Window Help Fig 47 Ortho SUV software window in Step 6 Indicating the strut projection a in field Strut 1 the tick is put The cursor is brought to area joint 1 pointed by arrow b while pressing left button of the mouse line in projection of centre of strut 1 is drawn c all well seen struts are marked 57 After that projections of strut joints must be drawn For this purpose in a field Projections of joint centers put a tick
66. lp D cy E e BEBO cr rc Angle 110 7 Angle 25 9 dC 4 84 T SUV Software vr 130131 DAINFA DISK CBAC amp File Edit Window Help D c e SEO c Angeiio Angle2 s o Tuc Axial Lat view v K m Pun EC V C o E Right T moo T Rotation xi 0 Fig 66 Ortho SUV program window in Step 11 vertical moving of red bone contours a necessary value is inserted into field of vertical moving 11 mm b tick opposite Up is put It has led to moving of red bone contours up c necessary value is inserted into field of vertical moving 15 mm d tick opposite Down is put It has led to moving of red bone contours downwards To move red bone contour on the AP view to the left it is necessary to insert the value of moving in mm and put a tick in the window Left After that red bone contour on the AP view will move to the left by the given value Fig 67 To move red bone contour to the right the tick should be inserted in the window Right Red bone contour on the lateral view is moved in a similar way The field Lat view must be used 85 G SUV Software vr 130131 D INFA_DISK_C BACKUP tpasmatono f File Edit Window Help Dos S BEO or c Angle 110 7 Angle 25 9 de Translation Axial Sue 0 pom Pom vi view Left Left 12 y Right mo Rotation SUV Software vr 130131 D INFA_DISK_C BACKUP rpaemaronorua SUV Co f File Edit Window Help D c N
67. ment that is clinical case has been created it is necessary to save it command Save in File menu in the patient case folder It is recommendable to repeat saving after every step Note 2 The software will not work without the Hasp Key Hence ensure that the Hasp key is kept safely
68. mic angle b as bone fragment is short centrators can not be used Distal centrator is moved off border of distal fragment Centrator with blue angle is placed on joint line and vertex of blue angle coincides with anterior third of joint line Due value of blue angle 83 deg is inserted It leads to axial line of violet tree takes position of anatomic axis of bone fragment Yellow point is placed on proximal border of distal fragment c software window at finding anatomic axes of femur in csagittal plane Anatomic axis of proximal fragment is found with the help of centrators 81 Having placed the bone fragment markers click on the Forward button to continue Step 11 Correction of the Final Position of the Mobile Fragment After execution of Step 10 and clicking the Fwd button in the field of roentgenograms yellow bone contours appear again Let s remind that yellow bone contours are made in Step 8 and with their help the program designates an initial position of a mobile fragment In addition it Step 11 red bone contours appear By red bone contours the program designates final position of a mobile fragment after deformity correction or fracture reduction NB Yellow bone contours mean the initial position of the mobile fragment Red bone contours mean the final position of the mobile fragment To correctly estimate the position of red bone contours maximal magnification must be used If in Step 11 bone contours are invisible
69. n the field Mobile fragment marker AP view Then move the cursor on the proximal end of the mobile fragment While left clicking the mouse draw an axial line of the basic bone fragment on the frontal roentgenogram top down After that the marker of the mobile bone fragment violet tree will appear Fig 57 The yellow point should settle down in the field of the top border of the distal fragment To strictly align the axis line of the fragment marker with the anatomic axis of the base bone fragment place the cursor over the left end of the 71 first centrator and while left clicking the mouse place this point on the cortical layer positioned to the left Similarly place the second outermost point of the centering line of the base bone fragment marker on the cortex positioned to the right At a some distance from proximal centrator depends on known rules of mid diaphysial lines of long bones definition similarly place the second centrator As a result the anatomic axis of the distal bone fragment will be positioned on AP view After that overlap the cursor with the red point connected with the yellow point and press the left button of the mouse Moving upwards or downwards the red point achieve that the pointer of bone fragment border yellow point coincided with the proximal border of the distal bone fragment Fig 57 SUV Software vr 121029 DAINFA_DISK C BACKUP rpacuaronor va SUV 260720 Aan IIH Sozonovskajasozonov
70. ne in the field of the lateral view Free plane parallel moving of red bone contour There is a button plane parallel moving in the panel of tools in Step 11 Tick here Then having placed the cursor with any of red points of the marker of proximal bone fragment green tree while left clicking the mouse move the cursor on the screen Hed bone contour will move together with the cursor Fig 68 Note that red bone contours change their position on both roentgenograms NB After necessary plane parallel moving of red bone contour do not forget to remove the tick from the button plane parallel moving fl File Edit Window Help D lt SS D Angle 110 7 Angle 2 5 9 eve e Translation Axial ue 0 Down AP view Lat view Left Left 0 Ly Right Right BO Rotation E o m 88 f SUV Software vr 130131 DAINFA DISK ABACKUPVrpaswaronorwsVSUVACosonosckasCosonosckan uv Amn File Edit Window Help D cy d SB IT sce jAMPedio JAmzse a 2 Translation Axial Ue 0 Down AP view Lat view Let Left o la Right Right Emo Rotation o i f SUV Software vr 130131 D INFA_DISK_C BACKUP rpasmatonorua SU 03 OHOBCKaA COS0OHOBC as suv H p b EN L Cl File Edit Window Help De SB ITI cK c Ange 110 7 Angle 2 s 9 Eu Translation Axial WPO Down AP view Lat view Left Left o la Right may
71. nt It was not possible to use centrators due to the shortness of distal fragment 35 mm To identify anatomic axes the blue angle was used Positions of crossing points of ankle joint lines and anatomic axes for AP and lateral view are known Paley D 2005 In Step 10 the centrator with blue angle was placed on the joint line in a way that apex of the blue angle was localized in the centre of joint line After that using options of the program necessary value of blue angle was set 89 deg for the AP and 80deg for lateral view As a result the axial line of the bone fragment marker corresponded to anatomic axis of distal fragment Fig 85d e To find time necessary for deformity correction Structures at Hisk SAR were designated SAR 1 was put on the osteotomy line at where the mobile fragment during its movement will cover the ongest distance Fig 85f SAR 2 was put in the projection at where main vessels and nerves will get its maximal stretching Fig 85g In Step 12 the rate of deformity correction 1 mm per day was entered After Calculate button was pressed program calculated the recommended number of days required for correction of the deformity When button Show had been pressed in the lower right field of the display a table appeared displaying the values of daily length change for each strut Fig 85h This table was printed out and given to the patient Deformity correction was done according to software
72. ntrator with the blue angle must be placed in a projection of joint line At the same time the vertex of the blue angle must be placed at a due point of crossing of the anatomic axis and the joint line After that necessary value of the blue angle must be set For this purpose there are fields Blue angles on AP view and Blue angles on Lat view in Step 10 For example there is a supracondylar deformation of a femur The length and the shape of distal fragment do not allow using the centrators For example it is known that the distal femoral anatomic angle in sagittal 80 plane is 83 deg and the anatomic axis should cross the joint line at its anterior third Moving with the help of the left mouse extreme red points of the centrator place the centrator to coincide with joint line and the vertex of the blue angle must be placed at the anterior third of the joint line After that in the field Blue angle of mobile fragment marker insert 83 and press the button on Blue angle of mobile fragment marker The axial line placed at the angle 83 deg to the centrator joint line designating the anatomic axis of distal fragment Fig 64 f gt SUV Software vr 121029 DNINFA DISK CBACKUPvrpaswaronorws SUV peranan Cer nnn 17082010 sud f File Edit Window Help c N SB ITI Angle 13 8 Ange2186 Fig 64 Finding anatomic axis of distal femoral bone fragment in frontal plane with help of blue angle a diagram of anato
73. ntre of support as well as eccentrically struts can be fixed to supports directly as well as using straight or Z shaped plates the struts can be fixed not only to basic and mobile supports but also to stabilizing supports the places of struts fixation to supports can be chosen by a surgeon randomly It s better to make equal distance between the points of fixation to form equilateral triangles But this term is not obligatory the strut length is formally not limited and depends on the length of threaded rods used None of these parameters requires aaditional and special data to be input in the software 30 4 Modes of Ortho SUV Frame operation For practical reasons the distal mobile support is moved relative to the proximal static basic support A length change of even one of the struts will cause the mobile support to dislocate in three planes By changing the lengths of every strut displacement of the mobile support over the required direction and distance is achieved The amount of the length change for every strut is calculated by a computer program There are two modes of operation for an Ortho SUV Frame 1 Fast struts mode 2 Deformity correction mode 4 1 Fast Struts mode This mode is used for acute fracture reduction or when deformity correction is implemented under visual control or fluoroscopy The procedure starts with the loosening of the large lock nuts moving them by their rotation
74. oint of cardan line marked by arrow c while left clicking mouse line in projection of the centre of joint 1 is drawn d all well seen cardan joints are marked NB Button Fwd changed color with black on green that allows making the following step As soon as the program has enough information to continue the Fwd sign turns green at which point continuation to the next step is possible 59 Step 7 Indicating the Focal Distance and Beam Center and the Strut and Joint Projections on the Lateral View Step 7 Figs 49 51 is carried out essentially as described for Step 6 Here it must again be emphasized that the numbers assigned to the strut and the joints in the program must correspond to those used in the corresponding frame calculations The arbitrary designation of numbers is not allowed As a rule for the program to work successfully it is sufficient to indicate three struts and one joint with the joint numbered differently from the indicated struts The struts and joints indicated on AP and lateral roentgenograms might not coincide In other words the AP view might feature one set of indicated joints and struts and the lateral view another As soon as the program has enough information to continue the Fwd button turns green and it is possible to continue to the following step T SUV Software vp 120903 D INFA_DISK_C BACKUP rp lt gt File Edit Window Help D c N SB D Focal distance Lat view B
75. ond group are found using tools of the software 5 2 1 Parameters measured on the frame The 12 parameters measured on the frame are strut length 6 parameters and the side lengths of the triangles 6 parameters whose apexes are the centers of the nuts fixing the strut joints to the ring or plate Strut length is a distance between the hook located on joint and the end of the strut length changing unit Fig 26 It is a mistake to measure the distance from the hook up to the end of the threaded rod 37 Fig 26 Strut lengths measurement a strut length L is measured between strut hook and ending point of strut length changing unit It is a mistake to measure distance from hook up to end of threaded rod b measurement using a ruler or measuring tape c measurement by laser range finder The sides of the triangles are measured between the centers of the nuts that fix the joints to the rings or to the plates Fig 27 It is erroneous to measure the distances between the centers of the nuts that fix the plates to the rings For the basic ring the sides of the triangle are indicated as A1 Base B1 Base C1 Base Thus A1 Base is the distance between joints 1 and 3 B1 Base is between joints 3 and 5 and C1 Base is between joints 5 and 1 For the mobile ring the sides of the triangle are indicated as A2 Mobile B2 Mobile C2 Mobile Thus A2 Mobile is the distance between joints 2 and 4 B2 Mobile
76. ong bone deformities 3 1 congenital deficiency fibular hemimelia congenital femoral deficiency tibial aplasia etc 3 2 Aquired deformities post traumatic post infectious idiopathic bone diseases leading to deformity Hypo Pseudo Achondroplasia Rickets Blount enchondromatosis mucopolysaccharidosis etc 4 Congenital limb length discrepancies 5 Foot deformities including clubfoot Charcot Marie Disease etc 6 Joint stiffness of elbow knee and ankle joints of any etiology 7 8 9 1 Old subluxations in elbow knee and ankle joints Aesthetic deformities Reconstructive procedures for example pelvic support osteotomy U Arthrodiastasis Further information featuring construction and advantages of hardware and software will be considered below 2 Design of Ortho SUV Frame Two external supports comprise the Ortho SUV Frame Fig 4 one basic and the other mobile These are united by six struts connected in 10 series Together these parts constitute the universal reduction unit mentioned above The basic ring with the aid of the transosseous elements fixes the main bony fragment while the mobile support holds the bony fragment to be transported If necessary the rigidity of the osteosynthesis can be increased by using additional stabilizing supports Fig 4 Ortho SUV Frame design a standard assembly b assembly completed with stabilizing support 1 b
77. opedic hexapod was patented in 1985 in France by Philippe Moniot Paley D 2011 At the beginning of 90th years of the last century in the llizarov Russian Research Center the device shown in Fig 3a was developed Shevtsov V I 2008 unpublished data However these frames were not clinically used partly due to the lack of software Fig 3 Orthopedic hexapods a device created in Ilizarov Russian Research Center b Taylor Spatial Frame c Ilizarov Hexapod System First orthopedic hexapods used clinically and sold commercially appeared in USA and Germany Those are Taylor Spatial Frame TSF Fig 3b with its usage started in 1994 and llizarov Hexapod System device IHS Fig 3c developed in 1995 Seide K et al 1999 These devices are becoming more and more popular at fracture treatment and long bone deformity correction due to the possibility to implement mathematical precision of the procedure without resorting to repetitive changes of unified reduction units Paley D 2005 Rozbruch S R et al 2006 Marangoz S et al 2008 Seide K et al 2008 Solomin L N et al 2008 Dammerer D et al 2011 Original transosseous hexapod Ortho SUV Frame was developed in Russia in 2006 There is an incorrect opinion that all known orthopaedic hexapods work using Stewart platform Taylor J C 1997 Seide K et al 1999 Paley D 2005 However IHS and TSF are closer to Gough s and Ceppel s platforms Fig 2a b
78. opposite to joint number which is going to be designated This results in the fact that around of the point designating the joint end of the strut line a small circle with a small line appeared The line of small circle has a red point on its end Move the cursor to this point press the left button of the mouse and move it so that a line connecting with small circle became axial line of joint Fig 48 Accuracy of lines drawn in the projection of struts and joints should be checked up in a mode of image magnification If some of lines are not precisely in a projection of an axis of strut or joint aim the cursor at any of three red points and while left clicking the mouse move the drawn lines in the necessary direction 58 SUV Software vp 121015 DAINFA_DISK_C BACKUP tpasmatonorwa SUV 20072012 V8 MH Sozonovskaja sozonovskaja suv T SUV Software vp 121015 D INFA_DISK_C BACKUP rpaemarono File Edit Window Help File Edit Window Help Oe SE SUV Software vp 121015 D INFA_DISK_C BACKUP lt gt File Edit Window Help t2 File Edit Window Help D c Bi asm Fig 48 Ortho SUV software window in Step 6 Indicating the joint and strut projection a in field Joint 1 put tick opposite to joint number which is going to be designated This results in that around of a point designating the joint end of the strut line a small circle with a small line appeared b cursor is brought to red p
79. ot coincide Note that the program calculates the integral trajectory for the bone fragment reduction i e according to the shortest distance Thus if there is axial displacement of the bone fragments the proximal end of the distal fragment is higher than the distal end of the proximal fragment and attempts are made to eliminate the translation the fragments will become inevitably interconnected The hasp key was removed before the program was shut down proximal must be controlled maximal magnification 2 Fixation of the proximal and distal bone fragments must be stable and exclude the possibility of fragment displacement relative fragment visually using appropriate supports 3 Take X rays in the same views If the proximal end of the distal fragment is higher than the distal end of the proximal fragment deformity correction fracture reduction must be performed in two stages 1 distraction to provide a 3 4 mm diastasis between the bone fragments program calculation planned for distraction 2 residual displacement is eliminated the second calculation in program Fig 71 the First shut down the program and only after that remove the hasp key 140 2 Reassembly of the external fixation frame stabilizing the supports repeated calculation in the program and elimination of the residual displacement 3 Control X ray images are obtained in view
80. oximal edge of mobile fragment which at deformity correction or reduction of fracture will be moved by the maximal distance Localization of this point must be identified using basic knowledge of long bone deformity correction For example there are valgus and shortening In this case the point which is located at osteotomy level in a projection of external cortex after deformity correction will be moved at the greater distance than any of the points which are closer to internal cortex This point must be designated as SAR 1 Fig 73 SAR 1 also must be marked in the lateral view SAR 1 on the lateral view must be the same point which was chosen for the AP view Fig 73c d NB SAH must be the same points for AP and lateral view M 96 C d Fig 73 Identification of SAR 1 i e point of mobile fragment which during deformity correction will pass the greatest distance a there are valgus and shortening Osteotomy has been made at CORA level Number of points are put on osteotomy line from internal up to external cortexes specified by arrows b point 1 during deformity correction will be moved at distance 1 1 This distance is more than distance at which any of points located closer to medial cortex are being moved Thus the point 1 is SAR 1 c projection of SAR 1 on the lateral view is shown It must be the same point which has been identified on AP d SAR 1 is marked by tool green cross on AP and
81. peated Thus the maximal strut length is limited only by length of threaded rod used NB There are no situations when both fixing screws 1 and 2 are loosened at the same time The loosing of the screw 1 allows fast strut mode to be completed The loosing of the screw 2 is necessary for reverse procedure At gradual deformity correction both screws must be tightened The precisely controlled relocation of bone fragments requires that the amount of length change be calculated for every strut This can be done using specialized software 5 Software for the Ortho SUV Frame 5 1 General information The program for working with the Ortho SUV Frame was written using the language C Builder Its volume is about 1 400 kb To install the program copy the executable file onto a hard disc The minimal requirements are IBM PC compatibility operating system Windows 2000 XP or Vista processor with a minimal quality of the DX486 and a minimum frequency of 1 5 GHz and a memory of 256 Mb RAM Installation requires at least 10 Mb of disk space Color display with a minimal resolution of 800 x 600 pixels is necessary software is available as a folder SUV Software vp There is a number of the version of the program instead of for example SUV Software vp 1 0 The folder has two files SUV Software vp exe and winspool dll The later version has greater number than the previous one Updated soft
82. physial lines of long bones definition similarly place the second centrator As a result on AP view the axial line of green tree will take place of anatomic axis of the proximal bone fragment After that overlap the cursor with the red point connected with the yellow point and press the left button of the mouse Moving upwards or downwards the red point achieve that the pointer of bone fragment border yellow point coincided with the distal border of proximal bone fragment Fig 56 SUV Software vr 121029 D INFA_DISK_C BACKUP rpasmaronorma SUV 26072012 aaa JIH Sozonovska fF File Edit Window Help ES D Step 10 Mark axis of bone Mark axis of bone i on Lat view 70 SV Sofware v 121029 DANA BER CBA CROP poor SU VASEDT A om SSS Sas THE a S xX f File Edit Window Help D c N FE Im cr 6 Angle 13 0 Angle 2 6 7 Fig 56 Ortho SUV software window in Step 10 at positioning of proximal bone fragment marker on AP view a field Base fragment marker is ticked After that in top down direction green tree is drawn b using centrators axial line has positioned according to mid diaphysial line anatomic axis of fragment Yellow point is placed on distal border of proximal fragment c diagram Arrows specify points of centrators placed in projection of lateral and medial cortexes The next stage is set of distal fragment bone marker in the frontal plane For this purpose tick i
83. plane with use of blue angle a centrator with blue angle is placed on joint line and vertex of blue angle coincides with centre of femoral head Due value of blue angle 90 deg is inserted in field Blue angle of base fragment It leads to that axial line of tree takes position of mechanical axis of bone fragment b centrator with blue angle is placed on knee joint line and vertex of blue angle coincides with centre of joint line Due value of blue angle 88 deg is inserted in field Blue angle of mobile fragment It leads to that axial line of violet tree takes position of mechanical axis of mobile fragment Yellow points are placed on borders of proximal and distal fragments For Lat view anatomic axes of fragments has been found with use of both centrators c diagram of finding mechanical axes of fragments in frontal plane Finding anatomic axes with the help of blue angle When the length of a bone fragment does not allow using centrators to find anatomic axis the blue angle can be used The anatomic axis as well as the mechanical axis is known to cross a joint line in the certain point at the certain angle Localization of crossing and value of an angle are specific for proximal and distal joints of each long bone in frontal and sagittal planes Paley D 2003 Solomin L N 2008 2013 With the reference to Ortho SUV software centrator with the blue angle is a joint line Thus to define an anatomic axis of a bone fragment ce
84. r clinical cases Before working with the program it is necessary to create a folder with the title of the clinical case for example Case 1 AP and lateral view of the patient must be placed in this folder Fig 34 Lat View 123 39 x 2 09 DSee Pro 3 JPEG dalin gt S A P JP m 20 c 2042 NO CDSee Pro 3 JPEG anin Fig 34 The clinical case folder should contain patients AP and lateral view TO start working double click SUV exe file Program window appears Press the New document button New document will be created with its first page entitled Step 1 Fig 35 WWW ortho suv org 46 V Software vp 1 INC i File Edit Window Help L S SS C2 mobile Fig 35 Program window step 1 after new document has been created NB After clinical case file had been created it must be saved in the same folder where patient s AP and lateral view are placed Fig 36 This file should be saved after passing each step of the software Lat View 1939 x 2 09 ACDSee Pro 3 JPEG dann A P 2039 x 2842 XO ACDSee Pro 3 JPEG dann Case 1 suv Mann SUY o Kb Fig 36 Clinical case folder must contain patients AP and Lat view as well as SUV file created by the software www ortho suv org 47 NB If for some reason difficulties have occurred usually associated with incorrect usage sent the folder contained X rays and SUV file to the following email address orthosuv gmail com In the ac
85. ram and Abstract Book St Petersburg 2008 P 339 http rniito org solomin eng deform class jpg 14 Solomin L N Terrell W Odessky J 2008 Multifactorial comparative analysis of llizarov apparatus and external fixation devices on the base of computer navigation Taylor Spatial Frame llizarov Hexapod Apparatus SUV Frame In 5th meeting of the ASAMI international Program and abstract book St Petersburg 2008 p 52 15 Solomin L N Comparative analysis of reduction capabilities provided by software based external fixation devices and llizarov apparatus L N Solomin V A Vilensky A I Utekhin W Terrell The Genius of Orthopedics Kurgan 2009 1 5 10 p p 16 Solomin L N Comparative analysis of reduction capabilities provided by software based external fixation devices and llizarov apparatus L N Solomin V A Vilensky 143 A I Utekhin W Terrell The Genius of Orthopedics Kurgan 2009 1 5 10 p p 17 Solomin L N Comparative analysis of rigidity fixation provided by software based external fixation devices and Ilizarov apparatus L N Solomin V A Vilensky A l Utekhin W Terrell Traumatology and Orthopedy of Russia St Petersburg 2009 2 20 25 p p 18 Solomin L 2013 The basic principles of external skeletal fixation using the llizarov and other devices Springer Milan 19 Solomin L Vilensky V Utekhin A Deformity Correction and Fracture Treatment
86. rod There is a swivel connection of joint with strut length changing unit in this place as well The hook used for measurement of strut length is fixed to the joint by means of a nut www ortho suv org Fig 8 Design of a joint of Ortho SUV Frame s strut a the joint with swivel connection to strut length changing unit of the next strut b fixing a strut to the ring c fixing strut to the plate d disassembled clutch e assembled clutch 1 joint 2 threaded tail 3 fixing nut 4 threaded rod 5 strut length changing unit 6 strut length changing unit of the next strut 7 hook 8 threaded tail with L shaped groove 9 coupling 10 small lock nut 11 straight plate Strut length changing unit Fig 9 consists of a body a connecting nut a threaded clutch and lock nuts The body and threaded clutch have 12 mm rust flies www ortho suv org 16 Fig 9 Strut length changing unit 1 body 2 connector nut 3 threaded clutch 4 lock nuts The body encloses two screws The screw 1 provides a mode of fracture reduction fast strut mode Fig 10 At a relaxation of the screw 1 connector nut can be moved by rotation along threaded rod Fig 10 There is a lock nut over the connector nut The screw 2 is intended for adjustment reverse of strut Fig 10 The tightening of the screw 2 fixes the body to the threaded clutch and they rotate together
87. s different from those that enabled the detection of the additional displacement of the fragments Perform an additional calculation in the program and eliminate the residual displacement he first stage is distraction to achieve 3 4 mm gap between fragments The second stage is residual deformity correction Fig 71 Insert the hasp key in to the USB port and after that shut down the program 141 8 Instead of the conclusion 8 1 Legalization Ortho SUV Frame is patented and certified All rights are reserved Copyright Patent and License infringement will be punishable by the fullest extent of the Russian Federation laws For any questions concerning copyright and license agreement registration apply to Ortho SUV Ltd executive director Victor Vilensky Vedeneeva Str 8 1 282 St Petersburg 195269 Russia Tel number 7 921 316 3703 http ortho suv org E mail orthosuv gmail com 8 2 Ortho SUV Frame training courses and workshops Complete information concerning training courses for the Ortho SUV Frame can be found at hittp ortho suv org http rniito org solomin http www rniito org download ortho suv lliz course 9 engl pdf and http www rniito org download ortho suv course 4 eng pdf To the attention of scientists and orthopedic surgeons We invite you to take part in scientific and practical work associated with the Ortho SUV Frame application and improvement Further information can
88. skaja suv E f File Edit Window Help D c S80 a 5e Angle 13 7 Angle 2 6 7 X Blue angles on AP view Blue angles on Lat view R ae angle of mobile fragment marker 90 0 Blue angle of mobile fragment marker 90 0 77 SUV Software vr 121029 D INFA_DISK_C BACKUP tpasmaronorma SUV 26072012 aaa SIH Sozonovskaja sozonc f File Edit Window Help D c RIT s M iss paga 72 Fig 57 Ortho SUV software window in Step 10 at positioning of distal bone fragment marker on AP view a field Mobile fragment marker is ticked After that in top down direction violet tree is drawn b with use of centrators axial line has positioned according mid diaphysial line anatomic axis of fragment Yellow point is placed on proximal border of mobile fragment c diagram Arrows specify points of centrators placed in projection of lateral and medial cortexes After that similarly place markers of proximal and distal fragments for the Lateral view Fig 58 The alternative method of finding anatomic axes of bone fragments is showed in Fig 63 SUV Software vr 121029 D INFA_DISK_C BACKUP rpasmaronorna SUV 26072012 ana JIH Sozonovskaja sozonovskaja suv File Edit Window Help D c SB D e Angle 13 5 Angle 2 6 1 i SUV Software vr 121029 DAINFA DISK BACKUP rpasmaronormua SUV 26072012 ana JIH Sozonovskaja sozonovs File Edit Window Help D c i EI Angl
89. t fragment marker of proximal fragment in frontal plane should be set For this purpose tick in the field Base fragment marker AP view Then move the cursor of the mouse on proximal end of the basic fragment While left clicking the mouse draw an axial line of the basic bone fragment on the frontal roentgenogram top down After that the marker of the basic bone fragment green tree will appear Fig 56 If the position of base fragment marker is correct yellow point will be in area of distal border of proximal fragment If an operator has mistakenly dragged the line not from bottom to top but from top to bottom the yellow point will assume the wrong location that is at the very top of the fragment marker To correct this mistake remove the tick in the field Base fragment marker AP view place the cursor over the image of the AP view and left click the mouse once The fragment marker will disappear Then go through the algorithm again this time dragging the line in the proper direction To strictly align the axis line of the fragment marker with the anatomic axis of the base bone fragment place the cursor over the left end of the first centrator and while left clicking the mouse place this point on the left cortex Similarly place the second outermost point of the centering line of the base bone fragment marker on the cortex positioned to the right At a some distance from proximal centrator depends on known rules of mid dia
90. t not to interfere with consequent nailing Fig 82b Method of the Unified Designation of External Fixation MUDEF 19 3 119 3 _ IV 3 9 Ortho SUV 1V 3 9 IX 8 2 1X 8 2 T 2 3 140 140 An attempt of close reduction in fast struts provided an improvement of bone fragment position Fig 82c Ortho SUV software was used to calculate elimination of residual displacement Fig 82d Bone fragment reduction carried out within 10 days Fig 82e After that nailing was executed Fig 82f 9 111 SUV Software vp 121029 DAINFA_D File Edit Window Help Del v9 wEBIm www ortho suv org 112 Fig 82 Photographs and roentgenograms of patient B 6 2 Application of Ortho SUV Frame in diaphyseal deformities 6 2 1 Both lower legs non unions accompanied with complex deformities 45 y o patient E was hospitalized with the diagnose nonunions of distal third in both tibias Complex six component three planar deformity of right lower leg Complex five component two planar deformity of left lower leg Fig 83a At the first stage combined external fixation of bones in both lower legs was performed using Ortho SUV Frame Fig 83b For the right leg www ortho suv org 113 11 12 100 IV 10 4 V 2 80 Ortho SUV w V1 12 90 VII 8 2 8 2 VIII 1 90 150 For the left leg IV 12 100 V 10 4 VI 2 80 Ortho SUV VII 12 90 VIIN S 2 8 2 VIII 4 10 150 The computer program was sequentiall
91. t stage V shaped foot osteotomy and applying of two Ortho SUV Frames was done Fig 86b www ortho suv org 128 sd MIEL 11 110 VIII A 10 VIII 8 2 8 2 Ortho SUV calc 4 10 calc 8 2 0 120 2 3 110 0 tars 4 10 tars 8 2 Ortho SUV m tars l m tars Il m tars V m tars lll 120 vee Free without transosseous elements proximal and distal rings were used to facilitate of struts fixation Calculations were done separately for each frame The first frame and the first calculation were used for hindfoot deformity correction Fig 86c The second device and the second calculation were used for midfoot deformity correction Fig 86d Correction of deformation was executed precisely according to calculations Fig 86e After deformity correction frame module transformation was done struts were substituted for Ilizarov hinges and free supports were removed Fig 86f Final configuration of the device is VII 11 110 VAIL 4 10 VIIL 8 2 8 2 o calc 4 10 calc 8 2 0 o tars 4 10 tars 8 2 o m tars l m tars Il m tars V m tars III 120 120 The period of fixation lasted 4 months In 6 5 months after operation frame was demounted Fig 86g 129 www ortho suv org 130 SUV Software vp 121029 D INFA_DISK_C BACKUP tpasmaronorua SUV CosoHoscxaa sozon 31101 f File Edit Window Help D c SEO a amp Angle 127 Angle 2 6 de x Step 11 Translation Axial
92. tch Rotation of the body in the direction increases strut length rotation in direction results in shortening of strut Full turn of the body 860 deg changes strut length up to 2 mm The scale interval is 2 mm Accordingly 45 deg turn changes strut length to 0 25 mm To control gradual 0 25 mm change of Strut length there are eight longitudinal lines on the external cylinder and one longitudinal line on the internal cylinder Turn from one line up to the next line corresponds the turn of the body by 45 deg and accordingly change of strut length by 0 25 mm After changing length of strut body and clutch must be stabilized by lock nuts the fixing screws should be fixed rotates as one unit the lock nuts should be loosened 34 Fig 24 Deformity correction mode gradual changing length of strut a loosing of lock nuts b rotation of the strut length changing unit in direction leads to strut lengthening in direction leads to strut shortening Turn from line to line changes length of strut by 0 25 mm c full turn 360 deg of strut length changing unit changes strut length by 2 mm The scale interval is 2 mm d strut is rotated by hand or at strut tension by spanner 12 mm e fixing of lock nuts NB Sometimes the scale length is not sufficient for a fragment displacement to be corrected completely In such cases the reverse www ortho suv org 35 procedure Fig 23 must be re
93. tes to fix the struts Figs 15c 17b 3 Use stabilizing supports to fix the struts Fig 17c d A feature of the program is that both roentgenograms appear only after the second lateral one has been loaded This is a feature of the program you will be able to work with the images on all of the following steps 1 The X ray field must include all struts and joints X rays retaken 1 Ihe X rays are made on narrow film and do not include all struts and joints 2 The images were obtained without the use of strut markers Fig 32 2 Strut markers must be placed on the struts prior to X ray imaging Fig 32 focal the The focal distance and or the center of the beam value was not entered Entering all the data Enter the required in this distance and window beam center After Step 7 has 1 Incorrect assembly 1 Correct assembly of 1 Partial re assembly been completed the program shows red lines that do not coincide with the strut projections s ranging from the non coincidence of one of the lines to the total displacement of all lines relating to the external fixation frame In the extreme case the red lines are beyond the visible field In advancing to Step 10 the program shows a dialog window of the external fixation frame first of all lack of adherence to the logo rule Fig 18 and the watch rule Fig 19 2
94. tion of mobile platform Change of length even of one strut leads to displacement mobile platform relative to basic one in three planes Therefore for necessary displacement of a mobile platform relative basic needs computer navigation The task of the software is to calculate required change of length of each strut using some data input There are active and passive navigation in robotics With reference to considered devices at active navigation the computer having received necessary coordinates of due position of an object in this case a mobile platform takes all necessary parameters for achievement of result itself If the operator approves modeled result the device for active computer navigation steers a mechanism to carry out the directed movement The autopilot works in the same way At passive navigation the operator put in a computer necessary coordinates of position of a mobile platform and parameters to describe its initial position including initial strut lengths as well After that the software calculates necessary change of lengths for each of strut Then the operator changes length of each of strut to achieve due position of mobile platform A car navigator may serve as an example In orthopedics the hexapod may be considered as an universal reduction unit to allow the movement of one platform one basic support with the bone fragment fixed inside relative to another by the shortest integral trajectory The first orth
95. tions perpendicular to each other For Ortho SUV 44 software AP and lateral views made at the angle not less than 45 can be used 7 If there are analog X rays they must be converted into digital form for example by photographing Camera should be located parallel to X ray view box and the X ray image should be taken completely Fig 33 NB The distance from the camera up to the X ray view box is not the focal distance The focal distance which was at X ray examination should be input into software Fig 33 Converting analog X rays into digital format a camera should be located parallel to X ray view box It is not the focal distance b image includes struts joints scaling ruler and marker of beam center www ortho suv org 45 5 3 Working With the Program After an initial training including 10 12 calculations the program assumes the following standard of work 6 12 minutes in case of fractures and shaft deformities 12 15 minutes in case of epimetaphyseal deformities and reconstruction surgeries It is necessary to provide maximum accuracy of each parameters input Steps 1 6 7 10 and 11 and proper performance of the procedures required Steps 4 10 and 12 It will provide ideal reduction and deformity correction NB The folder Ortho SUV Frame must be created on the working table of the computer This folder should contain folders SUV Software for files of the software and Cases fo
96. to the joint of strut 1 Fixing strut joint 2 to distal mobile ring www ortho suv org 28 insertion of threaded rods of strut 3 into Insertion of threaded rods of strut 4 into strut length changing unit of strut 3 It is strut length changing unit of strut 4 it is fixed to the joint of strut 2 Fixing strut fixed to the joint of strut 3 Fixing strut joint 3 to proximal basic ring joint 4 to distal mobile ring insertion of threaded rods of strut 5 into insertion of threaded rods of strut 1 into strut length changing unit of strut 5 it is strut length changing unit of strut 1 it is fixed to the joint of strut 4 Fixing strut fixed to the joint of strut 6 Fixing strut joint 5 to proximal basic ring joint 6 to distal mobile ring Note that all connector nuts are at some distance from strut length changing unit pointed by arrows www ortho suv org 29 J insertion of connector nuts into the body at osteotomy struts 1 3 and 5 should be of strut length changing unit Fixing screws temporarily disconnected from proximal 1 Stabilization of strut length changing support units by lock nuts Fig 21 Step by step Ortho SUV Frame assembling Hereby in Ortho SUV Frame assembling external supports of any shape and type excluding monolateral and arch supports can be used supports can be placed at any random angle to bone fragments axis the bone can be placed in the ce
97. tours on the AP and lateral views must be equal 137 of the external fi xation frame which requires an additional image X ray 2 Exact lengths of the struts and sides of the triangles are entered in mm 3 Exact length of the known section entered in mm 4 Exact focal distance entered in mm 5 Entering the numbers of the struts and joints according to the assembly of the external fixation frame 6 Thorough control of the data entered in Steps 1 7 Return to Steps 6 and 7 and mark the maximally possible number of struts and joints 1 Erase the bone contours and draw them again this time of equal length Precise the anatomical axes sizes When moving from Step 11 to Step 12 program shows a dialogue window Improper data When moving from Step 11 to Step 12 program shows a dialogue window Click both pointers After the Calculate button has been clicked to calculate the number of days required for the deformity correction or fracture AP and lateral views 2 The anatomic axes Step 9 of the mobile bone fragment on the AP and or lateral views do not sufficiently exceed the upper Or lower margins of the bone contour In the field Rotation direction and or value of rotation were not specified The button plane parallel moving has been clicked Fig 68 and or the command to confirm moving click pointers has not be
98. tware window in Step 5 Scaling of lateral view digital roentgenogram was the initial source a prior to scaling Dumbbell is outside of field of roentgenogram b after scaling Both ends of dumbbell are overlapped with ruler Field Interval between is filled in according to length of ruler 80 mm 54 lt SUV Software vr 120717 D INFA_DISK_C BACKUP tpasmaronorma SUV 26072012 5 File Edit Window Hel ae r ow elp Oe f S50 c EX Lc N Step Interval between Lat view Y A Fig 45 Ortho SUV software window in Step 5 Scaling of AP view analog roentgenogram was the initial source a prior to scaling Dumbbell is outside of field of roentgenogram b after scaling Both ends of dumbbell are overlapped with ends of the roentgenogram Field Interval between is filled in according to width of the analog roentgenogram 298 mm Step 6 Entering the Focal Distance and Beam Center Indicating Strut and Joint Projections on the AP View Type in the value of the focal distance for the AP view i e the distance between the anode of the X ray tube and the plate holder in the field Focal distance AP view in mm Fig 30 After that on the field of the roentgenogram mark the X ray beam center For this purpose put tick in a field of the panel Beam center Then bring the cursor to the label on the roentgenogram indicating the www ortho suv Org
99. twice a day C four times a day yf Back Show Print Clean Fig 77 Ortho SUV program window in Step 13 identification numbers of days needed for deformity correction a software has calculated recommended number of days for deformity correction at rate 1 mm day 19 days The user can ignore this value To do this just remove it and enter number of days required b there is another possibility to change number of days for deformity correction For this purpose it is necessary to change value in the field Rate of correction for necessary one for example 2 5 mm day and again do not forget it press the button Calculate The program has calculated that at new rate 8 days are necessary for deformity correction After that the user should specify at what rate lengths of strut can be changed The program gives a choice once a day twice a day and four times a day Having made a choice tick in an appropriate window Once a 102 day Twice a day and Four times a day Right after tick has been put the help will appear to the right of the basic window Fig 78 Mode Once a day In this mode strut length is controlled using 8 longitudinal lines on external cylinder and one line on internal cylinder Turn from one line to the next one corresponds to change of strut length by 0 25 mm for lengthening and for shortening 45 0 25 mm 0 25 mm E Turn from line to line 45
100. ut 2 is symbolized by the right arm pointing covering the watch Fig 19 Fig 19 The mnemonic watch rule Strut 1 corresponds to left arm i e arm that normally wears a watch Strut 2 corresponds to right hand pointing covering the watch The positions of the struts 1 and 2 should always comply with this rule regardless of whether the frame is applied to the left or to the right limb Further numbering is done counter clockwise Thus joints of struts www ortho suv org 26 1 3 and 5 are fixed to the basic proximal support joints of the struts 2 4 and 6 to the mobile distal support Fig 20 Fig 20 Struts numeration a b no matter which anatomic side is involved the positioning of struts 1 and 2 must comply with the watch rule and made counter clock wise struts 1 3 and 5 are fixed to the basic proximal Support joints of the Struts 2 4 and 6 to the mobile distal support www ortho suv org 27 The algorithm of Ortho SUV Frame assembling is illustrated in Fig 21 Note that before strut connection the screw 1 Fig 10a must be loosed in order that connector nut Fig 10b should have a possibility to be freely moved into the strut length changing unit a D assembling proximal basic ring assembling distal mobile ring C d fixing strut 1 to basic ring insertion of threaded rods of strut 2 into strut length changing unit of strut 2 it is fixed
101. ware is placed on website http ortho suv org Program works with digital roentgenograms saved in formats omp and jog The software is protected from non authorized use by HASP key Fig 25 The HASP key as an USB charm is included into the complete set of Ortho SUV Frame The appropriate HASP driver should be installed on a computer The driver can be taken from the website http www aladdin rd ru support downloads haspsrm It is necessary to download and install the driver Sentinel HASP for Windows Version 6 22 the interface GUI Before start your first work with the program please follow few essential steps described in Appendix 1 36 Fig 25 Before software use the HASP key must be inserted into USB port of a computer The red indicator confirms that the program is ready to work Working with the program involves advancing through its sequence of 13 steps At every step if necessary the operator can return to the previous one If the obligatory actions required at every given step are not performed moving to the next step is not possible 5 2 The parameters must be input into the software Two groups of parameters must be input into the computer program Group 1 Parameters measured on the frame 12 parameters and at making roentgenograms 2 parameters Group 2 The parameters determined on roentgenograms 14 parameters The first group of parameters can be taken using measuring tools Parameters of the sec
102. xation MUDEF Available at http ortho suv org index php option com_content amp view article amp id 1 27 amp ltemid 93 amp lang e n and http ortho suv org Accessed on October 23 2012 6 Paley D 2005 Principles of deformity correction Springer New York 7 Paley D 2011 History and science behind the six axis correction external fi xation devices in orthopaedic surgery oper Tech Orthop 21 125 128 Elsevier Inc 8 Rozbruch S R Correction of tibial deformity with use of the llizarov Taylor spatial frame S R Rozbruch A T Fragomen S llizarov J Bone Joint Surg 2006 Vol 88 A Suppl 4 P 156 174 9 Seide K Wolter D Kortmann HR 1999 Fracture reduction and deformity correction with the hexapod llizarov fixator Clin Orthop 363 186 195 10 Seide K 2004 Application of the Hexapod fixator Litos Hamburg 11 Seide K Gerlach U Inden Ph Bohn B Juergens Ch 2008 Dimensional corrections with the Hexapod system added to the llizarov apparatus In 5th meeting of the A S A M l international program and abstract book St Petersburg 2008 pp 83 84 12 Solomin L N The basic principles of external fixation using llizarov device L N Solomin _ italy Milan Springer Verlag 2008 357 p http rniito org solomin eng download the basics pdf 13 Solomin L N Practical Classification of long bone deformities L N Solomin V A Vilensky 5th Meeting of the ASAMI International Prog
103. xternal fixation external fixation struts differs from that It is necessary to use frame arrange the frame it is shown in Fig 14a b algorithm of strut struts as shown in Fig difficult to assembly submitted 14a b Use algorithm connect the at Fig 21a i of strut assembly struts with each submitted at Fig other 21a 2 Due to the short The distance between 1 The distance 1 Partial reassembly distance the supports is 120 between the supports of the external fixation www ortho suv org between basic supports it is difficult or impossible to arrange the struts Loading the AP image Step 2 does not result In its appearance in the program window During reloading of the file with all steps of the program previously completed at Step 3 the previously loaded roentgenogram s are not visible It is not possible to define the number of struts and joints necessary and thus to proceed to the next step on the X ray image Steps 6 and 7 itis difficult to define the numbers of struts and joints In spite of all struts and joints having been marked in Step 6 or 7 the program does not allow continuation to the next step the 150 mm 136 frame 2 Strut fixation of using Z shaped plates Figs 15c 17b 3 Fixation of some of the struts to the Stabilizing supports Fig 17c d if possible must not be 150 mm 2 Use Z shaped pla
104. y used for the right and left lower legs Fragment markers were set over projections of anatomical axes of the bone fragments Fig 83c The rate of deformity correction was found by software in Step 12 according to SAR points SAR 1 was set along the nonunion line in the place where the mobile fragment in the process of its transport will cover the longest distance Fig 83d SAR 2 was set in projection of main vessels and nerves Fig 83e In Step 12 the rate of deformity correction 1 mm per day was entered After Calculate button was pressed program calculated the recommended number of days required for correction of the deformity When button Show had been pressed in the lower right field of the display a table appeared displaying the values of daily length change for each strut Fig 83f This table was printed out and given to the patient Calculation for deformity correction of the left lower leg was executed in the same way Deformity correction was performed according to the calculations made Fig 83g Second stage involved nailing of both lower legs Fig 83h In 1 5 year after the surgery the locking nails were removed Fig 83i www ortho suv org 114 T SUV Software vp 121015 DAINFA_DISK_C BACKUP File Edit Window Help Duck 9 BED Agleii141 Angle 2 7 7 ie www ortho suv org Siasa vp 123015 DAREA DISK VAM Up nonam SU 20072012 e LL Wagon conor raga leu mtd ha P amn

Guide for users - Ortho-SUV - Art of Deformity Correction

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