1123

A Study on the Development of the Off-Line Software

for Regulating the 6 D.O.F Circular Fixator∗

Bum-Seok PARK∗∗ , In-Ho CHOI∗∗∗ , Jin-Woo KIM∗∗ ,

Seung-Yeol LEE∗∗ and Chang-Soo HAN∗∗∗∗

This paper presents the development of the scheduling software to adjust the Hexapod
Circular Fixator (HCF), which has 6 degrees-of-freedom. HCF is an instrument to correct
complex skeletal deformities by using the patient’s X-ray image. HCF scheduler evaluates
each lengthening/shortening data of the HCF’s struts to correct the bone deformity. HCF
scheduler is implemented in C++ as a window-based application program. Proposed schedul-
ing program is verified through bone model test and showed its usefulness through many
cases.

Key Words: External Fixator, Hexapod Circular Fixator (HCF), Scheduler, Stewart Plat-
form

operation time and inconveniences patients. To make up

1. Introduction
the weak points, hexapod circular fixator (HCF)(4) is used
An external fixator which is one of an orthopedics in- by Stewart-Gough platform(5) . As this, parallel mechan-
strument, is used to open tibia fractures, fractures accom- ism has been studied for various applications and analysis
panied by the burn, comminuted fractures accompanied by methods. Hunt(6) studied the structural kinematics of par-
severe bone loss, infected fractures or mal-union without allel mechanism and Ficher(7) referred to general theory
osteonecrosis, and distraction osteogenesis(1) . about Stewart platform.
The external circular fixator was invented by ilizarov, The HCF consists of two rings, six struts and twelve
MD in 1951. However, it has been generally known from joints to connect ring and strut. To change each strut
1980s, which has resulted in the clinical test by ilizarov length, 6-DOF relative motion of ring frame is possible.
in many orthopedic surgeons(2), (3) . Figure 1 is shown the So, the HCF has a simple structure when it is compared
llizarov fixator. with the Ilizarov Frame. In order to correct bone defor-
Usually, the external circular fixator is called an mity using the HCF, we have to adjust 6 strut length re-
Ilizarov Frame and it consists of two C-Rings or a full
ring with rods and hinges. As each ring is fixed to each
fracture and connected to rods and hinges, it is possible
to extend the bone length and correct angular deformity
at the same time. However, to correct angular deformity,
the illizarov frame must connect to various accessories.
The complexity of an Ilizarov Frame increases surgical
∗
Received 5th July, 2004 (No. 04-5113)
∗∗
Department of Mechanical Engineering, Hanyang Univer-
sity, 1271 Sa 1 dong, Ansan, Kyonggi Do 426–791, Korea.
E-mail: bspark@hanyang.ac.kr
∗∗∗
Department of Orthopedic Surgery, Seoul National Uni-
versity Hospital, 28 Yongon-dong, Shongno-gu, Seoul
110–744, South Korea. E-mail: inhoc@snu.ac.kr
∗∗∗∗
Department of Mechanical Engineering, Hanyang Univer-
sity, 1271 Sa 1 dong, Ansan Kyunggi Do 426–791, Korea.
E-mail: cshan@hanyang.ac.kr Fig. 1 Hexapod Circular Fixator

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spectively. But, it is difficult. Therefore, we need software of the HCF as follows:

to compute the strut’s length according to correcting rate.
li = −
−−→ −−−→ −−→
OOm + [R] · Om B− OA (i = 1,2,···,6) (1)
In this paper, we have performed the HCF analysis
and developed the software to provide the strut lengthen- Figure 3 shows arranged angle of joints. Joint vector
−−→ −−−−→
ing schedule for deformity in correction of bone fractures. OAi and Om Bi are as follows.
−−−→  
Software is developed through C++ language(8) . To con- OA1 = rr · cos(α) i + rr · sin(α) j
firm the validation of HCF software, we perform the bone −−−→  
OA2 = rr · cos(120◦ − α) i + rr · sin(120◦ − α) j
model test and clinical test with human. −−−→  
OA3 = rr · cos(120◦ + α) i + rr · sin(120◦ + α) j
2. Analysis of Hexapod Circular Fixator −−−→  
OA4 = rr · cos(240◦ − α) i + rr · sin(240◦ − α) j
−−−→  
2. 1 Hexapod Circular Fixator OA5 = rr · cos(240◦ + α) i + rr · sin(240◦ + α) j
The HCF’s ring is constructed in two half rings or two −−−→  
OA6 = rr · cos(−α) i + rr · sin(−α) j (2)
partial rings and the strut has a variable length. Ring and
strut are joined with a joint module on the skew (Fig. 1).
−−−−→  
HCF has a translation of 3 degrees of freedom and angular Om B1 = rm · cos(60◦ − β) i + rm · sin(60◦ − β) j
−−−−→  
distortion of 3 degrees of freedom. Hence, it is effective to Om B2 = rm · cos(60◦ + β) i + rm · sin(60◦ + β) j
correct translation and angular deformity simultaneously −−−−→  
Om B3 = rm · cos(180◦ − β) i + rm · sin(180◦ − β) j
in the case of a complicated deformity. −−−−→  
2. 2 Kinematic analysis of the HCF Om B4 = rm · cos(180◦ + β) i + rm · sin(180◦ + β) j
−−−−→  
HCF has a structure similar to Stewart-Gough plat- Om B5 = rm · cos(−60◦ − β) i + rm · sin(−60◦ − β) j
form of robotics filed: The six struts are installed on the −−−−→  
Om B6 = rm · cos(−60◦ + β) i + rm · sin(−60◦ + β) j (3)
skew between both rings. Regulating strut length makes
it possible to realize the relative motion between the two
rings. For this reason, we shall solve the strut length
of HCF by using the Stewart-Gough platform analysis
method. Figure 2 shows a schematic diagram of Stewart-
Gough platform.
Figure 2 shows the geometric relation of two rings
−−→
for the frame deformity: OA is the position vector of joint
A about reference frame center O. Also, position vector
−−→
OB of relative frame joint about reference frame center
−−−→
O, is described by vector sum of position vector OOm and
−−−→
relative joint vector [R]· Om B. Where [R] is rotation matrix
−−→
of a relative frame. By vector-loop equation for OA and
−−→
OB, we can obtain the strut’s vector
l. By taking the dot (a) Reference frame (b) Moving frame
product of vector
l with itself, we obtain the length of ith Fig. 3 Joint vector of reference and moving ring
strut for given the pose of relative frame and translation
between the ring centers.
We can write a vector-loop equation for the ith strut

Fig. 2 Schematic model of Stewart-Gough platform Fig. 4 Model of the Hexapod Circular Fixator

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−−−→
Deformity parameter is vector CCr between the ori- cludes patient’s name, age, patient ID, birthday, sex and
gin and the relative point. The origin and the relative point address. The surgical information includes surgical opera-
−−→
are defined at each bone fracture (Fig. 4). And vector OC tion part, anatomy and operation date. This data becomes
means the mounting vector from reference ring center O basis information for analysis and correction and are man-
−−−→
to origin point C. Therefore, vector OOm is as follows. aged by a database.
−−−→ −−→ −−−→ −−−−→ 3. 2 Frame information
OOm = OC + CCr + [R] · C r Om (4)
Figure 6 is a dialog box for frame data input. The
Allowing for the rotary offset between the reference
→
− size of the two rings is inputted simply by a button click,
ring and the bone fracture, the joint vector li is as follows:
and arranged angles of joint adapter are decided. If the

li = −
−→ −−−→ −−−−→
OC + [Rz ]CCr + [Rz ][R] · C r Om arranged angle of the joint adaptor is not inputted, the ar-
−−−−→ −−→
+[Rz ][R][Rz ]−1 · Om Bi − OAi (i = 1,2,···,6) (5) range angle is marked by 0, and has a predefined value.
Where, [Rz ] is Rotation matrix based on rotary offset and 3. 3 Deformity and mounting parameters
is defined by rotation from AP direction vector of the ref- Figure 7 displays control that is inputted by defor-
erence ring to that of the reference bone. mity of AP direction and lateral direction, where each of
HCF has a different reference by the position of frac- these controls is Ap view translation, AP view angulation,
tured bone; that is proximal tibia, distal femur, distal tibia lateral view translation, lateral view angulation, and axial
and foot. Usually, we select the fracture with distinct point view translation.
by the reference fracture. Patella is one of the distinct Figure 8 shows the mounting offset that appears in
points. Hence, in the case of the distal femur or the dis- radiographs of AP direction and lateral direction. The
tal tibia, fracture that is distal to body is selected as the
reference fracture. Similarly, a fracture that is proximal to
the body is selected as the reference fracture in the proxi-
mal femur or foot. Here, the ring that is fixed to reference
fracture defines the reference ring. Prescribed equations
are obtained when distal ring is in reference. And, when
proximal ring is in reference, the same method is used but
vector of axial direction is opposite.
3. HCF Scheduler
HCF scheduler’s interface is divided by the dialog
box of patient information, the dialog box of the frame
information, the section for deformity and mounting pa-
rameters, the section for correction condition and critical
point, and result table.
3. 1 Patient’s input data
Fig. 6 Dialog box of frame data
In Fig. 5, patient’s input data includes personal infor-
mation and surgical information. Personal information in-

Fig. 7 Control of deformity parameter

Fig. 5 Input dialog box of the patient data Fig. 8 Control of mounting parameter

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mounting offset shows the AP view offset, lateral view off-

Fig. 9 Axial view input control
Fig. 10 Input part of bone deformity and mounting offset
set and axial view offset.
Figure 9 shows the angular deformity and rotary off-
set of axial direction. Where as the top direction is the AP
view direction.
Figure 10 shows the deformity input control and
mounting offset control of the HCF scheduler. As each
control mimics the x-ray image of bone deformity patient,
the scheduler is more user-friendly. Bone deformity and
mounting offset that is inputted by the control on right
side lower column were marked, deformity and mounting
value change justly when moved by the control.
Figure 11 shows the method to represent data at initial
deformity correction and remaining deformity correction.
In the case of initial deformity, relative frame moves from
the deformed state to a neutral state and in the case of
remaining deformity correction, relative frame moves as
much as deformity in neutral state.
3. 4 Correction condition and critical point
There are two correction conditions: the correction
mode and the height of neutral frame (Fig. 12). The cor-
rection modes of HCF scheduler are in initial mode and
remaining mode. In the initial mode, the bone deformity
is corrected first. The final goal of this mode is the can-
cellation of the deformation to make the two frames of
the HCF parallel. The distance between the frames is the
height of neutral frame.
Because of errors in measurement and operation, the
correction seldom finishes in the initial mode, however. In
this case, we can finish the bone correction in remaining
mode. The remaining mode must follow the initial mode.
3. 5 Critical point
During the bone correction, skin muscles, nerves and
blood vessels are extended with the bones. Especially ex-
cessive extension of nerves can damage the legs. To pre-
vent the risk, the position of the nerves, which is described
by the vector from the origin of the reference bone frac-
ture, are defined a as critical point (Fig. 13). During the

(a) Initial deformity (b) Remaining deformity

Fig. 11 Initial/remaining deformity correction

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correction, the critical point displacement with respect to
the origin is limited by the user-defined correction value.
3. 6 Table of schedule data
Figure 14’s shows the table which is calculated by
Fig. 12 Operation data
Fig. 13 Critical point
HCF scheduling software. Shown data is the schedule for
bone correction from the first day to the last day. Accord-
ing to scheduling data, each strut is regulated.
Figure 15 shows the printed sheet display. After the
surgical operation has ended, according to the scheduled
table, the strut length is modified as much as decided size.
4. Experiment and Clinical Test
4. 1 Method
Two methods are used to verify the scheduler’s valid-
ity and performance. One of the methods is using a bone
model, and the other method is applying it directly to a
patient. With these two cases, we can confirm the result.
4. 2 Experiment of using the bone model
We made an experiment using a bone model instead
of an actual bone to test propriety of the program before a
clinical test. Actual surgical operations used to receive the
transformation amount and the installation offset using X-
rays, but this experiment obtained the deformity data using
a digital camera instead of X-ray. We used the indicator
made of wire in the AP view direction so that it was easy
to measure the angular deformity.
Tables 1, 2, and 3 are shown the parameters for bone
model test. Table 1 represents ring size, anatomy and
height between two rings at final state. Tables 2 and 3
are shown the deformity parameters and mounting param-
eters. Correction rate per day is 1 (mm/day).
When this data enter into the HCF software, we
may strut’s schedule for correction of deformed bone.
Figure 16 shows the initial state before the correction, and
Figs. 17 and 18 shows the last state after the initial cor-

Fig. 14 Scheduled table

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Fig. 15 Schedule sheet
Table 1 Frame parameters
Table 2 Deformity parameters
rection mode and the remaining correction mode respec-
tively. The results show that the deformed bone is cor-
rected. And, when errors are remained after the initial
mode, we conformed to reduce the remaining deformity
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Table 3 Mounting parameters
(a) AP view (b) Lateral view
Fig. 16 Deformed bone (Initial state)
(a) AP view (b) Lateral view
Fig. 17 Final state of the chronic mode
by the remaining mode. So, we could confirm the validity
of the data used to obtain the HCF Scheduler.
4. 3 Clinical test
By result of the bone model test, we confirmed bone
correction effectiveness which used the developed soft-
ware. The patient is male with deformity of lower right
leg. He had angular deformity of 20◦ in AP direction
mainly. Each ring size is 200 mm.
Figure 19 shows the appearance before patient’s sur-
gical operation which bone deformity is at left leg.
Figure 20 shows the picture of a HCF mounted on
a patient to correct the deformity by fracturing the bone
intentionally. To correct the deformity, strut length is
changed step by step.
Figure 21 shows that deformed bone is corrected after
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(a) AP view (b) Lateral view

Fig. 18 Final state of the residual mode

Fig. 20 Imm Post-Op

Fig. 21 Post-Op

lizarov fixator which needs the additional accessory to cor-

rect length and angular deformity.
2. As the HCF has a simple structure, we expect to
save surgical operation time.
3. By the development of the HCF Scheduling soft-
ware, we simply obtain the strut schedule about patient
which has been complicated bone deformity.
4. We confirmed the performance of the HCF Sched-
uler through bone model experiments and clinical tests.
Fig. 19 Pre-Op References
(1) Behrens, F., General Theory and Principles of External
deformity correction. The left leg is returned to normal Fixator, Clin. Orthop., Vol.241 (1989), pp.15–23.
compared to right leg. (2) Choi, I.H., Kim, J.K., Choi, K.W., Chung, C.Y., Cho, T.
and Lee, K.S., Biomechanical Analysis of Korean Ra-
5. Conclusions diolucent Carbon/Graphite Ring Fixator, J. Kor. Frac.
Soc., Vol.13 (2000), pp.1–12.
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HCF, and confirm the advantage of the HCF and the ac- and Lee, D.Y., Biomechanical Analysis of Unilateral-
curacy of scheduler data through an experiment by bone Ring Hybrid Fixation, Kor. Orthop. Res. Soc., Vol.1
model and clinical test. (1998), pp.135–144.
The conclusions of this paper are as follows: (4) Seide, K., Wolter, D. and Kortmann, H., Fracture
1. HCF has simple structure in comparison with il- Reduction and Deformity Correction with the Hexa-

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pod Ilizarov Fixator, Clin. Orthop., Vol.363 (1999), pp.705–712.

pp.188–195.
(5) Stewart, D., A Platform with Six Degrees of Freedom,
Proc. Inst. Mech. Eng., Vol.180 (1965), pp.371–378.
(6) Hunt, K.H., Structural Kinematics of In-Parallel-
Actuated Robot-Arms, Transactions of the ASME,
Journal of Mechanics, Transmission, Vol.105 (1983),
(7) Ficher, E.F., A Stewart Platform-Based Manipulator:
General Theory and Practical Construction, The Inter-
national Journal of a Robotic Research, Vol.5, No.2
(1988), pp157–182.
(8) Prata, S., C++ Primer Plus, 4th Edition, Paperback,
(2001).

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