A prospective study on use of Ilizarov external fixator for open fractures of Tibia

Introduction: Open fractures are more commonly seen in tibia as compared to other bones because of subcutaneous location and the tenuous soft tissue cover. There has been rise in open tibia fractures with increased road traffic accidents. Management of open tibial fracture remains controversial. Ilizarov external fixator is a better option for the treatment of these fractures. This study was conducted to evaluate the clinical outcome of open tibial fractures managed with an Ilizarov external fixator. Material & Methods: Twelve patients among those who presented to the emergency department with Type II, Type IIIA and Type IIIB Gustilo-Anderson type open tibial fracture were enrolled. All these cases were treated by Ilizarov external fixator and appropriate wound management. Active movements were started at the earliest after the surgery. Partial weight bearing with support was started from the second day after the surgery. Results: Mean age of the study subjects was 37.66 ± 8.77 years. Half of the patients had Type IIIB GustiloAnderson type fractures. The mean duration of fracture union was 7.1 months. Pin tract infection of the wires was the more common among complications. Excellent to good outcome was seen in 90% of study subjects. Conclusion: Ilizarov external fixator gives stable fixation of the open tibial fractures and allows better wound care. It also helps in early ambulation and rehabilitation of these patients.

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation / 中华创伤杂志(英文版)

PURPOSE@#To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation.@*METHODS@#This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures; 15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up.@*RESULTS@#Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome.@*CONCLUSION@#Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.

Distal femoral physeal crush injury with metaphyseal comminution - A report of two cases and a new perspective to physeal injury / 中华创伤杂志(英文版)

The physis of a long bone may get 'sandwiched' and crushed between the metaphysis and the epiphysis if it is traumatically loaded along its long axis. Such a physeal injury may lead to complications like angular deformities and growth restrictions and hence, management of such injuries requires adequate planning and attentive execution. Two patients with distal femoral physeal crush injury were treated using a ring fixator such that one ring had the wires passing through the epiphysis and the other through the femoral shaft. On table image intensifier controlled distraction of the crushed physis was done to bring the height of the physis similar to that of the opposite limb. Patients were followed up for more than two years clinically and radiologically. There was no clinical or radiological angular deformity of the operated limbs. MRI scans showed intact physes with no physeal bar formation in either of the two patients. The distraction obtained by the ring fixator appears to have provided ample 'breathing space' to the compressed physis and that the growth potential may have been re-gained by the procedure. However, two years is a relatively short duration of follow-up and further follow-up of longer duration and in greater number of patients is needed to gauge the actual effectiveness of the technique used by us.

Role of Ilizarov ring fixator in infected non union tibia.

Background: The main surgical principle in the management of diaphyseal bone infection is thorough debridement of all nonviable tissue. None of the previously mentioned techniques afford surgeon the ability to correct deformities, eliminate antibiotic therapy, regenerate new bone without grafts and allow weight bearing during treatment. Objectives: The present study was conducted to evaluate the clinical follow-up results with Ilizarov technique using three parameters: union, infection and function and to know the complications if any faced by the patients. Material and Methods: This was a prospective study planned to evaluate the results of Ilizarov ring fixator on follow-up of 18 cases of either sex with infected non-union tibia. Average age of presentation was 34.5 years. Follow-up roentgenographs were used to assess alignment, bone contact and later callus formation. Healing status of the fracture was monitored using biplane roentgenographs, unchanged fracture alignment with loosening of the frame, absence of pain during ambulation with the frame destabilized. The data thus collected were analysed by using percentage and valid conclusions were drawn. Result: Pain and swelling were the most common complication after application of ilizarov ring fixator. In this study of 18 cases, 11 (61.11%) patients had excellent, 2 (11.11%) good, 5 (27.77%) fair and none had poor results as per criterion laid down by Catteneo et al. Conclusion: Ilizarov technique was found to be useful to progressively lengthen the extremity, achieve union without bone grafting and to correct deformities in infected non-union with or without bone gap.