Treatment of High‐Energy Intra‐Articular Fractures of Tibia with Ilizarov External Fixator in Adults: A Tertiary Center Experience

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

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Management of high-energy tibial plateau fractures by Ilizarov external fixator

European Orthopaedics and Traumatology ◽

10.1007/s12570-013-0187-1 ◽

2013 ◽

Vol 5 (1) ◽

pp. 9-14 ◽

Cited By ~ 3

Author(s):

Kamal El-Gafary ◽

Wael El-adly ◽

Osama Farouk ◽

Mohamed Khaled ◽

Marwa Mahmoud Abdelaziz

Keyword(s):

External Fixator ◽

Tibial Plateau ◽

High Energy ◽

Tibial Plateau Fractures ◽

Ilizarov External Fixator

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Comminuted Fractures of the Distal Femur Treated with Ilizarov External Fixator. Case Series Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0010.8071 ◽

2017 ◽

Vol 19 (6) ◽

pp. 553-562 ◽

Cited By ~ 1

Author(s):

Łukasz Szelerski ◽

Radosław Górski ◽

Sławomir Żarek ◽

Karol Mochocki ◽

Paweł Małdyk

Keyword(s):

External Fixator ◽

Femoral Fractures ◽

Bone Union ◽

Ilizarov Method ◽

Ilizarov External Fixator ◽

Distal Femoral Fractures ◽

Articular Fractures ◽

Case Series Study ◽

Limb Injuries ◽

Ilizarov Apparatus

Background. Distal femoral fractures constitute a type of lower limb injuries that is rare and difficult to treat. Despite advances in surgical technique and development of implants used for internal fixation of fracture fragments, the treatment continues to result in numerous complications. The Ilizarov External Fixator reduces the risk of complications and allows for bone union. Material and methods. Six men with distal femoral fractures resulting from multisite and multiorgan injuries were treated at the Department of Orthopaedics and Musculoskeletal Traumatology of the Medical University of Warsaw between 2008 and 2016. Mean age of the patients was 42.6 years. Four of them were managed with the Ilizarov method as a primary treatment and two wore the apparatus as a second-line treatment following unsuccessful plate osteosynthesis. Results. Mean treatment duration with the Ilizarov apparatus was 29 weeks. Bone union was achieved in all patients. After the treatment, the patients ambulated unassisted, without orthopaedic aids. All patients returned to work. Conclusions. 1. The Ilizarov method allows for efficient fixation of comminuted distal femoral fractures, including C2 and C3 intra-articular fractures (AO/ASIF classification). 2. The use of the Ilizarov apparatus reduces soft tissue laceration, preserves blood supply to the bone fragments, and allows for easier skin care, which is particularly important in the case of open fractures. 3. Early rehabilitation with the patient fully loading the operated limb reduces muscle atrophy and stimulates bone union.

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Faculty Opinions recommendation of Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1069704.522617 ◽

2007 ◽

Author(s):

R Lor Randall

Keyword(s):

Limb Salvage ◽

External Fixator ◽

Distal Tibia ◽

Fibular Graft ◽

Ilizarov External Fixator

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Management of high-energy tibial shaft fractures using the hexapod circular external fixator

BMC Surgery ◽

10.1186/s12893-021-01106-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yanshi Liu ◽

Jialin Liu ◽

Maimaiaili Yushan ◽

Zhenhui Liu ◽

Tao Zhang ◽

...

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

High Energy ◽

Bone Union ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Clinical Visit ◽

Shaft Fractures ◽

Definitive Management ◽

Tibial Shaft Fractures

Abstract Background The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. Methods The study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results All patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1. Conclusions Definitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.

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