Evaluation of soft tissue and bone healing of high-energy open distal third and periarticular tibial fractures managed using the Ilizarov technique | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 47, Issue 4, December 2012, Pages 424-430 PDF (340.05 K) | ||
| Authors | ||
| Mohamed Nabi ElSayed; Ahmed M. ElBadrawi | ||
| Abstract | ||
| Study design Retrospective study. Objective This work evaluated the results of 25 patients who were treated with an Ilizarov external fixator for type II, IIIA, and IIIB open comminuted distal tibial fractures not involving the ankle articular surface. The aim of this study was to evaluate the results and efficacy of the external fixation technique using Ilizarov fixators in treating high-energy comminuted open distal leg fractures not involving the ankle joint integrity. Patients and methods Twelve Gustillo grade II, eight IIIA, and five IIIB comminuted tibial fractures in patients aged between 21 and 52 years (22 men and three women) treated with Ilizarov fixators were analyzed. All patients were candidates for reconstruction according to the NISSSA scoring system (score below 14). They were followed up for 12-18 months at monthly regular sessions. Each session included careful clinical evaluation using ASAMI evaluation criteria, fixator care procedure, skin and soft tissue healing progression, and radiological evaluation of fracture union. Results The mean duration of intraoperative application of the frame was 149.8 min (120-180 min) and the mean follow-up time was 12.48 months (12-18 months). After removal of frames, patients experienced minimal ankle pain and stiffness, which required short-term rehabilitation. All fractures healed between 20 and 32 weeks (mean 27.2 weeks) without additional bone grafting. Timing of removal of the frame varied between 6 and 8 months (6.44). Eight patients required a second operative procedure in the form of debridement, soft tissue reconstruction, and readjustment of the fixator to promote healing and correct deformity. Fifteen patients experienced wiretract infection (60%), which recovered when treated using local procedures. Varus angulation of 7-91 occurred in five fractures (20%) and was corrected gradually to achieve 3-41 just before frame removal. We evaluated the results of this technique using ASAMI criteria, which revealed 21 cases with excellent outcome, three with good outcome, and a single fair result. Conclusion On the basis of this work, we recommend this method for retaining the function of the limb after high-energy injuries to the distal leg. The Ilizarov fixator is safe, versatile, effective in providing stability, and allows proper soft tissue handling with easy postoperative correction of any residual deformity and early rehabilitation with relatively good cost-effectiveness. | ||
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