Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method

Abstract

Introduction: Segmental fractures in the juvenile distal tibia with physeal involvement present specific challenges. Injury to the growth plate may be overlooked, potentially resulting in late sequelae. Fracture stabilization can be complex. Previous reports of management of such an injury are by open reduction and internal fixation. This study reviews the management and outcome of a group of such patients treated with Ilizarov external fixators. Materials and methods: Patients aged 16 or younger treated in our unit between March 2013 and November 2014 by Ilizarov circular fine wire fixation for tibial fractures with ipsilateral physeal injuries were identified. Retrospective collection of patient demographics, fracture classification, treatment pathways, fixation methods, postoperative follow-up, outcomes, and complications was undertaken. Results: Eight patients were identified; two had Gustilo and Anderson grade IIIA open injuries. All were managed definitively using an Ilizarov external fixator in combination with percutaneous screw fixation of the physeal component as required. All patients were ambulant during treatment and were allowed unrestricted weight-bearing immediately postoperative. All but one attended school. All fractures united. In follow-up, one patient had a distal tibial physeal growth arrest, but there were no other complications. Conclusion: Pediatric patients with complex distal tibial fractures should be scrutinized for concomitant physeal injury. Where identified treatment, using a combination of internal fixation and an Ilizarov fixator can be considered.

Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications

“…Minor pin-site infections were treated with short courses of oral antibiotics without complications, while significant and deep infections necessitated pin removal and prolonged courses of antibiotics, yielding satisfactory outcomes. Mild pin-site infections were treatable with brief oral antibiotic regimens, according to a similar study by Rogers et al involving pediatric patients with complicated distal physeal tibial shaft fractures [ 20 ]. To improve patient outcomes, further research is needed to explore infection prevention techniques associated with this procedure.…”

Retrospective clinical outcomes in the definitive treatment of high-energy tibial diaphyseal fractures using hexapod external fixator versus monolateral external fixator

“…Although intramedullary nail is the gold standard in the management of tibial diaphyseal fractures, external fixation has a clear role in most cases due to the advantage of stabilization with limiting soft tissue dissection, especially for high-energy injuries with poor surrounding soft tissues [3,4,6,10,11,15,18,22,26]. Intramedullary nails work best in managing diaphyseal transverse fractures, but there are challenges in unstable oblique, spiral, and comminuted fractures [27].…”

“…Although open reduction and internal fixation (ORIF) which contributes to anatomic reduction has acted as the gold standard for diaphyseal fractures treatment, it is the most invasive form with potential infection risk, especially for highenergy fractures with severe soft tissue damage. Meticulous soft tissue care combined with external fixation has given satisfactory clinical results in recent years [3][4][5][6][7][8][9].…”

Effects of 1-stage revascularization and temporary external fixation combined with 2-stage Ilizarov technique in the treatment of bone defects in lower limb destruction injury: A case report

“…Temporary external fixation was able to stabilize the fracture site, and avoid more damage to the surrounding soft tissues to enhance the survival rate of the injured soft tissues. [8] However, it still remains debates on whether temporary external fixation was more applicable than Ilizarov technique for patients. Temporary external fixation was more briefness, shorter operation time, and lower cost.…”