Functional outcome and complications after treatment of comminuted tibial fractures or deformities using Ilizarov bone transport: a single-center study at 15- to 30-year follow-up

Abstract

Introduction The aim of this retrospective study was to evaluate long-term outcomes and complications of a single-center and single-surgeon patient series of isolated and comminuted tibial fractures with bone defects or tibial deformities treated by Ilizarov bone transport. Materials and methods Data from a consecutive series of patients with isolated comminuted tibial fractures (Fracture Group: FG) or deformities (Deformity Group: DG) treated between 1987 and 2002 were included. For clinical assessment, the Lower Extremities Functional Scale was used; complications were recorded according to the Dindo classification and statistical analysis was performed. Results Overall, 72 patients were enrolled with a mean follow-up of 21.6 years (range 15-30) a mean LEFS of 36.4 (range 0-100). In the FG, the mean LEFS was 21.3 (range 0-98.75), and the external fixation time (EFT) lasted 7.6 months (range 3-18 months) months. In the DG, the mean LEFS was 76.7 (range 55-100), and the EFT was 10.6 months (range 3-20 months). Between the two groups, the clinical evaluation was significantly different, while the EFT was not (p = 0.14). In the FG, the worst results were obtained in the cases of open fractures with a higher percentage of complications and the need for further surgical procedures. The cumulative rate of complications was 55.6% during the first 36 months and 66.7% at the minimum follow-up of 180 months. Conclusions Ilizarov bone transport, even at a long follow-up period, proved to be an effective technique for both definitive treatment of comminuted tibial fractures with bone defects or tibial deformities. Although our functional outcomes were lower in patients with exposed fractures, they were in line with the literature, but not influenced by the EFT when properly managed. Most complications occurred during the first 3 years; however, they could also arise much later, even until almost 30 years.

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100thbirthday of G. A. Ilizarov)

“…The use of EF for treating displaced intra-articular calcaneal fractures was an alternative to plating and screw fixation with good results achieved by clinicians in most cases due to early mobilization of the peritalar joints and early post-operative loading[ 23 , 24 ]. Long-term functional outcomes of definitive treatment utilizing bone transport for exposed comminuted tibial fractures with bone defects were in line with the literature[ 25 ].…”

“…Numerous published reports regarding complex trauma reflect the utilization of the Ilizarov techniques in adults, especially for para-articular injuries[ 17 - 24 ]. The Ilizarov bone transport for isolated and comminuted tibial fractures with bone defects or tibial deformities was found effective after studying its long-term outcomes and complications at one center for more than 30 years[ 25 ]. The Ilizarov ring fixator was recommended as an effective treatment modality for open comminuted distal femur fractures and resulted in high union rate, adequate alignment and satisfactory functional outcomes[ 17 ].…”

Complications Associated with Bifocal Bone Transport Using Unilateral External Rail Fixator in the Reconstruction of Femur Defects Caused by Infection: Outcome Analysis of 76 Patients

“…The treatment technique described above indeed possessed advantages in shortening the EFT and avoiding complications, but not effective enough in accelerating new bone regeneration in the transport gap. Not only, many studies on this eld included patients with infected tibial nonunion rather femoral, based on our review of the literature [1,3,4,23,[33][34][35][36]. Hence, the complications of this technique in the treatment of femoral nonunions caused by infection were evaluated by this study, and provide data for the formulation of better clinical strategies.…”

“…Over the past decades, the nonunions of the lower extremity with bone loss have been resolved successfully by bone transport techniques using unilateral external rail xators [3,13,16,31]. The bone graft surgery was recommended to perform at the docking site at the end of the distraction stage by many published articles [4,34,[36][37][38]. Wan et al [39] showed a series of 28 femoral bone defects treated by bone transport using a monolateral external xator, and obtained a good bone healing rate of 92.8%, because of the bone grafting at the docking site.…”

Efficacy Comparison of Trifocal Bone Transport Using Unilateral External Fixator for Femoral and Tibial Bone Defects Caused by Infection

“…The treatment objectives of orthopedic surgeons, in this case, include thorough debridement and removal of any obvious or potential sources of infection, to achieve stable xed target osseointegration, maintain equality and alignment of limb length, and obtain appropriate functions. Recently, several mature treatment options available to manage patients who have lower limb bone defects in the presence of infection were produced by scholars, including bone grafting with autogenous or allogenic bone grafts, tibialization of the bula, vascularized bular grafts, the Masquelet induced membrane technique, and conventional and modi ed Ilizarov methods [5][6][7][8].…”