The treatment of complex tibial shaft fractures by the Ilizarov method

Abstract

We report on the use of the Ilizarov method to treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and five AO 42B3 fractures) in adults. There were 28 men and 12 women with a mean age of 43 years (19 to 81). The series included 19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21 closed injuries. The mean time from injury to application of definitive Ilizarov frame was eight days (0 to 35) with 36 fractures successfully uniting without the need for any bone-stimulating procedure. The four remaining patients with nonunion healed with a second frame. There were no amputations and no deep infections. None required intervention for malunion. The total time to healing was calculated from date of injury to removal of the frame, with a median of 166 days (mean 187, (87 to 370)). Minor complications included snapped wires in two patients and minor pin-site infections treated with oral antibiotics in nine patients (23%). Clinical scores were available for 32 of the 40 patients at a median of 55 months (mean 62, (26 to 99)) post-injury, with 'good' Olerud and Molander ankle scores (median 80, mean 75, (10 to 100)), 'excellent' Lysholm knee scores (median 97, mean 88, (29 to 100)), a median Tegner activity score of 4 (mean 4, (0 to 9)) (comparable to 'moderately heavy labour / cycling and jogging') and Short Form-12 scores that exceeded the mean of the population as a whole (median physical component score 55 (mean 51, (20 to 64)), median mental component score 57 (mean 53, (21 to 62)). In conclusion, the Ilizarov method is a safe and reliable way of treating complex tibial shaft fractures with a high rate of primary union.

What Are the Biomechanical Effects of Half-pin and Fine-wire Configurations on Fracture Site Movement in Circular Frames?

“…The use of circular fixators is well established, with widespread anecdotal and clinical reports of positive outcomes in various challenging cases [10,18]. As an entirely modular system, good clinical outcomes rely on an appropriate understanding of how best to apply the frame components, tailored to each patient, to produce a construct which will sufficiently control the mechanical environment at the fracture or osteotomy site to allow bone healing [27,29].…”

“…In relating these results to real-world patients, it is important to reflect on not only the existing body of biomechanical evidence, but also the long and well-documented history of successful treatment of a wide variety of fractures and deformities using the Ilizarov method and fine-wire fixators [10,15,18]. On this basis, it seems fair to assume that properly applied fine-wire frames produce an environment at a fracture site compatible with bone healing, an assumption largely supported by the results we discussed.…”

“…The Ilizarov method is clinically established in fracture management, limb salvage, and deformity correction [10,18]. Research has been conducted to determine the basic mechanisms underlying this technique and is particularly relevant as insights are gained in the biomechanical requirements for and biology of bone healing.…”

What Are the Biomechanical Properties of the Taylor Spatial Frame™?

“…This combination is thought to generate an osteogenic mechanical environment [8,10,11,17,36], and the biomechanical theory has been supported by clinical results [12,33].…”

Fratture esposte diafisarie di tibia

“…Sebbene lo studio LEAP [21] abbia chiarito alcuni aspetti del trattamento delle fratture esposte di tibia, in esso veniva valutato solo l'impiego di fissatori esterni monoassiali, i quali presentano un comportamento biomeccanico assai differente rispetto ai fissatori esterni circolari o ibridi. In alcuni studi inerenti l'utilizzo di FE circolari e ibridi nel trattamento delle fratture esposte diafisarie di tibia, viene infatti riportato che il tasso di consolidazione è maggiore che nei FE monoassiali, così come inferiore è il rischio di revisioni e di infezioni [29][30][31][32][33][34][35][36]. Un vantaggio specifico dei FE circolari, è la possibilità del loro impiego per colmare le severe perdite di sostanza ossea, spesso associate alle fratture con esposizione di grado severo (Gustilo III), mediante l'utilizzo di tecniche di trasporto osseo e compressione/distrazione.…”