The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases

Abstract

Introduction Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. Materials and Methods Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. Results The mean time of fixator treatment was 29 (range 15–65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2–186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. Conclusion The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.

Carefix hexaxial spatial frame versus Ilizarov circular external fixator in treating high-energy tibial shaft fractures：a retrospective study

“…The xation strength is adjusted according to the fracture union process, which conforms to the Wolff's law of bone growth and is conducive to fracture union. Satisfactory outcomes were achieved in the treatment of TSFs using either CHSF or ICEF [10,11,[24][25][26][27]. But in terms of intraoperative procedures, surgeons prefer to use CHSF because of the short operation time and fewer C-arm radiograph times.…”

Combined osteosynthesis for tibial shaft fracture treatment

“…Но его применение осложняется большой продолжительностью (3-9 месяцев) фиксации аппаратом и, в связи с этим, высокой частотой случаев инфекций в области спиц. Это некомфортно для пациентов [18][19][20].…”

“…Сочетание аппарата наружной фиксации и интрамедуллярных эластичных спиц с HA-покрытием позволяет преодолеть недостатки как внешних, так и внутренних устройств. Наружный остеосинтез обеспечивает все преимущества метода Илизарова: сохранение кровообращения, отсутствие повреждения мягких тканей, функция сустава и нагрузка в ранние сроки [19][20][21]. Эластичные интрамедуллярные спицы не повреждают a. nutricia и механически стимулируют эндостальное и периостальное костеобразование [22].…”