Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method

Messner, Juergen; Johnson, Louise; Taylor, David; Harwood, Paul; Britten, S.; Foster, Patrick

doi:10.1302/0301-620x.100b3.bjj-2017-0863.r1

Cited by 20 publications

(13 citation statements)

References 40 publications

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“…For this reason, we decided to not consider it among the sequelae recorded at long follow-up. Messner et al reported that Ilizarov is a safe, effective, and reliable method for the treatment of tibial fractures with good but short-term outcomes [21]. Other studies have compared the complication rate of external fixation devices and highlighted possible solutions.…”

Section: Discussionmentioning

confidence: 99%

“…Among these, during the follow-up period, we could not evaluate 74 patients (50.7%) because of two main reasons: they could not be contacted by telephone (having moved), or they had died. Therefore, 72 among 146 (49.3%) were retrospectively enrolled in the present study; no one was lost up to the average final clinical follow-up of 21 was the most represented with 46 cases (82%), bicycle accidents in 6 cases (11%) and 4 cases (7%) of falls from height. In the DG, there were 16 patients treated, 6 cases for post-traumatic tibial deformities, 4 cases for valgus knees, 4 cases for hypometric tibias (Fig.…”

Section: Patients' Datamentioning

confidence: 99%

“….6 years (range[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The average patient's age at the time of surgery was 50.2 ± 11.3 years (range 28-78) in the FG and 28.6 ± 10.5 years (range 16-50) in the DG.…”

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confidence: 99%

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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

Biz

Crimì

Fantoni

et al. 2020

Arch Orthop Trauma Surg

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Patients' Datamentioning

confidence: 99%

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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

Biz

Crimì

Fantoni

et al. 2020

Arch Orthop Trauma Surg

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“…Of the excluded full texts, the most common reason for exclusion was that open fractures could not be separated (10 studies) [19][20][21][22][23][24][25][26][27][28] followed by studies with too small population (7 studies). [29][30][31][32][33][34][35] In two studies, 36,37 distal tibia fractures were no distinguishable from diaphyseal fractures, and two studies 38,39 reported only the incidence of compartment syndrome.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Stenroos

Puhakka

Nietosvaara³

et al. 2019

Eur J Pediatr Surg

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Tibia fractures are among the most common long-bone fractures in children. Despite this, there is no current consensus on the optimal treatment strategy for closed displaced tibia shaft fractures in the pediatric patient population. The aim of this study is to compare the reported complications and outcomes of reduction and cast immobilization versus flexible intramedullary nailing in the treatment of pediatric tibia shaft fractures. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this prospectively registered systematic review. Eleven studies were included. Quality of the studies was assessed using the Coleman methodology score. Mantel–Haenszel cumulative odds ratios were used to compare the risk of complication between different methods of treatment. Eleven studies including 1,083 patients with diaphyseal fractures of the tibia met the inclusion criteria. The most common fracture type was simple 42-A (782; 91%). Majority (75%) of the patients were treated nonoperatively. The total complication rate was higher among operatively treated patients (24 vs. 9%; p < 0.05). Satisfactory fracture alignment had to be restored surgically in 5% of the primarily nonoperatively treated patients. The evidence levels of the included studies were II (1), III (2), and IV (7). Three-fourths of closed diaphyseal fractures of the tibia in children are still treated with reduction and cast immobilization. Flexible intramedullary nailing is associated with significantly higher complication rate than nonoperative treatment.

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“…Available evidence would suggest that Ilizarov management is safe, effective and well tolerated in children with tibial fractures. 12 , 13 …”

Section: Onclusionmentioning

confidence: 99%

Ilizarov Method for Acute Paediatric Tibial Fractures

Messner¹,

Prior²,

Pincher³

et al. 2021

Strategies in Trauma and Limb Reconstruction

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A bstract Aim and background A systemic method for the application of Ilizarov fixators and on-table fracture reduction is described in this instructional article. This technique has been developed from the unit's practice in adult patients. The indications, underlying principles and rationale for the method are also discussed. Technique The basic concept involves the construction of a series of concentric, colinear rings aligned with the mechanical axis of the limb. An orthogonal ring block is initially placed on the proximal segment and extended distally. Wire to ring reduction techniques are used resulting in the contact, alignment and stability required for early full weight-bearing, free movement of knee and ankle, and subsequent healing. Conclusion and clinical significance Our step-by-step guide takes the reader through a systematic approach to surgery along with tips and tricks on how to achieve reduction and avoid the common pitfalls. With this method, it is possible to achieve an on-table reduction and correction of a multiplanar deformity without the use of expensive hexapod technology. This may allow less experienced users reproduce the technique with a shorter learning curve. How to cite this article Messner J, Prior CP, Pincher B et al . Ilizarov Method for Acute Paediatric Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):46–52.

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Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method

Abstract: The Ilizarov method is a safe, effective and reliable method for the treatment of complex paediatric tibial fractures. Cite this article: Bone Joint J 2018;100-B:396-403.

Cited by 20 publications

References 40 publications

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

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

Treatment of Closed Tibia Shaft Fractures in Children: A Systematic Review and Meta-Analysis

Ilizarov Method for Acute Paediatric Tibial Fractures

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