A Comparison of Functional Outcome of Open Reduction Internal Fixation Versus Ilizarov External Fixation in Complex Proximal Tibial Fractures: Randomized Controlled Trial

Abstract

Objective: Proximal tibia fractures can be treated with open reduction and internal fixation (ORIF), hybrid fixation, or external fixation; however, it is still unknown which method is better than the others. The purpose of the study was to compare the clinical and functional outcomes handled by Ilizarov and ORIF in order to determine the gold standard treatment choice for proximal tibia fractures. This study aimed to compare the functional outcomes of open reduction internal fixation and Ilizarov external fixation in the treatment of complicated proximal tibial fractures.
 Methodology: An RCT was carried out in the Orthopaedic Department at PIMS Islamabad. It was carried out during a 12-month period after the synopsis was approved.This study included 104 patients with Schatzker's grade IV–VI fractures who presented to the orthopaedic department at PIMS, Islamabad. Using the lottery approach, the patients were split into two treatment groups at random. Group B uses the Ilizarov External Fixation procedure, while Group A uses the Open Reduction and Internal Fixation (ORIF) technique. Every three weeks, post-operative follow-ups were conducted. Up until the fracture healed, post-operative radiographs were taken every three weeks. Every patient had a 24-week clinical follow-up. At the follow-up appointment, each patient's outcomes were documented in accordance with the operational definition. SPSS was used to enter and process all of the data.
 Using SPSS v25.0, all of the data were input and processed. The surgery time, VAS score, and length of hospital stay were compared between the two groups using an independent sample t-test. The functional outcome at six months was compared between the two groups using the Chi-square test. A significant p-value was defined as ≤0.05.
 Results: There were 31 (59.6%) men and 21 (40.4%) women in group A, and 36 (69.2%) men and 16 (30.8%) women in group B.In group A, the mean age was 44.87±14.15 years, while in group B, it was 44.25±15.68 years. In terms of functional outcome, 22 (42.3%) of the ORIF technique group had excellent outcomes, while 10 (19.2%), 16 (30.8%), and 4 (7.7%) had good, fair, and poor outcomes, respectively. In contrast, 35 (67.3%) of the Ilizarov technique group had excellent outcomes, while 10 (19.2%), 5 (9.6%), and 2 (3.8%) had good, fair, and poor outcomes, respectively. These results have a statistically significant p-value of 0.024.
 Conclusion: Compared to open reduction and internal fixation, Ilizarov external fixation is a more reliable method for fixing complicated proximal tibial fractures. For patients with complicated proximal tibial fractures, the Ilizarov external fixation approach yields superior functional outcomes than the open reduction internal fixation technique.
 KEY WORDS: Proximal Tibia Fracture, Open Reduction , Internal Fixation, Ilizarov External Fixation.