Complex proximal tibia fracture dislocations managed by Ilizaorov fixator-A case series with review of literature

Abstract

Background: Bicondylartibial fractures are serious injuries and are difficult to manage even for the most experienced trauma surgeons. The soft tissue around proximal tibia demonstrates poor healing response following dissection or manipulation. Hence surgical fixation of these injuries by osteosynthesis has shown mixed results over the years. Case Series: We conducted a prospective study of five consecutive patients of compound proximal tibia bicondylar fractures from January 2013 to June 2016. All of them were compound type 3A or 3B injuries classified according to Gustilo-Anderson grading system of open injuries. ILIZAROV fixator was used for treatment in all the cases. The fixator was kept for an average of twelve to twenty weeks. The patients range of motion and knee society score was recorded at the end of 32 weeks. Results: The average range of movements achieved in the knee joint was105 degrees at the end of eight months. Complications included knee stiffness and pin site infections. Knee stiffness was managed by subjecting the patient to aggressive physiotherapy by continuous passive movements. In one patient manipulation under general anesthesia had to be done. Two patients had pin site infections which were superficial and subsided by antibiotics and daily pin site dressings. The knee society score was excellent in four patients and good in one patient. Conclusion: This case series emphasizes the clinical success and low morbidity to the patient when treated with ILIZAROV fixator. The technique is suited well to manage complex proximal tibia injuries as it provides a stable construct in all the planes. Anatomical reduction of fragments can be achieved by closed reduction using olive wires during ILIZAROV application. This would avoid excessive dissection of soft tissue required during plating. Keywords: Proximal tibia fracture; Knee dislocation; ILIZAROV fixator; Knee joint