Functional and Radiological Outcomes of Proximal Tibial Fracture with Compromised Skin Condition Treated with Ilizarov External Fixator: A Clinical Interventional Study

Abstract

Introduction: In proximal tibia fractures, the main goal is to achieve accurate reduction and stability without significantly compromising the soft tissue integrity and vascularity. Ilizarov external fixation minimises iatrogenic soft tissue dissection and associated complication and permits early mobilisation and weight bearing. Aim: To describe the clinicoradiological outcome of proximal tibial fractures with compromised skin condition treated with ilizarov external fixation with or without minimal internal fixation. Materials and Methods: A prospective clinical interventional study containing 30 cases (23 closed with compromised skin condition and seven open) of proximal tibia fractures who were treated with ilizarov external fixator between June 2018 to October 2020 was conducted. After discharge patients were followed-up at an interval of two weeks after discharge, and then on monthly basis until fracture union occurred for a minimum period of 6-12 months. Results were analysed both clinically and radiologically using Johner and Wruh’s criteria. Results: In present study of 24 males and six females were included and their mean age was 39.66±11.32 years. Fracture union was achieved in all cases with a maximum period of 22 weeks and minimum being 12 weeks on fixator. Average number of days on fixator was 105. Average range of motion of knee was 115.52±13.32° with one patient having extension lag up to 15° and six patients having extension lag up to 10°. No patient complained of functional knee instability. Pin track infection occurred in six patients, three patients had joint stiffness and limb shortening occurred in two patients. Overall results according to Johner and Wruh’s criteria were excellent in 23 patients, good in five patients and fair in two patients. Conclusion: Illizarov external fixature is an excellent treatment method in proximal tibia fracture with compromised skin condition not immediately amenable to internal fixation.