Abstract
IntroductionThe 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 methodsData 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.ResultsOverall, 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.ConclusionsIlizarov 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.
Highlights
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
The treatment of tibial bone and soft-tissue defects, especially greater than 5 cm, secondary to high-energy trauma or debridement for non-union, are great challenges for the orthopaedic surgeons in terms of limb reconstruction and soft tissue coverage. The management of these injuries has been revolutionised so much by the Ilizarov method that some authors have declared this technique of distraction osteogenesis the gold standard for bone tibial defects [1, 2]
Ilizarov bone transport is useful in a wide number of other clinical conditions, both in paediatric and adult age [3, 4], even if the most common use remains the treatment of limb length inequality or complex deformities
Summary
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. The treatment of tibial bone and soft-tissue defects, especially greater than 5 cm, secondary to high-energy trauma or debridement for non-union, are great challenges for the orthopaedic surgeons in terms of limb reconstruction and soft tissue coverage. The management of these injuries has been revolutionised so much by the Ilizarov method that some authors have declared this technique of distraction osteogenesis the gold standard for bone tibial defects [1, 2]. Other methods have been devised for tibial bone transport, such as mono-lateral fixators or intramedullary nail systems [7]
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