To evaluate the outcome of Ilizarov ring fixator using hybrid technique in Tibial trauma

Abstract

Introduction: The management of infected nonunion of the tibia is challenging, particularly with segmental bone loss, multiple draining sinuses, poor soft tissue cover, osteopenia, adjacent joint stiffness, limb deformity, or multidrug-resistant polymicrobial infection. The Ilizarov method permits early rehabilitation and addresses all the problems such as non-union, infection, shortening, soft tissue loss and deformity simultaneously at single stage. The conventional all wire Ilizarov frame has certain disadvantages when done in diaphysis such as Muscle and tendon transfixation which leads to pain and contracture of adjacent joints, neurovascular injury and patient discomfort. Half pins used in hybrid Ilizarov causes minimal transfixation of the surrounding soft tissues and neurovascular injury thus causing less morbidity and increased range of motion. Methods: The present study was a prospective randomized open study in which aim was to evaluate outcome of Ilizarov ring fixator using Hybrid technique in tibial trauma. The study was conducted in 30 skeletally mature patients in Department of Orthopaedics, SGRD University of health sciences, Amritsar from July 2017 to May 2019. The patients were assessed clinically based on history and physical examination. Radiological evaluation using plain antero-posterior and true lateral radiographs of the involved leg was done and evaluated by ASAMI score and complications. Results: Mean age was 37.7 years. Out of 30 cases 24(80%) were male and 6(20%) were female. Right tibia was involved in 24 cases out of 30 cases. 29 cases had history of road side accident and 1 had history of fall from height. The bone results were excellent in 21 cases (70%), good in 6 cases (20%), fair in 2 cases(6.67%) and poor in 1 case(3.33%). Functional results were excellent in 17 cases (56.67%), good in 9 cases (30%) and fair in 4 cases (13.33%). No poor functional result was noted. In present study following complications were noted, limp in 12 cases(40%), ankle stiffness in 7 cases(23.33%), pin site infection in 9 cases(30%), limb oedema in 7 cases(23.33%), knee stiffness in 3 cases(10%), loosening of pins in 2 cases(6.67%), deformity in 2 cases(6.67%) and refracture in 1 case(3.33%). There was no complication of neurovascular injury, malunion, breakage of wires, axial deviation or limb length discrepancy. Conclusion: It is thus concluded in present study that with the use of hybrid Ilizarov fixator, bone results are same, functional results are better, post-operative pain is less, less neurovascular injury, decreased joint stiffness, increased range of movements as compared to conventional all wire Ilizarov fixator. Although studies state that pins increase the stiffness of the frame thus decreasing union rate, we found that union rate in hybrid Ilizarov fixator was same as compared to conventional all wire Ilizarov fixator. Thus we conclude that hybrid Ilizarov fixator is better than conventional Ilizarov fixator in all aspects. Keywords: hybrid ilizarov,half pins,ASAMI Score