Treatment of Open Comminuted Diaphyseal Fracture of the Tibia by Ilizarov

Abstract

Background: Management of open diaphyseal tibial shaft fractures can be comminuted due to lack of soft tissue coverage and blood supply of the tibial shaft. Open reduction and internal fixation [ORIF] with plates and screws achieves stability, allows joint mobilization but does not allow early weight bearing which as a stimulus is a must for early union. Closed reduction and intramedullary fixation compromise the intramedullary blood supply and increases the risk of infection in open fractures. Ilizarov is considered safe in treating these open injuries, at the same time it has the advantages of easy application, minimal invasive, and convenient subsequent soft tissue repair. Objective: The aim of current study was to evaluate treatment of open comminuted diaphyseal tibial fracture by ilizarov external fixator; its effective, availability, outcomes and complications. Patients and Methods: This prospective study included a total of 10 patients with comminuted tibial diaphyseal fractures managed with early Ilizarov external fixator, attending at Alharam Hospital. This study was conducted between Feb 2018 and July 2019. General assessment indicators included pain, complete union, deformity in comparison to healthy limb, infection, leg limb discrepancy, stiffness and activity of the patients were analysed. Results: Follow-up of all participants for analysis was done. The follow-up time was 17 months. Three cases developed ankle stiffness. The average total range of knee motion in our cases was 130.5 (range 125-140). A significant limp occurred only in 3 cases. NO persistent limp persisted in our cases. Fifteen patients had minimal pain at the site of fracture. Signicant pain occurred in three cases. Pin site infection occurred in 7 patients. All the patients achieved full union and activity. Excellent results were obtained in 4 cases (40%). Good results were obtained in 3 cases (30%) with overall good to excellent results were about (70%). Fair results were obtained in 3 cases (30%). Conclusion: It could be concluded that the Ilizarov external fixator is a golden horse for orthopedic surgeons. It holds wonderful promise in the management of open diaphyseal tibial shaft fractures.