Comminuted Tibial Fractures Research Articles

Functional outcome and complications after treatment of comminuted tibial fractures or deformities using Ilizarov bone transport: a single-center study at 15- to 30-year follow-up

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.

Management of open infected comminuted tibial fractures using Ilizarov concept

Bone loss is very common in high energy trauma. It could be treated either by amputation and prosthesis or by reconstruction of both bony and soft tissue structures. The choice of treatment in a given case must be based on the assessment of the local and general condition of the patient such as regional neurovascular supply, and the residual articular and muscular function. Reconstruction may require bone grafts, tibiofibular synostosis, free microvascular soft tissue or bone transplants. The use of Ilizarov concept gives another option for treatment of bone defects. In this study, infected tibial fractures were treated using Ilizarov concept. Twenty-eight patients (20 males and 8 females) with open comminuted infected fracture of the tibia were included. After debridement, all cases had variable amount of bone defects and were treated using Ilizarov technique. Follow-up was for at least 1year. Filling of the bone defect was achieved either by compression-distraction method in 13 cases (group I) or by means of bone transport in the other 15 cases (group II). The results were judged as excellent in 16 patients, good in 9 and fair in 2, while one patient was of poor result. Type of fracture, age of the patient and sex had no statistically significant relation with the final end results. Furthermore, there was no significant difference between the two groups. The average external fixator index was 45days/cm (range from 35 to 70days/cm). The mean external fixator index was less in group I. In the management of infected comminuted tibial shaft fractures, bone transport is indicated for the treatment of major bone loss, whereas compression-distraction is suitable only for treating less extensive bone gaps.

Use of a lateral tibial head buttress plate to repair a tibial fracture in a labrador retriever

A lateral tibial head buttress plate designed for human beings was used to repair a highly comminuted tibial fracture in a two-year-old male labrador retriever caused by a gunshot wound....