Reconstruction of Acute Traumatic Tibial Fractures with the Ilizarov Method

Abstract

Background: Since the first application of external fixators in 1853, the indications, popularity, and designs have changed continuously. A variety of reliable pin fixators are now available with different clinical and mechanical properties1. They are easy to apply and have become quite handy in centers where poly trauma is regularly managed2. A comparatively recent innovation, the Ilizarov circular external fixator3 has the advantage of stability and
rigidity and is widely used in Russia, Europe and America in the management of complicated fractures of upper and lower limbs. Recently introduced in Nigeria, the circular frame is yet to enjoy adequate popularity, due to unavailability and lack of trained manpower in its use7. At Hopeville Specialist Hospital, we adopted
the Ilizarov device and techniques as a primary treatment method for complicated fractures. This study aims to review the results of treatment and evaluate the utility of the Ilizarov techniques in our practice.
Method: A retrospective study of 35 fractures of the tibia in 33 patients, treated in our hospital between January 2000 and March 2006.
Results: There were 23 males (69.7%) and 10 females (30.3%). Average age was 35.3 years. 27(77.1%) fractures were open and 8 (22.9%) were closed. According to Gustilo et al8, open fractures were two Type I, thirteen Type II and twelve Type III. Two (5.7%) were bicondylar plateau fractures with extensive shaft extension, twenty-four (68.6%) fractures in the midshaft, five (14.3%) fractures at the distal third and four (11.4%) were pilon type of
fractures. There were seven segmental diaphyseal fractures. To date, thirty-three fractures are healed. The average time for application of the apparatus to fracture healing was 4.3 months. One fracture required autogenous bone graft for union. One patient is undergoing callus transportation for bone replacement. The most common complication was pin tract infection seen in nine (25.7%) patients.
Conclusion: We treated 35 tibial fractures in 33 patients using Ilizarov techniques as primary treatment method. Thirty-three fractures have healed. The results are promising and our experience confirms the utility of the technique in our practice. We conclude that the Ilizarov technique is an effective device for the treatment of long bone fractures with a high rate of union and a relatively low complication rate. We recommend it to any surgeon involved in the treatment of fractures. We suggest a \" Centre for Ilizarov Techniques\" be established in Nigeria for training of doctors.


Keywords: Ilizarov apparatus, acute fracture care.

Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 66-69