The Ilizarov external fixator - a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients
1 Department of Orthopaedics, Central Hospital (Kärnsjukhuset), Skövde SE-541 85, Sweden
2 Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy at Gothenburg University, Mölndal SE-431 80, Sweden
BMC Musculoskeletal Disorders 2013, 14:11 doi:10.1186/1471-2474-14-11Published: 7 January 2013
In dislocated proximal tibial fractures, the most frequently used treatment is ORIF with screws and plates. Minimally-invasive techniques using external fixation are an alternative. The aim of this study was to analyse the clinical and radiological results using the Ilizarov technique in both uni- and bicondylar tibial fractures.
Thirty consecutive patients with isolated fractures of the proximal tibia were treated with the Ilizarov technique, 11 Schatzker I-IV with 2–3 rings and 19 Schatzker V-VI with 3–4 tibial rings and a femoral, hinged, two-ring extension. Unrestricted weight-bearing was allowed. Pre and post-operatively, conventional radiographs, computerized tomography scans, post-operative pain assessments and complications were evaluated. The knee function was evaluated with the EQ-5D, NHP and KOOS scores, as well as self-appraisal.
All the fractures healed. Twenty-five patients achieved a range of motion better than 10-100º. The type I-IV fractures had a shorter operating time and hospital stay, as well as better knee flexion, and the self-appraisal indicated that they tolerated the treatment better. Pin infections occurred in 4% of the pin sites, but only two patients required debridement. Two patients developed compartment syndrome and underwent fasciotomy. No patient complained of functional knee instability. Two patients underwent a total knee arthroplasty because of residual pain. The overall result was judged as satisfactory in twenty-seven patients.
The Ilizarov method produces a good clinical outcome and is a valuable treatment alternative in proximal tibial fractures of all types.