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Open Access Research article

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients

Telmo Ramos1*, Jón Karlsson2, Bengt I Eriksson2 and Lars Nistor1

Author Affiliations

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

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BMC Musculoskeletal Disorders 2013, 14:30  doi:10.1186/1471-2474-14-30

Published: 17 January 2013

Abstract

Background

The management of displaced distal tibial fractures is still controversial. The different internal fixation techniques are often burdened by relatively high complication rates. Minimally invasive techniques with ring fixators have been introduced as an alternative allowing immediate reduction and stabilization, avoiding a staged protocol. The aim of this prospective study was to analyze the clinical and radiographic outcome the Ilizarov technique in patients with distal metaphyseal tibial fractures, with or without intra-articular involvement.

Methods

Thirty-nine consecutive patients with isolated fractures treated with the Ilizarov technique were followed prospectively for one year. Depending on the type of fracture, 4 or 5 rings were used, in some cases with additional foot extension. Unrestricted weight-bearing was allowed in all cases. Pre- and post-operatively conventional radiographs, post-operative pain assessment and complications were evaluated. The function was evaluated clinically and with self-appraisal protocols: EQ-5D, NHP and FAOS.

Results

No patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and/or the removal of isolated pins. Two patients required debridement. One of them had a deep infection and developed a residual deformity which was corrected and healed after re-operation. Another patient had a severe residual deformity. The fixator was removed after a median period of 16 weeks (range 11–30). The radiological results were poor in 5 patients but the overall self-appraisal showed satisfactory results in 36 patients.

Conclusions

The Ilizarov method allowed early definitive treatment with a low complication rate and a good clinical outcome.

Keywords:
Distal tibial fractures; Ilizarov method; External fixation