The Use of the Ilizarov Fixator for the Treatment of Open and Closed Tibial Shaft and Distal Tibial Fractures in Patients with Complex Cases

Abstract

Introduction Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. Materials and Methods Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. Results The mean time of fixator treatment was 29 (range 15–65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2–186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. Conclusion The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.

Zusammenfassung

Einleitung Offene und geschlossene Frakturen des Tibiaschafts oder der distalen Tibia können für den Chirurgen eine Herausforderung in der Behandlung darstellen. Wenn die Frakturen von erschwerenden Zuständen, wie verschiedenen Begleiterkrankungen, ausgeprägten Weichteilverletzungen, Osteomyelitis und/oder Noncompliance begleitet werden. Ziel dieser retrospektiven Studie war es, unseren Ansatz und unsere Ergebnisse mit dem Ilizarov-Fixateur als Behandlungsoption für solche individuell komplexen Fälle vorzustellen. Material und Methoden Zwischen 2005 und 2018 wurden 20 Patienten mit dem Ilizarov-Fixateur bei Frakturen des Tibiaschafts/der distalen Tibia behandelt. Die Indikationen hierfür waren offene Frakturen 2. bis 3. Grades bei 10 Patienten, eine offene Fraktur 1. Grades bei einem Patienten und geschlossene Frakturen bei 9 Patienten. Zu den erschwerenden Zuständen gehörten Weichteilverletzungen, Osteomyelitis, Beindeformitäten, multiple Traumata, Rauchen, Alkohol-/Drogenmissbrauch und Fettleibigkeit (BMI >60). Neben demografischen Daten wurden retrospektiv der Zeitpunkt der Fixateurbehandlung, Komplikationen und der Endpunkt der Konsolidierung ausgewertet. Ergebnisse Die durchschnittliche Behandlungsdauer mit dem Fixateur betrug 29 Wochen (Range 15–65). Eine vollständige Frakturkonsolidierung wurde bei 13 Patienten (65%) mit dem Ilizarov-Fixateur erreicht. Die durchschnittliche Nachbeobachtungszeit nach Entfernung des Fixateurs betrug bei 14 Patienten 36 Monate (Range 2–186). Bei 5 Patienten mit vollständiger Konsolidierung konnte keine weitere Nachsorge durchgeführt werden. Ein Patient wurde amputiert. Bei 6 Patienten mit fehlender Konsolidierung wurde nachfolgend eine interne Osteosynthese durchgeführt. Schlussfolgerung Die Verwendung des Iizarov-Fixateurs stellt eine Behandlungsoption für einzelne Hochrisikopatienten mit komplizierten Verläufen dar. Das Verfahren sollte jedoch aufgrund der hohen Komplikationsrate und des langen Behandlungsprozesses als Rettungsmaßnahme angesehen werden.

Keywords

Ilizarov - lower leg fracture - tibial fracture - external fixator

Schlüsselwörter

Ilizarov - Unterschenkelfraktur - Tibiafraktur - Fixateur externe

Publication History

Received: 11 May 2022

Accepted after revision: 26 July 2022

Article published online:
27 September 2022

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