Analysis of results of huge segmental bone loss of tibia treated with Ilizarov external fixator: our experience in Indian population
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232616Keywords:
Complex tibia fracture, Ilizarov external fixator, ASAMI score, Knee society score, St. Pierre scoring systemAbstract
Background: Orthopaedic surgeons face challenges in treating complex tibial fractures with bone loss due to complications like infection, repeat surgeries, and patient psychological burden. The Ilizarov external fixator approach offers better clinical and radiological results, addressing these issues. The purpose of this study was to examine the outcome of tibial segmental loss treated with the Iliazrov external fixator.
Methods: The study was done between January 2015 to December 2021. It’s a prospective as well as retro-prospective study. The age group of 18-65 years was considered. Patients were monitored monthly, up to nine months post-surgery, or until bone union. Functional and bone outcomes of the patients were evaluated using ASAMI criteria, knee society score, and St. Pierre ankle scoring system.
Results: The study included 20 patients, all of them were male and had a mean age of 34.1±10.1. Bone union was achieved in all cases. After ilizarov application, the average bone defect was 82.6±42.9 mm. The final regeneration attained was 75.1±47.5 mm. The average limb length difference was 20.41±6.55 mm after achieving union. Out of 20 patients, 13 and 4 had good and fair ASAMI score, 1, 4, and 13 had fair, good, and excellent knee society score, and17 had fair St. Pierre score and 3 patients were lost to follow-up.
Conclusions: Ilizarov technique is an excellent way for treating complicated tibial fractures. The difficulties, challenges, and complications associated with Ilizarov external fixation are negligible compared to the significant difficulties associated with open techniques.
References
Breasted JH. The Edwin Smith Surgical Papyrus. Chicago, IL: University of Chicago Press. 1980.
Court-Brown CM, Rimmer S, Prakash U. The epidemiology of open long bone fractures. Injury. 1998;29:529-34.
Tucker HL, Kendra JC, Kinnebrew TE. Management of unstable open and closed fractures using the Ilizarov method. Clin Orthop 1992;280:125-35.
Wilson JN. Injuries of the leg. Watson-Jones Fractures and Joint Injuries, 6th ed. Churchill living stone; 1992;1073.
Miacchi AB. Historical Review. Operative principles of Ilizarov, Baltimure; Williams and Wilkins. 1991.
Williams J, Gibbons M, Trundle H, Murray D, Worlock P. Complications of nailing in closed tibial fractures. J Orthop Trauma. 1995;9:476-81.
Lang GJ, Cohen BE, Boss MJ, Kellam JF. Proximal third tibial shaft fractures: Should they be nailed? Clin Orthop. 1995;315:64-74.
Mukhopadhaya J, Raj M. Distraction osteogenesis using combined locking plate and Ilizarov fixator in the treatment of bone defect: a report of 2 cases. Indian J Orthopaed. 2017;51(2):222.
Telmo R, Carl E, Bengt IE, Jón K, Lars N. The Ilizarov external fixator-a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients. BMC Musculoskeletal Disorders. 2013;14:11.
Baratz M, Watson AD, Imbriglia JE. Orthopaedic surgery: the essentials. New York: Thieme Medical Publishers. 1999:517.
Hupel TM, Weinberg JA, Aksenov SA, Schemitsch EH. Effect of unreamed, limited reamed and standard reamed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma. 2001;15:18-27.
Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orthop. 1986;212:18-25.
Ilizarov GA, SoIbel’man LM. Some clinical and experimental data concerning bloodless lengthening of lower extremities. Eksp Khir Anest. 1969;14:27-32.
Cattaneo R, Villa A, Catagni M, Tentori L. Treatment of infected and non-infected non-union by Ilizarov compression. Rev Chir Orthop. 1985;71:223-9.
Grill F, Franke J. The Ilizarov distractor for the correction of relapsed or neglected clubfoot. J Bone Joint Surg Br. 1987;69-B:593-7.
Dagher F, Roukoz S. Compound tibial fractures with bone loss treated by the Ilizarov technique. J Bone Joint Surg Br. 1991;73:316-321.
Dendrinos GK, Kontos S, Lyritsis E. Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am. 1995;77:835-46.
Naggar L, Chevalley F, Blanc CH, Livio JJ. Treatment of large bone defects with the Ilizarov technique. J Trauma 1993;34:390-3.
Polyzois D, Papachristou G, Kotsiopoulos K, Plessas S. Treatment of tibial and femoral bone loss by distraction osteogenesis. Experience in 28 infected and 14 clean cases. Acta Orthop Scand. 1997;275:84-8.
Marsh JL, Prokuski L, Biermann JS. Chronic infected tibial nonunions with bone loss. Conventional techniques versus bone transport. Clin Orthop. 1994;301:139-46.
