Comparative effectiveness of the Ilizarov method versus internal fixation for complex tibial fractures
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261204Keywords:
Ilizarov method, Internal fixation, Tibial fracture, Functional outcome, Radiological unionAbstract
Background: Complex tibial fractures often occur with high-energy trauma and significant soft tissue injury. Optimal management remains controversial due to infection risks, nonunion and functional impairment. Both internal fixation and the Ilizarov method are widely used, yet comparative data in resource-limited settings remain limited. This study compared clinical, radiological and functional outcomes of the Ilizarov method versus internal fixation in complex tibial fractures.
Methods: This comparative observational study was conducted in the Department of Orthopedics at 250 Bed General Hospital, Pabna and City Health Aid Hospital, Pabna, Bangladesh, from January 2024 to January 2025. A total of 30 patients with complex tibial fractures were enrolled and allocated into two groups based on the surgical intervention received. Fifteen patients underwent Ilizarov external fixation and fifteen received internal fixation. Operative parameters, union time, complications and 12-month functional outcomes were assessed. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 25.0.
Results: Operative time was longer in the Ilizarov group (p=0.004). Time to full weight bearing (p=0.006) and radiological union (p=0.049) were significantly shorter with Ilizarov fixation. Knee society scores (p=0.016) and Oxford knee scores (p=0.009) were significantly higher in the Ilizarov group at 12 months. Pin tract infection occurred in 26.7% of Ilizarov cases, while deep infection and nonunion were more frequent in the internal fixation group. Overall complication rates did not differ significantly.
Conclusions: The Ilizarov method provided earlier rehabilitation and superior functional outcomes compared to internal fixation in complex tibial fractures.
References
Korkmaz M, Kizilkurt T, Pehlivanoglu T, Kahraman A, Balci HI, Sen C. Management of complex tibial plateau fractures: A comparative study of Ilizarov external fixation method with or without minimal internal fixation. Turkish Journal of Trauma & Emergency Surgery/Ulusal Travma ve Acil Cerrahi Dergisi. 2025;31(2).
Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What's new in the management of complex tibial plateau fractures? Injury. 2016;47(6):1162-9.
Elsoe R, Larsen P, Nielsen NP, Swenne J, Rasmussen S, Ostgaard SE. Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015;38(9):e780-6.
Karunakaran A, Rajamani SG. A prospective study of locking plate fixation in tibial plateau fractures. Int J Orthop. 2018;4(1):1133-41.
Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18(10):649-57.
Henkelmann R, Frosch KH, Glaab R, Lill H, Schoepp C, Seybold D, Josten C, Hepp P, Committee TRAUMA of the AGA-Society for Arthroscopy and Joint Surgery. Infection following fractures of the proximal tibia–a systematic review of incidence and outcome. BMC Musculoskelet Disord. 2017;18(1):481.
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475-84.
Ilizarov GA. The principles of the Ilizarov method. Bull Hosp Joint Dis Orthop Institute. 1988;48(1):1.
Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma Acute Care Surg. 2007;63(5):1043-53.
Subramanyam KN, Tammanaiah M, Mundargi AV, Bhoskar RN, Reddy PS. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chinese J Traumatol. 2019;22(03):166-71.
Metcalfe D, Hickson CJ, McKee L, Griffin XL. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol. 2015;16(4):275-85.
Li Z, Wang P, Li L, Li C, Lu H, Ou C. Comparison between open reduction with internal fixation to circular external fixation for tibial plateau fractures: A systematic review and meta-analysis. PloS One. 2020;15(9):e0232911.
Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am. 2006;88(12):2613-23.
Naja AS, Bouji N, Eddine MN, Alfarii H, Reindl R, Tfayli Y, et al. A meta-analysis comparing external fixation against open reduction and internal fixation for the management of tibial plateau fractures. Strategies in Trauma and Limb Reconstruction. 2022;17(2):105.
Gálvez-Sirvent E, Ibarzábal-Gil A, Rodríguez-Merchán EC. Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes and management. EFORT Open Rev. 2022;7(8):554-68.
Baloch SR, Rafi MS, Junaid J, Shah M, Siddiq F, Ata-Ur-Rahman S, et al. Ilizarov fixation method of tibia plateau fractures: a prospective observational study. Cureus. 2020;12(10).
Hassan F, Khan AQ, Ahmed W, Hassan N, Kumar S, Fazlani N. Assessment of Mean American Knee Society Scorefor Complex Plateau Fractures with Llizarov External Fixation. Ann PIMS-Shaheed Zulfiqar Ali Bhutto Med Univ. 2023;19(3):245-50.
Ferreira N, Senoge ME. Functional outcome of bicondylar tibial plateau fractures treated with the Ilizarov circular external fixator. SA Orthop J. 2011;10(3):80-4.
Szelerski Ł, Żarek S, Górski R, Mochocki K, Górski R, Morasiewicz P, et al. Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia—a retrospective comparative analysis. J Orthop Surg Res. 2020;15(1):179.
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