Abstract
Introduction: Complex tibial diaphyseal fractures are rare injuries and can present significant challenges to the surgeon. Successful fixation and subsequent union can be difficult to achieve due to the relatively poor blood supply of the tibia and extent of soft tissue injury. This study describes our early experience of treating eighteen patients with these injuries by the Ilizarov method.
Methods: Patients were prospectively identified. Follow up was performed in the out-patient clinic and by notes review. Fractures were classified using the AO classification. Bony union was evaluated on both a clinical and radiological basis, which included remodelling bone trabeculae on two radiographs and ability to weight bear without discomfort or walking aids on a dynamised frame. The mean patient age was 38 years with a male: female ratio of 12:6. Of the eighteen patients four had concomitant injuries.
Results: There were four 42-B3 type fractures, seven 42-C1 and seven 42-C3. Ten were open (eight IIIB, two IIIA) and eight closed. We identified two groups: closed fractures and open fractures. The mean time to union in the closed group was 149 days (21 weeks) and 186 days (27 weeks) in the open group. There was one hypertrophic non union requiring further surgery using the Ilizarov method. Six patients had an episode of superficial pin site infection, all of which settled with oral antibiotic therapy. There was no deep sepsis. No patients required bone grafting.
Conclusion: The Ilizarov method offers safe, reliable and rapid healing for both closed and open complex tibial diaphyseal fractures. These early results demonstrate improvements in union times and complication rates when compared with similar injuries treated by internal fixation.
Correspondence should be addressed to: S. Dhar, BLRS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
