Management of paediatric tibial shaft fractures with the Taylor Spatial frame

Abstract

Introduction: The Ilizarov method and fixation is a well established treatment in lower limb reconstruction, but little has been reported about the outcome of its use in the treatment of segmental tibial fractures. Aim: To review a single unit's experience of the Ilizarov method in segmental tibial fractures. Materials and methods: 33 patients, aged 18-75 years, were reviewed retrospectively after the completion of treatment. 24 patients were male, 20 patients had open fractures; these were all graded as Gustilo-Anderson IIIb. Demographic data, type of fracture, period spent in the fixator, incidence of secondary operations and complications were recorded. The patients were asked to complete a Lysholm knee scale and Tegner activity level scale to assess knee function, an Olander and Moldeavia Ankle score to assess ankle function and a SF-36 health questionnaire. Results: All fractures were united at the end of treatment; the mean time spent in frame was 181 days. In three cases of non-union occurred at one fracture site these were corrected with the application of a second frame. Malunion was reported in one case, this was corrected with reapplication of a frame and satisfactory union was achieved soon after.Complications were few in number, one patient required excision of a ring sequestrum and one case of DVT was reported. There was no incidence of compartment syndrome.The mean Lysholm knee score dropped from 91 to 58, the mean Tegner activity score dropped from 6 to 2, and the mean Olander and Moldeavia ankle score dropped from 95 to 55 before and after the fracture. The SF-36 scoring gave a mean PCS of 39 and MCS of 51. Conclusion: The Ilizarov treatment of segmental tibial fractures can lead to relatively fast union rates, with an acceptably low incidence of complication. Due to the high velocity mechanism of injury the residual impairment of the limb is still significant.