Results of Distal Tibia Extra-Articular Type I & Type II Open Fractures Treated with Primary Ilizarov External Fixator - A Prospective Observational Study

Abstract

BACKGROUNDDistal tibia fractures are a common consequence of road traffic accidents or sport injuries and are considered to be difficult to treat surgically as tibia lies subcutaneously, has precarious blood supply, has high risk of infection, risk of skin necrosis after internal fixation and may also go for malunion and non-union. The prime advantage with Ilizarov technique is that with this technique one can treat the patients with an immediate single stage procedure irrespective of soft tissue status. METHODS19 patients (M=15, F=4) in 18-65 years age group with isolated distal tibia extraarticular fractures open type I & II who were undergoing treatment with circular external fixator (Ilizarov technique) were included in the study conducted from 1 st July 2017 to 31 st May 2018. Depending on the type of fractures, 3 or 4 rings with or without foot frame were used. Full weight bearing was allowed in all cases. Operative time (In minutes), intraoperative blood loss by mopping method, clinico-radiological union, intra-operative complications, post-operative complications, and ankle range of motion were assessed. American Orthopaedic Foot and Ankle Society (AOFAS) score was taken to assess functional outcome. Average follow up period was 11 months (Range 6-16 months). RESULTSAccording to AO classification, A1 fractures were five, A2 fractures were ten and four had A3 fractures. 11 had Gustilo type I and 8 had type II injuries. Mean hospital stay was 9 days (range 5-14 days). Mean ankle dorsiflexion was 18 0 and plantarflexion was 30 o . Pin tract infection was seen in 5 (26.31%) of our cases which were not deep, and they were treated successfully after giving oral antibiotics and local pin tract care. All patients had satisfactory AOFAS score. Only one patient had non-union which was treated with corticotomy and distraction osteogenesis. CONCLUSIONSWe recommend using Ilizarov circular ring fixator application in such type of fractures as it has got minimum complication rate and most importantly it can be done as single stage procedure irrespective of soft tissue status. Immediate postoperative ambulation and weight bearing can be given via this device.