Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates.

BACKGROUND: The purpose of this study was to compare two methods of stabilization for proximal tibia fractures (AO 41) with a complete metaphyseal component, external fixation with the Ilizarov wire frame, and internal fixation with locking plates. METHODS: Patients from two level 1 trauma centers treated between 2009 and 2015 were included in a retrospective comparing cohort study. The first center stabilized the non-pathological, proximal tibia fractures exclusively with external fixation and the second with internal plating. Combined clinically and radiologically evaluated, bone healing was the primary outcome. The secondary outcomes included complications, range of motion (ROM) and axial alignment of the knee, the reoperation rate within 6 months, heterotopic ossifications (HTO), and signs of posttraumatic osteoarthritis (PTOA). A logistic regression analysis corrected for uneven distributed parameters. RESULTS: The 62 patients treated with Ilizarov frame and the 68 patients treated with plate fixation were comparable regarding epidemiological parameters, injury characteristics, and comorbidity except for injury severity score (ISS) and smoking behavior. The time of healing was shorter in the group undergoing plate fixation (p = 0.041); however, the incidence of non-unions was equal. Furthermore, there was no difference regarding the rate of deep infections, thrombosis, alignment, reoperations, PTOA, and ROM. Heterotopic ossifications were more prevalent following plate fixation (13.2 vs 1.6%, p = .013). External fixation was associated with a higher rate of superficial infections (40.4 vs 2.9%, p = .000). The initial displacement, the incidence of deep infections, and the classification significantly influenced the incidence of non-unions in both groups (p < 0.02). CONCLUSIONS: Fixation of proximal tibia fractures with plates resulted in a slightly shorter healing time compared to Ilizarov frame stabilization. Furthermore, the complication profiles differ with more heterotopic ossifications and less superficial infections following internal plating. TRIAL REGISTRATION: DRKS, DRKS00013275 , Registered 11/2/2017, Retrospectively registered.

[Preliminary results for treatment of tibial plateau fractures with the Ilizarov technique of ligamentotaxis]. / Plato tibia kiriklarinda ilizarov metodu ile ligamantotaksis tedavisinin erken dönem sonuçlari.

BACKGROUND: The results of the eight patients who admitted to emergency room with tibial plateau fractures and treated with Ilizarov technique, were retrospective evaluated both clinically and radiologically. METHODS: Seven (87%) men and one (13%) woman ranging in age from 23 to 38, were evaluated. All the cases were between type IV to VI according to Hohl classification preoperatively. Closed indirect reduction by ligamentotaxis was attempted in all fractures, no open technique was performed. RESULTS: Three (38%) cases had open fractures (type I according to Gustilo-Andersen Classification) preoperatively. Six (75%) traffic accident and two (25%) falling from a height were detected as etiology. The cases, whose average follow up was 14 (6-28) months, were evaluated according to Iowa knee score scale and seven (87%) cases were good and excellent. Both clinical and radiological solid fusion were obtained in all cases after removing the frame. Although all the cases had minimal to moderate pin tract infection, all were resolved with dressing and oral antibiotherapy without removing the wires. CONCLUSIONS: Closed reduction with Ilizarov technique is appropriate for treatment of plateau tibia fractures with minimal morbidity.

Resultados de alargamiento tibial con la técnica de ilizarov

Entre enero de 1992 y junio de 1997, 21 tibias en 21 pacientes se alargaron usando la técnica de ilizarov. El seguimiento fue de 5 meses a 5 años. La etiología del acortamiento en el miembro fue adquirido en 12 tibias y congénitas en 9. 20 tibias tuvieron tratamiento unifocal y una bifocal. El promedio de alargamiento fue de 6.0 cm, con un rango de 4 a 12 cm, el cual fue equivalente al 22.6 por ciento del promedio total de aumento en la longitud del segmento afectado, rango de 8.8 por ciento a 41 por ciento. El tiempo de corticalización del alargamiento fue en promedio 7 meses, con un rango de 4 a 12 meses. Las complicaciones a nivel óseo requirieron 7 cirugías adicionales, incluyendo 4 recolocaciones de clavos, 2 correcciones de deformidad angular en antecurvatum medinate recolocación del fijador y una por articotomía incompleta. 5 pacientes presentaron contractura en flexión de rodilla, 3 se movilizaron bajo anestesia y a 2 se les realizó deflexión de rodilla. Los resultados de este trabajo confirman que no hay alargamiento sin riesgo, pero existen ventajas evidentes con el método ilizarov, apoyo precoz, corrección simultánea de deformidades angulares coexistentes, lo que es difícil con otras técnicas quirúrgicas. La tasa de alargamiento y el índice de alargamiento obtenido en esta serie confirman el uso continuo de una distracción gradual previa selección del paciente.