Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia-a retrospective comparative analysis.

INTRODUCTION: This study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia. MATERIAL AND METHODS: In a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000-2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity. RESULTS: Union rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827). DISCUSSION: Our study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Stress Fractures of Tibia Treated with Ilizarov External Fixator.

BACKGROUND: Stress fractures are the result of cyclic loading of the bone, which gradually becomes damaged. Most often they are treated by rest or plaster cast and, in rare cases, by internal fixation. There is little published data on initial reposition followed by stabilization with the Ilizarov apparatus in such fractures. MATERIAL AND METHODS: Six patients were treated with an external fixator according to the Ilizarov method for a stress fracture of the tibia between 2007 and 2015. Three patients were initially treated conservatively. Due to increasing tibial deformation, they were qualified for surgical treatment with external stabilization. In the other patients, surgery was the first-line treatment. All patients demonstrated risk factors for a stress fracture. After the surgery, they fully loaded the operated limb. RESULTS: No patient developed malunion, nonunion, infection or venous thrombosis. The average time from the first operation to the removal of the external fixator was 19 weeks. Radiographic and clinical outcomes were satisfactory in all patients. CONCLUSION: 1. The Ilizarov method allows for successful stabilization of stress fractures of the tibia. 2. It may be a good alternative to internal stabilization, especially in patients with multiple comorbidities which affect bone quality and may impair soft tissue healing.

Open Trimalleolar Fractures Treated with Ilizarov External Fixator.

BACKGROUND: Open trimalleolar fractures are some of the most severe fractures of the ankle joint region and some of the most difficult in trauma surgery. Repositioning with internal fixation is the most common surgical treatment method. There is little published data on primary repositioning and external fixation. MATERIAL AND METHODS: Five patients with open trimalleolar were fitted with Ilizarov external fixators in single-stage procedures. RESULTS: Full weight bearing was possible following surgical treatment in all five patients. None of the patients developed malunion, infections or vein thrombosis. For all patients, the Ilizarov apparatus was remodelled after six weeks to allow movement in the ankle. Three patients developed posttraumatic arthrosis requiring joint fusion. Arthrodesis was performed in two patients, and another patient will require it in the future. None of the patients developed any inflammatory complications. The mean duration of treatment with an external fixator was 11.6 weeks (range: 9-15 weeks). Radiological and clinical outcomes were satisfactory in all patients. CONCLUSIONS: The Ilizarov method allows for early and definitive treatment of open trimalleolar fractures with a low risk of complications and a good clinical outcome.