A one-wire method for anatomic reduction of tibial fractures with Ilizarov frame.

UNLABELLED: Traditional external fixator techniques do not always correct minor residual malalignment. We asked whether using a one-wire method that corrects minor malalignment with an olive traction wire placed in the plane of the deformity allowed (1) uniform healing, (2) proper alignment, and (3) adequate reduction of fracture gaps. We retrospectively evaluated 72 patients in whom we used closed tibial fracture reduction using a circular external frame. We identified the plane of the residual deformity after alignment on a traction table using a C-arm. In this plane, the final correction was performed with traction through an olive wire. Satisfactory alignment (less than 3 degrees deviation from normal) was obtained in 68 of the 72 patients (94%), and satisfactory reduction (gaps less than 2 mm) attained in 51 (71%). In no case was the fracture site opened surgically. Four patients underwent additional alignment correction with conical washers outside the operating room but no other efforts were needed to obtain further reduction after the initial surgery. Fractures healed in an average of 20 weeks. We observed no major infections. The Ilizarov frame has been a valuable tool to achieve alignment and anatomic or near anatomic reduction of closed tibial fractures. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results.

Surgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67-100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.