ILIZAROV TECHNIQUE IN COMMINUTED DISTAL TIBIA FRACTURES TREATMENT

Ivica Lalić; Vladimir  Harhaji; Oliver Dulić; Mile  Bjelobrk; Nataša Janjić; Nensi Lalić; Marko Bojović; Marko Mladenović

doi:10.5937/afmnai40-41694

Ivica Lalić University Business Academy in Novi Sad, Faculty of Pharmacy https://orcid.org/0000-0001-6292-6608
Vladimir Harhaji University Business Academy in Novi Sad, Faculty of Pharmacy https://orcid.org/0000-0003-2077-4153
Oliver Dulić University of Novi Sad, Faculty of Medicine in Novi Sad, Serbia https://orcid.org/0000-0002-5914-9956
Mile Bjelobrk University of Novi Sad, Faculty of Medicine in Novi Sad, Serbia https://orcid.org/0000-0003-3169-2989
Nataša Janjić University of Novi Sad, Faculty of Medicine in Novi Sad, Serbia https://orcid.org/0000-0003-4034-9808
Nensi Lalić University of Novi Sad, Faculty of Medicine in Novi Sad, Serbia https://orcid.org/0000-0002-8673-953X
Marko Bojović https://orcid.org/0000-0002-4304-8974
Marko Mladenović University Clinical Center of Niš, Clinic for Orthopedic Surgery and Traumatology, Niš, Serbia

DOI: https://doi.org/10.5937/afmnai40-41694

Keywords: Ilizarov technique, distal tibia fractures, comminuted fractures, ASAMI classification

Abstract

Introduction: High-energy distal tibia fractures are characterized by great comminution and extensive lesions of surrounding soft tissues. The risk of developing complications during treatment is high. Applying Ilizarov's technique reduces risk of complications significantly, and provides us with good final treatment results.

Methods: In our prospective observation study, 41 patients were included, and their clinical characteristics were evaluated during evaluation period using following instruments: Gustillo-Anderson, Checketts-Otterburns and AO/OTA classification. Bone healing results were assessed using the ASAMI protocol. Functional treatment results were represented using modified Karlström-Ollerud scoring system. Analysis and monitoring time (follow up) was 18 months.

Results: Using radiographic and clinical parameters, we had recorded complete healing in all fractures. In intra-articular fractures group 43B, circular fixator was removed after 16 weeks (range 13-31), while in fracture type 43C group, it was removed after 18 weeks (range 13-29). The ASAMI evaluation of bone healing showed: 31 (75%) excellent, 76 (15%) good, 3 (8%) satisfactory, and 1 (2%) poor results. Functional recovery results present after 6 months showed us mean value of 24.7 using modified Karlström-Ollerud scoring system in three follow-up periods, which represents recovery. Results present 12 months after surgery showed mean value of 27.6, representing satisfactory recovery, while during last parameter measurement performed after 18 months, the value was 29.5, which indicates good functional recovery.

Conclusion: Transosseous osteosynthesis Ilizarov treatment applied in closed and open comminuted distal tibia fractures showed good final bone and function results with minimal complications, and contributed to better patient’s quality of life.

Author Biography

Ivica Lalić, University Business Academy in Novi Sad, Faculty of Pharmacy

Asistent

References

1. Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future. Bone 2002;31(3):430-3

https://doi.org/10.1016/s8756-3282(02)00832-3

2. Honkanen R, Tuppurainen M, Kröger H, Alhava E, Saarikoski S. Relationships between risk factors and fractures differ by type of fracture: a population-based study of 12,192 perimenopausal women. Osteoporos Int 1998;8(1):25-31. https://doi.org/10.1007/s001980050044

3. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures an increasing problem? Acta Orthop Scand 1998;69(1):43-7. https://doi.org/10.3109/17453679809002355

4. Ruedi T, Matter P, Allgower M. Intra-articular fractures of the distal tibial end. Helv Chir Acta 1968;35(5):556-82. PMID: 4974693

5. Herscovici D Jr, Scaduto JM. Management of high-energy foot and ankle injuries in the geriatric population. Geriatr Orthop Surg Rehabil 2012;3(1):33-44. https://doi.org/10.1177/2151458511436112

6. Mandi DM, Belin RP, Banks J, Barrett B. Pilon fractures. Clin Podiatr Med Surg 2012;29(2):243-78 https://doi.org/10.1016/j.cpm.2012.01.001

7. Ruedi TP, Allgower M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res 1979;(138):105-10. PMID: 376196

8. Association OT. Fracture and disolcation compendium. J Orthop Trauma 1996;10:1-55. PMID: 8814583

9. Rockwood and Green’s: Fractures in Adults. 6th edition. Philadelphia: Lippincott Williams & Wilkins; 2006.

10. Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatout L, Simon P, Mainard
D, Vix N, Dechoux E: Distal tibia fractures: management and complications of 101 cases. Int Orthop 2010; 34(4):583–8. https://doi.org/10.1007/s00264-009-0832-z

11. Dillin L, Slabaugh P: Delayed wound healing, infection, and non-union following open reduction and internal fixation of tibial plafond fractures. J Trauma 1986; 26(12):1116–19. https://doi.org/10.1097/00005373-198612000-00011

12. McFerran MA, Smith SW, Boulas HJ, Schwartz HS: Complications encountered in the treatment of pilon fractures. J Orthop Trauma 1992; 6(2):195–200 https://doi.org/10.1097/00005131-199206000-00011

13. Teeny SM, Wiss DA: Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 1993; 292:108–117. PMID: 8519097

14. Tull F, Borrelli: Soft-tissue injury associated with closed fractures: evaluation and management. J Am Acad Orthop Surg 2003;11:431–8. https://doi.org/10.5435/00124635-200311000-00007

15. Casstevens C, Le T, Archdeacon MT, Wyrick JD: Management of extraarticular fractures of the distal tibia: intramedullary Nailing versus Plate fixation. J Am Acad Orthop Surg 2012 ;20(11):675–83. https://doi.org/10.5435/jaaos-20-11-675
16. Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury 2011; 42(10):975–84. https://doi.org/10.1016/j.injury.2010.02.019

17. Tornetta P III, Weiner L, Bergman M, Watnik N, Steuer J, Kelly M, Yang E.
Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma 1993;7(6):489–96. https://doi.org/10.1097/00005131-199312000-00001

18. Wrysch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD,
Schwartz HS. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am 1996; 78(11):1646–57. https://doi.org/10.2106/00004623-199611000-00003

19. Ristiniemi J, Flinkkila T, Hyvonen P, Lakovaara M, Pakarinen H, Jalovvara P.
RhBMP-7 accelerates the healing in distal tibial fractures treated by external fixation. J Bone Joint Surg Br 2007; 89(2):265–72. https://doi.org/10.1302/0301-620x.89b2.18230
20. Barbieri R, Schenk R, Koval K, Aurori K, Aurori B. Hybrid external fixation in the
treatment of tibial plafond fractures. Clin Orthop Rel Res 1996; 332:16–22. https://doi.org/10.1097/00003086-199611000-00004

21. Lovisetti G, Agus MA, Pace F, Capitani D, Sala F: Management of distal tibial intraarticular fractures with circular external fixation. Strategies Trauma Limb Reconstr 2009; 4(1):1–6 https://doi.org/10.1007/s11751-009-0050-7

22. Vasiliadis ES, Grivas TB, Psarakis SA, Evangelos P, Kaspiris A, Triantafyllopoulos
G. Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia. J Orthop Surg Res 2009; 4:35. https://doi.org/10.1186/1749-799x-4-35

23. Vidyadhara S, Rao SK: Ilizarov treatment of complex tibial pilon fractures.
Int Orthop 2006; 30(2):113–7. https://doi.org/10.1007/s00264-005-0038-y

24. Ilizarov GA: A new principle of osteosynthesis using crossing wires and rings. In Collected Scientific Works of the Kurgan Regional Scientific Medical Society. Edited by Ilizarov GA. Kurgan: Union of Soviet Socialists Republic; 1954:145–160. https://doi.org/10.1308%2F003588410X12518836439326

25. Ilizarov GA: Transosseous osteosynthesis. 1st edition. Berlin Heidelberger New
York. Springer Verlag; 1992.

26. Paul HK, Seth SL. Gustilo-Anderson classification. Clin Orthop Relat Res 2012;470(11):3270-4. https://doi.org/10.1007%2Fs11999-012-2376-6

27. Tscherne HG, Gotzen L. Fractures with soft tissue injuries. Berlin: Springer-Verlag; 1984.

28. Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Rev 2013;3(12):CD004551. doi:10.1002/14651858.CD004551.pub3. PMID: 24302374

29. Checketts RG, MacEachern AG, Otterburn M. Pin track infection and the principles of pin site care. In: Goldberg A, De Bastiani A, Graham Apley A, editors. Orthofix external fixation in trauma and orthopeadics. Berlin, Heidelberg, New York: Springer; 2000. pp. 97–103.

30. Patil S, Montgomery R. Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br 2006;88-B:928-32. https://doi.org/10.1302/0301-620x.88b7.17639

31. Karlstrom G, Olerud S. Fractures of the tibial shaft: a critical evaluation of treatment alternatives. Clin Orthop 1974;105:82-115. PMID: 4609658

32. El-Mowafi H, El-Hawary A, Kandil Y. The management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy. Foot (Edinb) 2015;25(4):238-43 https://doi.org/10.1016/j.foot.2015.08.004

33. Kapoor SK, Kataria H, Patra SR, Boruah T. Capsuloligamentotaxis and definitive fixation by an ankle-spanning Ilizarov fixator in high-energy pilon fractures. J Bone Joint Surg Br 2010;92(8):1100-6. https://doi.org/10.1302/0301-620X.92B8.23602

34. Ramos T, Karlsson J, Eriksson BI, Nistor L. Treatment of distal tibial fractures with the Ilizarov external fixator-a prospective observational study in 39 consecutive patients. BMC Musculoskelet Disord 2013; 17;14:30. https://doi.org/10.1186/1471-2474-14-30

35. Papadokostakis G, Kontakis G, Giannoudis P, Hadjipavlou A. External fixation devices in the treatment of fractures of the tibial plafond. A systematic review of the literature. J Bone Joint Surg Br 2008;90-B(1):1-6. https://doi.org/10.1302/0301-620x.90b1.19858

36. Osman W, Alaya Z, Hamdi K, Hassini L, Braiki M et al. Treatment of high-energy pilon fractures using the Ilizarov treatment. Pan African Medical Journal 2017;27:199. https://doi.org/10.11604/pamj.2017.27.199.11066