Segementni prelomi tibije lečeni fiksatorom po Ilizarov-u

  • Slavko Tomić Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Nemanja Slavković Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Goran Tulić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Andreja Baljozović Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Želimir Jovanović Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Milan Mirković Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Stanislav Rajković Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Nikola Bogosavljević Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
  • Dušan Šaponjski Clinical Centre of Serbia, Centre for Radiology and MRI, Belgrade, Serbia
  • Sladjana Mihajlović University Hospital “Dragiša Mišović”, Clinic for Gynecology, Belgrade, Serbia
  • Danilo Jeremić Institute for Orthopaedic Surgery “Banjica”, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP190110070T
Ključne reči: tibial fractures, external fixators, ilizarov technique, recovery of function

Sažetak


Background/Aim. Segmental fractures represent complex tibial injuries, featuring a unique fracture type that is most commonly caused by high-energy trauma. These fractures are considered to be a treatment challenge for orthopaedic surgeons due to their sporadic presentation, wide zone of soft tissue injury, and increased rate of complications. They are characterized by a highly unstable intermediary segment and a high rate of open fractures.  The method of Ilizarov with its characteristics could offer many advantages over the existing operative techniques. This method, using a percutaneous approach, minimizes the intraoperative trauma and avoids the additional compromising of the biological environment at the fracture site. The aim of this study was to evaluate the results of the Ilizarov fixator in the treatment of segmental tibial fractures. Methods. We analyzed 30 patients treated with the Ilizarov fixator between 2012 and 2017. The average age of patients was 36 years (from 24 to 65). The most common mechanism of injury was a road traffic accident. Open fractures were noted in 22 cases. All fractures were reduced using indirect percutaneous techniques with a great focus on achieving the correct length, rotation, and axial alignment of fragments. All patients were advised to bear weight as tolerated from the second postoperative day. Bone healing and functional results were evaluated according to the criteria established by the Association for the Study and Application of the Method of Ilizarov. Results. Bone healing was achieved in all patients. The average time to union was 25 weeks (19 to 36 weeks).  Bone results were excellent in 23 patients, good in five, and fair in two patients. Functional results were excellent in 22 cases, good in 5, and fair in three cases. Eight patients had minor pin-tract infections, successfully treated with oral antibiotics. Patients were without any major complications. Conclusion. The Ilizarov method is a safe and efficient treatment modality for segmental tibial fractures.

Reference

Zhang J, He X, Li M, Yu Y, Zhu L. Treatment of segmental tibial fractures with supercutaneous plat-ing. Orthopaedics 2014; 37(8): 712‒6.

Woll TS, Duwelius PJ. The segmental tibial fracture. Clin Or-thop Relat Res 1992; (281): 204‒7.

Reynders P. Open acute segmental tibial fracture fixation using the less invasive stabilization system (LISS): study of 23 con-secutive cases. Injury 2009; 40(4): 449–54.

Miller NC, Askew AE. Tibia fractures. An overview of evalua-tion and treatment. Orthop Nurs 2007; 26(4): 216‒23; quiz 224‒5.

Mcmurtry J, Mounasamy V. Segmental Tibia Fractures. Ann Or-thop Rheumatol 2015; 3(3): 1051.

Oztürkmen Y, Karamehmetoğlu M, Karadeniz H, Azboy I, Canikli-oğlu M. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury 2009; 40(3): 321–6.

Foster PA, Barton SB, Jones SC, Morrison RJ, Britten S. The treatment of complex tibial shaft fractures by the Ilizarov method. J Bone Joint Surg Br 2012; 94(12): 1678–83.

Webb LX, Bosse MJ, Castillo RC, MacKenzie EJ. Analysis of surgeon-controlled variables in the treatment of limb-threatening type-III open tibial diaphyseal fractures. J Bone Joint Surg Am 2007; 89(5): 923‒8.

Wani N, Baba A, Kangoo K, Mir M. Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. Int Orthop 2011; 35(6): 915–23.

Bari MM, Islam S, AHMA R, Rahman M. Management of Segmental Fracture Tibia by Ilizarov Technique. MOJ Orthop Rheumatol 2015; 3(3): 00097.

Shadgan B, Pereira G, Menon M, Jafari S, Darlene Reid W, O'Bri-en PJ. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol 2015; 16(3): 185–92.

El Rosasy MA. Appraisal of the role of external skeletal fixa-tion in the management of sequelae of open tibial fractures. Indian J Orthop 2008; 42(4): 420‒5.

Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part II. The influence of the rate and fre-quency of distraction. Clin Orthop Relat Res 1989; (239): 263–85.

Mkize S, Ferreira Ν. Outcome of bilateral circular fixators in complex lower limb fractures. SA Orthop J 2017; 16(3): 51‒4.

Court-Brown CM. Fractures of the tibia and fibula. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Fractures in adults. 6th ed. Philadelphia: Lippincott; 2006. p. 2079–146.

Melis GC, Sotgiu F, Lepori M, Guido P. Intramedullary nailing in segmental tibial fractures. J Bone Joint Surg Am 1981; 63(8): 1310‒8.

Gustilo RB, Mendoza RM, Williams DN. Problem in the man-agement of type III (severe) open fractures: a new classifica-tion of type III open fractures. J Trauma 1984; 24(8): 742–6.

Oestern HJ, Tscherne H. Pathophysiology and Classification of Soft Tissue Injuries Associated with Fractures. In: Tscherne H, Gotzen L, editors. Fractures with Soft Tissue Injuries. Berlin, Heidelberg: Springer; 1984. p. 1‒9.

Shahid M, Hussain A, Bridgeman P, Bose D. Clinical outcomes of the Ilizarov method after an infected tibial non union. Arch Trauma Res 2013; 2(2): 71‒5.

Tomić S. Pseudoarthrosis and bone defects, Ilizarov method. Belgrade: Želnid; 2001. p. 214‒35. (Serbian)

Claes L, Augat P, Schorlemmer S, Konrads C, Ignatius A, Ehrnthal-ler C. Temporary distraction and compression of a diaphyseal osteotomy accelerates bone healing. J Orthop Res 2008; 26(6) 772–7.

Teraa M, Blokhuis TJ, Tang L, Leenen LP. Segmental tibial frac-tures: an infrequent but demanding injury. Clin Orthop Relat Res 2013; 471(9): 2790‒6.

French B, Tornetta P 3rd. High energy tibial shaft fractures. Or-thop Clin North Am 2002; 33(1):211-30, ix.

Sohn HS, Chung JY, Song HK. Analysis of complications and clinical outcomes in the treatment of segmental tibial fractures according to the method of internal fixation. Asian J Surg 2019; 42(7): 740‒5.

Weiss RJ, Montgomery SM, Ehlin A, Al Dabbagh Z, Stark A, Jansson KA. Decreasing incidence of tibial shaft fractures be-tween 1998 and 2004: information based on 10,627 Swedish inpatients. Acta Orthop 2008; 79(4): 526‒33.

Abdelsatar T, Elsawy M, Zayda A, Samy A. Management of segmental tibial fractures by an Ilizarov external fixator. Menoufia Med J 2016; 29(3): 680‒4.

Tilkeridis K, Owen AJ, Royston SL, Dennison MG, Vinsent M, Vashista G. The Ilizarov method for the treatment of segmen-tal tibial fractures. Injury Extra 2009; 40: 228.

Giotakis N, Panchani SK, Narayan B, Larkin JJ, Al Maskari S, Nayagam S. Segmental fractures of the tibia treated by circu-lar external fixation. J Bone Joint Surg Br 2010; 92(5): 687–92.

Audigex L, Griffin B, Bhandari M, Kellam J, Rüedi TP. Path analysis of factors for delayed healing and nonunion in 416 operatively treated tibial shaft fractures. Clin Orthop Relat Res 2005; 438: 221–32.

Objavljeno
2021/04/02
Broj časopisa
Vol. 78 Br. 3 (2021): Vojnosanitetski Pregled
Rubrika
Originalni članak