Clinical and functional outcomes of acute distal tibia fractures treated with Ilizarov external fixation: a retrospective study

Introduction Distal tibia pilon fractures are complex injuries involving the tibial articular surface. Managing these fractures requires balancing stable fixation with soft tissue preservation. The Ilizarov technique offers a minimally invasive alternative to traditional open reduction and internal fixation (ORIF), allowing for gradual correction and early weight bearing.

This study aimed to evaluate functional and radiological outcomes in patients with distal tibia fractures managed by limited open reduction and Ilizarov fixation.

Materials and Methods The study was conducted in a tertiary care hospital's Department of Orthopaedics over two years. The inclusion criteria were patients aged >18 years with distal tibia fractures. Exclusion criteria included refracture, previous surgeries, and associated vascular injury. The study included 20 patients (18 males, 2 females) with a mean age of 39.2 ± 10.5 years. Most injuries (80 %) were due to road traffic accidents. Fracture patterns were classified according to the AO-OTA classification. The surgical procedure involved placing the patient supine under spinal anesthesia. Traction was applied, and fluoroscopy was used to assess reduction. A three-ring tibial Ilizarov frame was assembled and applied, with additional fixation for the calcaneum. The median time to full weight bearing was 26 days.

Results At frame removal, all cases had ankle stiffness, but two months post-removal, 85 % of cases had full ankle range of motion. The median time to frame removal was 17.5 weeks, and the median time to consolidation was 22 weeks. Patellar tendon bearing cast was applied for 3 weeks followed by a PTB brace with foot extension for the next 4 weeks.

Discussion The Ilizarov technique should be considered as a viable option, especially for complex fracture patterns or cases with compromised soft tissue envelopes not amenable to ORIF.

Conclusion The Ilizarov technique represents a valuable approach for managing distal tibia pilon fractures, demonstrating improved clinical outcomes and minimal complications.

1. 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):1100-1106. doi: 10.1302/0301-620X.92B8.23602.

2. Vasiliadis ES, Grivas TB, Psarakis SA, et al. Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia. J Orthop Surg Res. 2009;4:35. doi: 10.1186/1749-799X-4-35.

3. Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg (1978). 1984;103(3):190-194. doi: 10.1007/BF00435553.

4. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;(241):146-165.

5. 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.

6. Galante VN, Vicenti G, Corina G, et al. Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures. Injury. 2016;47 Suppl 4:S131-S137. doi: 10.1016/j.injury.2016.07.045.

7. Osman W, Alaya Z, Kaziz H, et al. Treatment of high-energy pilon fractures using the ILIZAROV treatment. Pan Afr Med J. 2017;27:199. doi: 10.11604/pamj.2017.27.199.11066.

8. Giannoudis VP, Ewins E, Taylor DM, et al. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr. 2021;16(2):86-95. doi: 10.5005/jp-journals-10080-1516.

9. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-988. doi: 10.1302/0301-620X.92B7.22959.

10. 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;14:30. doi: 10.1186/1471-2474-14-30.

11. Korkmaz A, Ciftdemir M, Ozcan M, et al. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury. 2013;44(10):1270-1274. doi: 10.1016/j.injury.2013.06.016.