Treatment of high-energy gunshot wounds to the extremity with the Ilizarov small wire external fixator

Abstract

Current treatment of comminuted fractures of the extremities caused by high-energy gunshot wounds centers around external fixation. Monolateral external fixators are most commonly used today. The purpose of this study is to examine the use of the Ilizarov small wire external fixator as an alternative method for the treatment of these difficult fractures.
Eight patients who suffered severely comminuted long bone fractures caused by high-energy gunshot injury were treated with the Ilizarov small wire external fixator. The fracture sites were as follows: three distal humerus, one mid-radius, two proximal tibia, one distal tibia, and one distal femur fracture. Efficacy of treatment was determined by functional results (return to work, range of motion), radiologic results, complications, time course of functional return and additional procedures required. The average time of follow up was 25 months. One patient (mid-radius fracture) was lost to follow-up.
There were no cases ofosteomyelitis and all fractures went onto union. All of the limbs were salvaged with good length and alignment as seen on radiograph. There was one case of cellulitis that occurred in an HIV positive patient that resolved following Ilizarov removal. There was one reoperation for a pin reinsertion following incidental removal by the patient. The average length of fixation of all fractures was 16 weeks. All patients returned to work prior to Ilizarov removal and none had instability.
The results of this study suggest that the Ilizarov small wire external fixator may be superior to traditional monolateral frames with lower complication rates.