The Management of Complex Fractures of The Proximal End of The Tibia by The Ilizarov Method

Abstract

From February 1993 to September 1993, in the Department of Orthopaedic Surgery and Traumatology in Ege University, 15 (4 female, 11 male) complex fractures of the proximal end of the tibia were treated with the Ilizarov technique and fixator. The average age in these cases is 38 (min. 21, max. 54). There were 6 (40%) open fractures. These were classified according to Gustilo Type II. Two flaps were required for wound closure. The incidence of the individual types of fractures. 3 B1 (20%), 7 C1 (47%) and 5 C2 (33%), based on the AO classification. Our average operation time is 1 hour 30 min. We reviewed all the cases after an average follow-up of 9 months (min. 6, max. 13). Clinical bone healing was obtained within an average of 14 (min. 12, max. 16) weeks. Of remarkable complications we only have got pin tract infections in 6 cases. Approximately 10% of the 142 wire site became inflamed and 14 wire sites were treated for infection with antibiotics, skin release around the offending wire, or wire removal. Functional results were assessed with the modified knee-rating system of the "Hospital for Special Surgery". There were excellent results in 9 (60%), good results in 4 (27%), and fair results in 2 (13%). Knee range of motion was full or more than 100° in all except one patient. It appears that ligamentataxis with Ilizarov method and fixator of the management of complex fractures of the proximal end of the tibia offers the best approach for achieving optimum results. The object of our treatment with the Ilizarov fixator in addition to the anatomical reconstruction is the mobility of the adjacent joints and an immediate ambulatory function with partial and even complete weight bearing. It was concluded that, the intraarticular fracture of the tibial plateau can be reconstructed anatomically and the fragments can be held in place by the technique and extenal fixator of Ilizarov.