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Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures

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Abstract

We evaluated the results of patients with Gustilo types II, IIIA and IIIB open tibial fractures managed early with the Ilizarov external fixator (IEF). Sixty patients (51 males, nine females; age range 20–62 years; mean age 32.8 years) with type II (11 patients), type IIIA (13) and type IIIB (36) tibial diaphyseal fractures underwent emergency debridement and minimal bone fixation (with external fixator), followed by definite fixation with the IEF after three to five days. Average duration of the hospital stay was 8.6 days. All fractures united with an average union time of 21.1 weeks (standard deviation [SD] 3.18) in type II, 21.7 weeks (SD 3.57) in IIIA and 24. 9 weeks (SD 5.14) in IIIB fractures. The difference between union time in type II and IIIA was not significant (p > 0.05), but that between IIIA (and also type II) and IIIB was significant (p < 0.05). The healing index in patients who underwent lengthening was 1.5 months/cm. The wounds in 27 patients were managed by delayed primary closure, in 19 patients with second intent (all IIIB), in 11 patients with skin grafting (mostly type IIIB fractures) and in three patients with musculocutaneous flaps. The most common complications of the procedure were pin tract infection and pain at the fracture site. Most of the patients were able to achieve good knee and ankle range of motion. Early application of the Ilizarov fixator constitutes an excellent management of open tibial fractures, especially types II, IIIA and IIIB, due to good functional and radiological results. Despite the technical difficulties and some complications (which are mostly minor) IEF may be the preferred method in open tibial fractures, especially types II and III.

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Conflict of interest

No funds were received directly or indirectly by any of the authors in the funding of this study. No benefits in any form have been received or will be received by us from any commercial party directly or indirectly on the subject of the manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, Government Medical College, Srinagar, India

    Naveed Wani, Khurshid Kangoo & Mohammad Mir

  2. Department of Orthopaedics, SKIMS Medical College, Srinagar, India

    Asif Baba

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  1. Naveed Wani
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  2. Asif Baba
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  3. Khurshid Kangoo
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  4. Mohammad Mir
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Correspondence to Asif Baba.

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Authors’ contribution

ANB is the principal author of the manuscript and was involved in collection of literature and preparing the manuscript. NBW and KAK were responsible for organising the study, collection of data, overall patient care and decision-making. MRM was involved in arranging patient care and proof reading the manuscript.

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Wani, N., Baba, A., Kangoo, K. et al. Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. International Orthopaedics (SICOT) 35, 915–923 (2011). https://doi.org/10.1007/s00264-010-1023-7

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  • DOI: https://doi.org/10.1007/s00264-010-1023-7

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