The use of a low-profile Ilizarov external fixator in the treatment of complex fractures and non-unions of the distal femur

Abstract

The aim of this study was to assess the effectiveness of a modified (low-profile) Ilizarov fixation in the treatment of complex fractures of the distal femur such asseptic or aseptic non-unions following previous surgeries, osteoporotic fractures, and high-grade open fractures. Ten male patients with a mean age of 50 years (range, 22-72 years) were treated with a modified Ilizarov fixator. The system was composed of tensioned olive wires attached to four 5/8 rings (two proximal and two distal to the fracture line) connected to each other with three rods. The fixator was not extended to the proximal femur nor across the knee to the tibia, and no Schanz screws were used. The main outcomes evaluated were union, time in fixator and IOWA knee score. Time in the fixator averaged 158 days (range, 125-180). Mean follow-up was 74 months (range, 24-108 months). All fractures united without major complications. One case healed with a 3 degrees varus angulation at the fracture site. The mean IOWA score was 83.8 (range, 70-98). Although superficial pin-tract infection was observed at 10 pin sites, no patient developed deep infection requiring premature pin removal. There was breakage of one wire, which was replaced under anaesthesia, and one patient presented a patella fracture after a fall, which healed after tension-band wire fixation. Considering the high union and low complication rates, we suggest the use of a low-profile Ilizarov fixator in the management of certain distal femoral fractures and non-unions that may be difficult to manage using other means of fixation.