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. 2024 May-Jun;44(3):146-152.
doi: 10.5144/0256-4947.2024.146. Epub 2024 Jun 6.

Radiographic and functional results of Ilizarov fixation in the management of nonunion of tibia and femur fractures: a retrospective case series

Mohamed A A Ibrahim  1 , Khalid M Alhomayani  2 , Usama Gaber  1 , Hashem A Bukhary  2 , Samir A Nematallah  1 , Mostafa M Elgahel  1
Affiliations

Radiographic and functional results of Ilizarov fixation in the management of nonunion of tibia and femur fractures: a retrospective case series

Mohamed A A Ibrahim et al. Ann Saudi Med. 2024 May-Jun.

Abstract

Background: Femoral and tibial fractures may result in delayed union and nonunion, posing significant challenges in orthopedic practice. The Ilizarov technique has emerged as a promising solution for managing these complex cases.

Objectives: Evaluate the radiographic and functional results of Ilizarov fixation in the treatment of nonunion of tibia and femur fractures.

Design: Retrospective.

Settings: Hospitals affiliated with a university hospital.

Patients and methods: Patient demographics, fracture characteristics, and treatment details were analyzed for the period from October 2015 to September 2022 in patients who were treated for nonunion of the tibia and femur using the Ilizarov fixator. Clinical and radiological assessments were performed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. The study focused on assessing the average duration for union and frame removal, bone results, successful union rates, and functional results using the ASAMI criteria, obtaining data from the existing medical records, spanning various medical facilities treating nonunion fractures.

Sample size: 126 patients.

Results: The average duration for union and frame removal was 8 months, with excellent bone results observed in 60.32% of cases. Out of 126 patients, 118 achieved successful union, while there were 2 failure cases necessitating amputation (1.52%). Functional results revealed excellent outcomes in 39.68% of cases. Complications included pin tract infections, ankle and knee stiffness, and limb shortening. External fixation duration and infection eradication were consistent with previous research, emphasizing the technique's effectiveness.

Conclusions: The Ilizarov technique proved highly effective in managing nonunion tibia and femur fractures, offering favorable outcomes in terms of union, infection control, pain relief, and functional recovery. While excellent bone outcomes do not guarantee optimal function, this method remains a reliable approach for complex cases.

Limitations: Potential biases inherent in retrospective analyses and the need for further randomized controlled trials to comprehensively compare treatment modalities.

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Conflict of interest statement

CONFLICT OF INTEREST: None.

Figures

Figure 1.
Figure 1.
Radiograph demonstrating the initial management of a Gustilo-Anderson type 2 open fracture of the left distal tibia, utilizing an external fixator for the tibia fracture and a plate for the distal fibula.
Figure 2.
Figure 2.
Radiograph showing the management after one month, with removal of the external fixator and subsequent intramedullary nailing.
Figure 3.
Figure 3.
Clinical image depicting varus angulation and recurvatum deformity following revision surgery with placement of a plate and autogenous bone graft.
Figure 4.
Figure 4.
Radiograph illustrating the application of the Ilizarov technique following removal of the plate due to persistent complications.
Figure 5.
Figure 5.
Radiograph demonstrating union of the fracture, successful eradication of infection, and significant correction of deformity after 5 months.
See this image and copyright information in PMC

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