Appraisal of the role of external skeletal fixation in the management of sequelae of open tibial fractures

Background: Severe open tibial fractures are more apt to be followed by complications even with the universally accepted lines of treatment. The present study investigated the role of external skeletal fixation, based on Ilizarov techniques, in the management of the sequelae of open tibial fractures with modifications to meet the requirements of each case. Materials and Methods: We reviewed the results of treatment of 148 cases of late presentation with complicated open tibial fractures. Their ages ranged from 12 to 74 years (average, 34 years). Active infection was present in 40 cases. We performed acute shortening and relengthening in 60 cases; excision of nonunion, acute deformity correction, and lengthening for nonunion with deformity in 30 cases; segmental excision and bone transport in 20 cases; gradual deformity correction after osteotomy in 15 cases; and distraction and gradual deformity correction for hypertrophic nonunion with deformity in 23 cases. Ilizarov external fixator was used in 96 (65%) cases, and monolateral fixator was used in 52 (35%) cases. The mean follow-up was 35 months (range 24 to 118 months). Results: Fracture union was achieved in all cases (100%). Evaluation of results were based on both objective (clinical and radiological) and subjective criteria and patients′ satisfaction. The results were satisfactory in 139 cases (94%) and unsatisfactory in nine (6%) cases because of residual leg length discrepancy, joint stiffness, and persistent pain. Conclusions: The use of external fixation, based on Ilizarov techniques, is invaluable in the management of difficult open tibia fractures. However, the technique should be tailored to the requirements of each case. The functional outcome is predetermined by the soft tissue status before treatment.