Middle Term Results of The Ilizarov Type Circular External Fixator Application for The Tibial Diaphyseal Open Fractures

Abstract

Objectives: To assess results of the İlizarov method and İlizarov type circular external fixator for high energy, open tibial diaphysis fractures. Materials and methods: Between June 1998 and January 2002, 56 tibial open fractures of 51 patients aged 17 to 56 (mean 34.2) years underwent İlizarov type circular external fixation. 35 were male and 16 were female. There were 15 Type I, 22 Type II, 13 Type III A and six Type III B open fractures. All Type I ve Type II open fractures were highly contaminated, comminuted, segmented or defective. Results: the mean follow-up period was 94 (range 72-109) months. 52 of 56 tibia healed nonproblematically but four needed bone grafting with a second operation. The mean union time was 19 (range12-43) weeks. Complications consisted often low grade and one deep pin tract infection, two and three cm shortness in two cases. Conclusion: Our study suggests that İlizarov method and İlizarov type circular external fixator is more beneficial than the other alternatives on open tibial diaphyseal fractures with its giving possibility to three dimensional and multi level movement, minor traumatizing feature. ©2008, Firat University, Medical Faculty.

Keywords

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Açık Tibia Cisim Kırıklarının Tedavisinde İlizarov Tipi Sirküler Eksternal Fiksatör Uygulamalarımızın Orta Dönem Sonuçları

Öz

Amaç: İlizarov tipi sirküler eksternal fiksatörün tibia açık kırıklarının tedavisinde etkinliğinin araştırılması. Gereç ve Yöntem: Ankara Numune Eğitim ve Araştırma Hastenesi II. Ortopedi Kliniğinde Haziran 1998 – Ocak 2002 tarihleri arasında 51 hastanın 56 tibia açık kırığı İlizarov tipi sirküler eksternal fiksatör uygulanarak tedavi edildi. Otuz beşi (%68.6) erkek 16'sı (%31.4) bayan olan hastalarımızın yaş ortalaması 34.2 (17-56) idi. Olgularımızın 15'i (%26.8) Tip I, 22'si (%39.3) Tip II, 13'ü (%23.2) Tip III A, altısı (%10.7)Tip III B olarak değerlendirildi. Tip I ve Tip II açık kırıkların hepsi ya çok parçalı ya da aşırı kontamineydi. Değerlendirme Johner – Wrush kriterlerine göre yapıldı Bulgular: Ortalama 94 (72-109) ay izlem sonucunda 52 tibiada tam kaynama elde edildi. Sadece dört hastada ikinci bir operasyonla grefaj uygulanarak kaynama sağlandı. Kaynama süresi ortalama 19 (12–43) hafta idi. Hastaların onunda yüzeyel, birinde derin tel yolu enfeksiyonu gelişti.. Hiçbir hastamızda kozmetik yada fonksiyonel yakınmaya yol açacak açılanma, kısalık, hareket kısıtlılığı olmadı. Sonuç: Açık tibia kırıklarında, özellikle aşırı kontaminasyon, çok parçalanma, segmenter veya defektif olgularda İlizarov tipi sirküler eksternal fiksatör üç boyutlu ve çok seviyeli harekete olanak sağlarken minör travmatizan bir sistem olması nedeniyle avantajlı bir yöntem olarak görülmektedir.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Tibia, açık kırık, sirküler eksternal fiksatör

References

1. Giannoudis PV, Papakostidis C, Kouvidis G, Kanaris NK. The role of plating in the operative treatment of severe open tibial fractures: A systematic review. Int Orthop 2007; Sept 1. [Epub ahead of publication]
2. Court-Brown CM, McBirnie J. The epidemiyoloji of tibial fractures. J Bone Joint Surg 1995; 77(B): 417-421.
3. McKee MD, Yoo DJ, Zdero R, et al. Combined single-stage osseous and soft tissue reconstruction of the tibia with the Ilizarov method and tissue transfer. J Orthop Trauma 2008; 22: 183-189.
4. Gustillo RB, Mendosa RM, Willams DN. Problems in the management of Type III (severe) open fractures: A new classification of Type III open fractures. J Trauma 1984; 24: 742-746.
5. Barei DP, Taitsman LA, Beingessner D, Dunbar RP, Nork SE. Open diaphyseal long bone fractures: A reduction method using devitalized or extruded osseous fragments. J Orthop Trauma 2007; 21: 574-578.
6. Johner R, Wruhs O. Classification of the tibial shaft fractures and correlation with rigid internal fixation. Clin Orthop 1983; 178: 225-231.
7. Kataria H, Sharma N, Kanojia RK. Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg 2007; 15: 137-143.
8. Patzakis MS, Wilkins J, Moore TM. Considerations in reducing the infection rate in open tibial fractures. Clin Orthop Relat Res 1983; 36-41.

9. Olson SA. Open fractures of the tibial shaft. Inst Course Lect 1997; 46: 293-302.
10. Giannoudis PV, Papakostidis C, Roberts C. A review of the management of the of open fractures of the tibia and femur. J Bone Joint Surg 2006; 88B: 281-289.
11. Teilinen L, Lindahl JE, Tukiainen EJ. Acute unreamed intramedullary nailing and soft tissue reconstruction with muscle flaps for the treatment of severe open tibial shaft fractures. Injury 2007; 38: 906-912.
12. Schemitsch EH, Kowalski MJ, Swiontkovoski MF, Horrington RM. Effects of reamed versus unreamed locked nailing on callus blood flow and early strength of union in a fractured sheep tibial model. Orthop Trans 1994; 18: 145-151.
13. Tornetta P III, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of Grade IIIB open tibial fractures: A prospective randomised comparison of external fixation and nonreamed locked nailing. J Bone Joint Surg 1994; 76(B): 13-19.
14. Wu CC, Shih CH. Complicated open fractures of the distal distal tibia treated by secondary interlocking nailing. J Trauma 1993; 34(6): 792-796.
15. Morandi M, Zembo M. The Ilizarov compression-distraction osteosynthesis. A method for infected pseudoartrosis and segmental bone defects. In: D’Ambrossio RD, Mourier RL (Editors). Orthopaedic infections. 1st Ed. New Jersey: Slack Inc 1989; 163-190.
16. Gasser B, Boman B, Wyder D, Schneider E. Stiffness characteristics of the ilizarov circular device as opposed to conventional external fixators. J Biomec Eng 1990; 112: 15-21.
17. İlizarov GA. The treatment of the fractures. In: Ilizarov GA, Green SA (Editors). Transosseous osteosynthesis. 1st Ed. Berlin: Springer-Verlag 1992; 381-400.
18. Paley D. Problems, obstacles and complications of limb lenghtening by Ilizarov technique. Clin Orthop 1990; 250: 81- 104.
19. Ilizarov GA. Clinical application of the tension stres effect for limb lenghtening. Clin Orthop 1990; 250: 8-26.
20. Okike K, Bhattocharya T. Trends in the management of open fractures. A critical analysis. J Bone Joint Surg 2006; 88(A): 2739-2748.
21. Kabul Tarihi:11.11.2008