We treated 60 patients with type III Pilon fractures (Ruedi and Allgower Classification) between 1996 and 2005. The fractures were distracted and then fixed with an Ilizarov circular ring fixator, without the use of open surgery. No internal fixation was used for the tibia or fibula. No bone grafting was performed.

The average time from injury to frame application was four days. The patient stayed ib frame for a mean time of 15 weeks. No second operative procedure was needed. All cases united in good alignment.

The patients were reviewed from ten years to nine months after frame removal. Four separate evaluations were performed (functional, objective, radiological and an SF-36). The function and the range of movement were better than the radiological assessment suggested.

This method of treatment gives better results with fewer complications than open surgery with internal fixation

Purpose of Study We present a method of treating these infected humeral shaft non-unions with an open debridement procedure followed by stabilisation with the Ilizarov frame.

Materials Thirteen infected non-unions of the humerus in adult patients have been treated by this method. Ten patients have completed their treatment and three are still undergoing treatment.

The site of the non-union is approached through the pre-existing scar and any remaining metalwork is removed. The ends of the non-union are mobilised and bone is resected from both ends until there is fresh bleeding. The two bone ends are fashioned such that one will fit as a spike inside the medullary cavity of the other. The bone ends are held in position with two temporary K wires until the frame has been applied.

A standard four ring Ilizarov frame is applied with Rancho pins in the proximal humerus and a half ring in the distal humerus. The temporary K wires are removed and the frame is compressed to increase the contact between the bone ends. The routine hospital stay is one week and the patients are given intravenous antibiotics throughout their admission.

They are reviewed in the outpatient clinic at monthly intervals and the frame is used to compress the bone ends by two to three millimetres on each visit. When there are radiographic signs of union the frame is removed under a general anaesthetic.

Results Nine of the ten patients who have completed their treatment have gone on to union in a mean of 8.25 months with a good functional result. Unfortunately three patients had transient radial nerve palsies.

Conclusions This technique has achieved union and eradication of infection in nine out of ten patients in whom all other forms of treatment had failed.

Non-unions of the supracondylar area of the humerus are uncommon but they produce profound functional disability. We have successfully treated a series of these non-unions surgically using the Coventry hip screw. This is a large metaphyseal screw which is applied through both humeral condyles and then compressed on to a single 4. 5mm narrow tibial plate applied to the lateral aspect of the humeral shaft.

Between 1993 and 2000 we operated on thirteen consecutive patients aged 20 to 81 years (mean age 51 years). All the patients had a severe functional disability. The mean time to surgery was 23 months following their accidents. The average follow up was 16 months (range 8–18 months). All but two of the thirteen patients went on to bony union. The mean time to radiological union was six months (2 to 12 months). The mean arc of flexion doubled to 90 degrees.

Until now, the recommended operative technique for stabilisation of non-unions of the distal humerus is identical to that described for primary fracture repair, and involves fixation with two 3. 5 mm plates at 90 degrees. In our experience, this was the technique usually used at the initial operation/s, and is therefore likely to fail again. This correlates with the reported 6–12% non-union rate in the literature. In this series, stable fixation was achieved by using the Coventry hip screw.

This paper describes the outcome of type III pilon fractures of the distal tibia treated primarily with an Ilizarov ring fixator.

Only patients with an intra-articular fracture of the tibial plafond on plainradiographs that corresponded to type III pattern with the system of Rfiedi andAllgower were included.

There were thirteen patients with a mean age of 45 (range 29–65), twelve males and one female. The mechanism of injury in all the patients was high-speed road traffic accident.

Operative fixation consisted of fracture reduction and stabilisation using the llizarov circular frame external fixator and olive tipped wires. Further insult to the already damaged soft tissues was avoided.

Bony union was achieved in all cases. Treatment in the frame lasted between 3 and 10 months (average 6. 3 months). Neither deep infection nor soft tissue complications occurred.

Outcome measurements included the Olerud ankle score, modified Ovadia and Beals radiological criteria, and the SF-36 Health Questionnaire.

Wound and deep infections were successfully avoided and bony union was achieved in all our patients. This compares well with other fixation techniques. The use of the llizarov circular frame external fixator without any additional internal reduction or fixation procedures is a definite option for the treatment of these high-energy injuries.