Introduction: Surgeons treating tibial fractures by the Ilizarov Method are faced with the diagnostic dilemma of determining whether a fracture has united to remove the frame safely.

Methods: Considering frame removal we use three criteria:

Consideration of natural history of the injury – characteristics of the injury and existing knowledge of healing times.

Results: Premature frame removal was identified in 2/106 tibial fractures treated with Ilizarov frames. In both cases subsequent CT scanning identified a healed fibula and stiff non-union of the tibia. In both, original fracture geometry was complex, with fracture lines outwith the planes of radiographic assessment. Timely frame removal in104/106 (98%).

Discussion: In both cases of premature removal the frame was reapplied to achieve union. Premature removal must be balanced against the patient’s desire to have their cumbersome fixator removed at the earliest opportunity.

It is said “It is better to leave a frame on one month too long than to remove it a day too soon”, but this merely emphasises that timing of frame removal remains an art rather than an exact science.

Marsh and Montgomery have previously suggested use of CT scanning to assess union in peri-articular fractures. We recommend that in high energy tibial fractures whose fracture pattern geometry lies outwith the antero-posterior and lateral radiograph views, a CT scan should be considered to detect stiff non-union and avoid premature frame removal.