We report on the use of the Ilizarov method to treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and five AO 42B3 fractures) in adults. There were 28 men and 12 women with a mean age of 43 years (19 to 81). The series included 19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21 closed injuries. The mean time from injury to application of definitive Ilizarov frame was eight days (0 to 35) with 36 fractures successfully uniting without the need for any bone-stimulating procedure. The four remaining patients with nonunion healed with a second frame. There were no amputations and no deep infections. None required intervention for malunion. The total time to healing was calculated from date of injury to removal of the frame, with a median of 166 days (mean 187, (87 to 370)). Minor complications included snapped wires in two patients and minor pin-site infections treated with oral antibiotics in nine patients (23%). Clinical scores were available for 32 of the 40 patients at a median of 55 months (mean 62, (26 to 99)) post-injury, with ‘good’ Olerud and Molander ankle scores (median 80, mean 75, (10 to 100)), ‘excellent’ Lysholm knee scores (median 97, mean 88, (29 to 100)), a median Tegner activity score of 4 (mean 4, (0 to 9)) (comparable to ‘moderately heavy labour / cycling and jogging’) and Short Form-12 scores that exceeded the mean of the population as a whole (median physical component score 55 (mean 51, (20 to 64)), median mental component score 57 (mean 53, (21 to 62)). In conclusion, the Ilizarov method is a safe and reliable way of treating complex tibial shaft fractures with a high rate of primary union.

Introduction: Complex tibial diaphyseal fractures are rare injuries and can present significant challenges to the surgeon. Successful fixation and subsequent union can be difficult to achieve due to the relatively poor blood supply of the tibia and extent of soft tissue injury. This study describes our early experience of treating eighteen patients with these injuries by the Ilizarov method.

Methods: Patients were prospectively identified. Follow up was performed in the out-patient clinic and by notes review. Fractures were classified using the AO classification. Bony union was evaluated on both a clinical and radiological basis, which included remodelling bone trabeculae on two radiographs and ability to weight bear without discomfort or walking aids on a dynamised frame. The mean patient age was 38 years with a male: female ratio of 12:6. Of the eighteen patients four had concomitant injuries.

Results: There were four 42-B3 type fractures, seven 42-C1 and seven 42-C3. Ten were open (eight IIIB, two IIIA) and eight closed. We identified two groups: closed fractures and open fractures. The mean time to union in the closed group was 149 days (21 weeks) and 186 days (27 weeks) in the open group. There was one hypertrophic non union requiring further surgery using the Ilizarov method. Six patients had an episode of superficial pin site infection, all of which settled with oral antibiotic therapy. There was no deep sepsis. No patients required bone grafting.

Conclusion: The Ilizarov method offers safe, reliable and rapid healing for both closed and open complex tibial diaphyseal fractures. These early results demonstrate improvements in union times and complication rates when compared with similar injuries treated by internal fixation.