Pilon fractures are complex, high-energy, intra-articular fractures of the distal tibia. Achieving good outcomes is challenging due to fracture complexity and extensive soft tissue damage. The purpose of this study was to determine the long-term functional and clinical outcomes of definitive management with fine wire Ilizarov fixation for closed pilon fractures. 185 patients treated over a 14-year period (2004–2018) were included. All patients had Ilizarov frames applied to restore mechanical axis and fine wires to control periarticular fragments. CT scans were performed post operatively to confirm satisfactory restoration of the articular surface. All frames were dynamized prior to removal. Patients' functional outcome was assessed using the validated Chertsey Outcome Score for Trauma (“COST”). Review of clinical notes and imaging was used to determine complications and time to union.Introduction
Materials and Methods
Shear plane non unions: biomechanical study and clinical application using an all wire Illizarov frame. 60 degree osteotomy of plastic tibiae were stabilised using four different Ilizarov frame configurations. Models were loaded and shear displacement measured at the fracture site. The optimum frame design was identified and used in clinical practice. The transfracture locked olive wire frame model offered the least displacement in the experimental model This frame model was used in two patients with shear plane non unions and both healed satisfactorily Both displacements had previously failed to unite with standard frame constructs. Transfracture locked olive wire frame design is useful in the treatment of tibial non unions with shear plane.
The purpose of this study was to review the long term functional results of patients undergoing treatment for high energy tibial plateau fractures. Between January 1994 and June 2013 our unit managed 105 high energy tibial plateau fractures (Schatzker IV-VI) with an Ilizarov frame. All cases were treated via ligamentotaxis and percutaneous fine wire fixation or with a limited open reduction of the joint surface. A retrospective analysis of all patients that have undergone Ilizarov fixation of a tibial plateau fracture was performed with radiological and clinical functional outcome measurements. We analysed 105 patients with a mean follow up of 93.5 months (range 5–200). The patient group had an average age of 49 years (range 15–87) with 62 patients being male. Fracture pattern was analysed with Schatzker's classification showing 18 type IV, 10 type V and 77 type VI tibial plateau fractures. All fractures had an average time to union of 145 days. Patients had and average range of movement of 117 degrees. Patients undergoing Ilizarov treatment for high energy tibial plateau fractures achieve successful results long term. Definitive treatment should be decided with respect to fracture pattern and the soft tissue envelope. The management aim should be to achieve anatomical reduction and stable fixation to enable early mobilization. Our study confirms the good functional outcomes and low morbidity that can be achieved in high energy fractures treated with Ilizarov fixation.
The purpose of this study was to assess the impact of Ilizarov frame fixation and total contact casting on the complications of Charcot arthropathy. The diabetic charcot foot or ankle is a potentially limb threatening disorder. This progressive disorder is characterised by osteopenia, bone fragmentation and joint subluxation. The risk of significant deformity and osteomyelitis lead to high rates of amputation in these patients. We analysed patients with acute charcot arthropathy attending the Rowley Bristow Unit between 2008 and 2012. We assessed 48 patients with a mean age of 59 years. Mean follow up was 24 months. 12 patients were managed with Ilizarov frame fixation and 36 using total contact casting. The duration of management was determined using serial infrared temperature monitoring to ensure the temperature of the limb normalised before patients were deemed safe to remove their immobilisation. The mean duration of Iliazarov frame fixation was 6.2 months and 5.3 months duration for total contact casting. In the Ilizarov group pin site infections were common and treated with a short course of antibiotics. In total one patient required below knee amputation following Ilizarov frame fixation. No patients suffered with osteomyelitis. We feel that prompt management of acute charcot arthropathy with either total contact casting where appropriate or Ilizarov frame fixation can reduce serious complications of this disorder.
Currently the debate continues in definitive fixation method for complex tibial plateau fractures. The aim of surgical management remains prevention of further damage to the articular cartilage, whilst avoiding iatrogenic risks - Low Risk Surgery (LRS). The purpose of this study was to determine the functional impact, clinical radiological outcome following tibial plateau fractures treated with either external fixation or internal fixation. 124 Schatzker IV-VI tibial plateau fractures were reviewed following surgical fixation. Fractures analysed included 24 type IV, 20 type V and 80 type VI tibial plateau fractures. The majority of Schatzker IV fractures were treated with internal fixation, but 67 of 80 Schatzker VI fractures were treated with the Ilizarov method. The average IOWA knee score, was 86 (16 to 100) and the average range of motion was 133 degrees (60 to 150). There were no differences between the circular fixator group and the internal fixation group in terms of range of motion or IOWA scores. There were comparable functional outcomes and complication rates between both groups. In summary patients with high energy tibial plateau fracture treated with internal or external fixation, have a good chance of achieving satisfactory long term knee function.
We report our experience of a humanitarian mission to treat the earthquake victims of October 2005 in Pakistan. The team with their equipment, in two periods of four and ten days respectively, treated 26 fractures in 25 patients with the Ilizarov frame and principles. There were 21 III B open fractures and three Tscherne III closed fractures. Seventeen fractures were infected with discharging pus and non-viable bone. Injuries were treated aggressively using different Ilizarov techniques of reconstruction surgery. All but two open fractures required a plastic surgical procedure for wound cover. Three months post-operatively eight out of thirteen fractures which had been treated in the first four days of the visit were healed and corticotomy for bone lengthening, performed during the second 10 days period visit. All wounds have remained clean with no evidence of superficial or deep infection. Limb lengthening procedures are planned for the rest of the patients.
