Acute Trauma Applications of the Ilizarov Method

摘要

Objective: To evaluate the results of treatment of patients with acute trauma of the lower extremities using the Ilizarov technique.Method: Retrospective study of eight patients who were treated between 1999 and 2007 for acute trauma to the lower extremities. There were four Type III pilon fractures, five open wounds, three tibial shaft fractures, one comminuted supracondylar femoral fracture, and one tibial plateau fracture (Schatzker VI).Results: There were seven males and one female with an average age of 49 years (range 25 ? 74 years). Results were classified in Bone and Functional results. There were six excellent, one good and one poor bone result. The functional result was good in four patients, fair in two patients with three ankles (one patient had a bilateral injury), and poor in two patients.Conclusion: The Ilizarov external fixation technique is a valuable tool in the treatment of acute trauma of the lower extremities. Introduction The most important factors influencing the outcome of treatment of long bone fractures are the severity of the soft tissue injury and the degree of skeletal involvement. Although the articular reduction is important, the surgeon should try to limit soft tissue damage and avoid additional complications at the risk of achieving a less than anatomic joint, which may result in a good functional outcome. The Ilizarov method is an excellent alternative to more conventional methods in cases of severe wound contamination and in cases of soft tissue and bone loss (1). The treatment of bone loss occurring as a result of acute trauma has traditionally been a complex surgical problem. In an attempt to avoid the problems associated with deficient graft materials and free tissue transfers, internal bone transport is a technique that has been a successful methodology for bony reconstruction for acute bone loss (2). In addition, the Ilizarov fixator may achieve stability even in cases of bone comminution when internal fixation devices can do no better than tenuous fixation.This article describes the author?s experience with the Ilizarov method for the treatment of patients with acute trauma of the lower extremities. Subjects and Methods Between September 1999 and October 2007 eight patients with acute trauma to the lower extremities were treated by the author. All patients were treated with the Ilizarov technique. The mechanism of the injury was motor vehicle accidents in six patients, a motor cycle accident in one patient and a fall in one patient. Four injuries in three patients were closed, (one patient had bilateral fractures), and five injuries were associated with an open wound. There were four displaced intra-articular fractures of the distal tibia (R?edi and Allg?wer Type III pilon fractures). There were three tibial shaft fractures; one comminuted supracondylar femoral fracture and one tibial plateau fracture (Schatzker VI) (Table 1).