Forty-two high-energy tibial fractures (18 closed and 24 open) in 41 patients were treated with the Ilizarov apparatus between 1999 and 2004. Open wounds were debrided and tension free primary closure using interrupted nylon sutures was attempted wherever appropriate. In others, either split thickness skin grafting or local gastrocnemius flaps were used. Corticotomy and bone transport was instituted in patients with significant bone loss. Early weight bearing with range of motion exercises of ankle and knee joints were encouraged. Average fracture healing time was 5.3 months (range 3.5 - 8.5 months). Complications included pin site inflammation / infection (40.4 %), muscle transfixation (2 cases), shortening (3 cases), ankle joint stiffness (2 cases) and wire fracture (1 case). Based on Johner and Wruh's Criteria, there were 34 excellent, 6 good, 2 fair, and no poor results. The Ilizarov device provided early and definitive fixation for high-energy tibial fractures with good results. Introduction Fractures of tibia are very common in patients with trauma (1). Their treatment, prognosis, and outcome are mainly determined by the mechanism of injury, degree of resulting comminution, soft tissue injury and displacement (2). Fractures produced by indirect trauma have a better prognosis than those produced by direct trauma (3,4). The risk of delayed union and nonunion in closed (1,4) and open treatment is increased with comminution (5). Open fractures have a higher infection rate than closed fractures (6) and the rate increases with the increasing severity of the soft tissue injury (7,8). Minimally displaced fractures allow more simple treatment than displaced fractures (1). Therefore high-energy injuries have added to the number and complexity of fractures of long bones, especially those of tibia and so have the treatment modalities addressing them. We evaluated the use of Ilizarov device as the initial and definitive mode of fracture stabilization of these fractures. Materials And Methods From 1999 to 2004, 42 high-energy tibial fractures in 41 patients (37 male, 4 female) were treated primarily with Ilizarov apparatus. Grade III open and/or comminuted tibial fractures was the major inclusion criteria. Exclusion criteria included low energy fractures; grade 3C open fractures and patients who found the apparatus aesthetically unacceptable. The mean age was 39.1 years (range, 14-65 years). Road traffic accidents were responsible for majority of cases (33). Three of the fractures were segmental, and 1 was bilateral. Four patients had multiple traumas. There were 18 closed fractures and 24 open fractures. Using the Gustilo and Anderson (8) classification, 4 were Grade I, 3 were Grade II, 8 were Grade IIIA and 9 were Grade IIIB. There were 21 proximal metaphyseal, 17 diaphyseal and 3 distal metaphyseal fractures.Informed consent was obtained in all cases. All open wounds were irrigated copiously with normal saline followed by debridement of all the devitalised bone and soft tissue. Antibiotic treatment was initiated in the emergency room with Cefazolin given intravenously for all open fractures and additional gentamycin for Grade III open fractures. The antibiotics were given for 3 days in type I and II wounds and for 5 days for type III wounds. Tension free primary closure using interrupted nylon sutures was attempted wherever appropriate. If safe closure could not be accomplished, the size of the wound was minimised by mobilization of the adjacent tissues over the bone with or without additional split thickness skin grafting. All the Grade IIIA fractures were closed successfully with no wound complications. Of the Grade IIIB fractures, 2 wounds could be successfully approximated and four cases required a gastrocnemius flap. Two patients with a Grade IIIB comminuted fracture presented late after injury with wound infection. A thorough debridement of all the devitalized bone, soft tissue and the infected material was done with primary
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