Functional outcome analysis of management of compound fractures of tibia with Ilizarov Fixator

Kumaresapathy, S (2008) Functional outcome analysis of management of compound fractures of tibia with Ilizarov Fixator. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Tibia is most frequent site of an open fracture, with incidence ranging from 49.4% to 63.2%. India has the highest road accident rates in the world one of every forty two vehicle in country had met with an accident in 1986. A large proportion of vehicles involved were two wheelers. The lower Limbs are involved in 49.6 % of motor cycle accidents. By its very location the tibia is prone to frequent injuries. Furthermore, the blood supply of the tibia is more precarious, high-energy tibial fractures are associated with compartment syndrome or neural or vascular injuries(27,28). Open fractures have a higher infection rate than closed fractures(21,29) and the rate increases with the increasing severity of the soft tissue injury(25,26).The risk of delayed union and nonunion in closed, and open treatment is increased with comminution. Their treatment, prognosis, and outcome are mainly determined by the mechanism of injury, degree of comminution, soft tissue injury and displacement. AIM OF STUDY: Aim of our study is to highlight the important role of Ilizarov technique in the management of Grossly Comminuted Compound Tibial fracture. Aim of our study is to analyze the result of 20 cases of these complex grossly comminuted compound tibial fractures with Ilizarov technique. MATERIALS AND METHODS: Material consists of 20 cases of compound comminuted tibia using Ilizarov technique at Govt. Royapettah Hospital, Chennai between June 2005 to September 2007. The following types of cases were included 1. Compound diaphyseal fracture comminuted 2. Compound periarticular fracture. 3. Compound tibial plateau fracture 4. Compound metaphyseal fracture with shaft extension. 5. Compound segmental fracture. 6. Compound diaphyseal fracture with bone loss. Over the past 28 months we analyzed the treatment of 20 cases of compound tibial comminuted fracture using Ilizarov technique. METHODS: Frame Construction. Two half rings are selected that are 2-3 cm larger than the major diameter of the injured limb. The rings are positioned in the same plane and a bolt and nut anchor together at both ends of the half rings. Typically, a 4 ring assembly is required with 2 rings proximal and distal to fracture site. Two rings are used on large fragments. Ring & drop post used for smaller fragments. Two proximal & distal rings are connected via two rods of appropriate length . RESULTS: In our study, 20 cases were followed up until union and for further period till date. Patients were assessed for pain and functional limitations, and examined for angular and rotational mal-alignment and range of motion. Leg lengths were measured clinically. Pin tract infection occurred in 4 (20%) of cases. 2 resolved by systemic antibiotics for 5 days, in another one, soft tissue release around the offending wire was done and in one the wires had to be completely removed and reapplied. 2 (10%) patients had an angulation of 10° at the fracture site, and 4 (20%) had shortening between 1-2 cms of the fractured leg. Knee and ankle range of motion was satisfactory in almost all cases. There were no cases of osteomyelitis or neurologic or vascular complications among these patients. CONCLUSION: From our study of 20 cases of management of compound comminuted fracture tibia with Ilizarov technique, we conclude that Ilizarov technique has a definite role in the management of fracture tibia like 1. Open comminuted fracture: Open segmental fracture, Open fracture with bone loss, Open complex fracture. 2. It reduces hospital stay, 3. Full functional recovery, 4. Early weight bearing, 5. Gives definite union. To date we have not had any significant complication with Ilizarov method. Pain during treatment and acceptance of apparatus were two important subjective problems encountered in our experiences. The usage of Ilizarov apparatus provides definitive fixation for highenergy tibial fractures. Early weight bearing even in severely comminuted fractures is the key factor that separates it from other methods of fixation. It promotes early functional recovery, eliminating fracture disease. Dynamisation and correction of deformities in any plane is easily accomplished. Frame constructs could be modified to facilitate wound cover and access. Therefore it lends the much-needed flexibility in complex fractures

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional outcome analysis ; management ; compound fractures ; tibia ; Ilizarov Fixator.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 17:59
Last Modified: 17 Sep 2017 15:13

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