Abstract
BACKGROUND: Ilizarov external fixator is now considered a suitable alternate treatment modalityfor
treatment of complex tibial pilon fractures with questionable soft tissue integrity; it allows early weight
bearing without jeopardizing the fracture stability and bone healing.
OBJECTIVE: The purpose of study was to evaluate clinico-radiological outcome and morbidity of the
llizarov external fixator used for fixation of complex tibial pilon fractures.
METHODS: This retrospective analytic cross-sectional study was conducted at Orthopaedic Surgery
department, Dow Medical College / Dr Ruth Pfau Civil Hospital Karachi, from June 2014 to May 2017. A
total of 17 consecutive patients with complex tibial pilon fracture (AO type 43C) operated with Ilizarov
external fixator technique were evaluated functionally by using the American Orthopaedic Foot and
Ankle Society scoring system (AOFAS) and radio-logically for fracture union (delayed, nonunion) after a
mean followup of 6 months. Post-surgical complications were noted. Polytrauma patients with additional
fracture in pelvis and spine, pathological fracture, delayed presentation (> 2 weeks) and AO type 43A &
B were excluded from the study.
RESULTS: Total 17 patients (29.4% female and 70.6% male) with mean age 28 years (range, 1/7 - 48 years)
were analyzed in this study. 11 (64.7%) fractures had left ankle while 6 (35.2%) fractures had right ankle
involvement. The minimum follow-up was 3 months after complete frame removal. According to AO
classification, C1 in 9 cases, C2 in 3 cases and C3 in 5 cases. All fractures were united in average 14.6
weeks (range 10-28 weeks). According to AOFAS scoring system, the final functional results were
excellent in 5 (29.4%), good in 10 (58.8%) and fair in 2 (11.7%). There were 82.3% pin tract infections in
this series. Ankle joint arthritis was noted in five patients. We had no instance of postoperative deep
infection and neurovascular complications due to Ilizarov fixation.
CONCLUSIONS: The Ilizarov ring fixator is a minimal invasive procedure that offers biological
advantages and is a suitable alternate for treatment of complex tibial pilon fractures with questionable
soft tissue integrity providing fracture healing, rapid functional recovery, and avoidance of major
complications associated with extensive operative dissection needed with plate osteosynthesis.
Mehtab Ahmed Pirwani, Jagdesh Kumar, Muhammad Soughat Katto, Nusrat Rasheed, Badaruddin Sahito, Ghulam Mustafa Kiam Khani. (2018) Evaluation of Complex Tibial Pilon Fractures Treated with Ilizarov External Fixator, Journal of Liaquat University of Medical and Health Sciences, Volume-17, Issue-2.
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