Ilizarov external fixation versus plate osteosynthesis in the management of complex extra-articular distal tibial fractures

Abstract

Background: This study aimed to compare Ilizarov external fixation (IE) versus plate osteosynthesis (PO) as a definitive treatment of complex extra-articular distal tibial fractures. Methods: A comparative prospective randomized control study was carried out on series of thirty cases met the inclusion criteria, classified into two equal groups. The 1st one was managed using plate osteosynthesis. The 2nd one was managed using IE. For group A, non-weight bearing ambulation was allowed two days after the surgery while partial weight bearing was allowed depending on the clinical and radiological criteria of the progress in union. Regarding the 2nd group, weight bearing was initiated as tolerated one day after the surgery. the patients carry out their own physiotherapy as well as the pin-site care. Results: According to Ovadia and Beals scoring system objective score in group A (excellent 3, good 8, fair 2, poor 2) while in group B (excellent 8, good 4, fair 2, poor 1) P-value was 0.268083 which is insignificant. Regarding subjective score in group A (excellent 4, good 8, fair 1, poor 2). In group B (excellent 8, good 4, fair 2, poor 1) P-value was 0.34303 which is insignificant. The average time for union was16.69 weeks (range, 14 - 28weeks) in the 1st group and 18.33 weeks (ranging from16 to 26 weeks) in the 2nd group. The results can be considered the same in both groups and many cases showed satisfaction with the outcome. Conclusions: IE and PO are efficient in treating and fixing closed extra articular fractures with no significance except for superficial infection as all patients in group B had pin tract infection while in group A 2 patients had superficial infection which treated successfully with oral antibiotics. Proper handling to soft tissues is pivotal for better healing of the fractures and to prevent complications as well.

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