Outcome of Ilizarov External Fixator for the Treatment of Gap Non-uniting Mid Shaft Tibia-fibula Fractures: Our Experience.

Many patients come with open fracture tibia-fibula initially managed by surgical toileting and the application of indigenous uniaxial external fixator in our country. Many of them lead to non-uniting fracture or sometimes signs of union absent within 4 months from the time of initial fracture and become infected also. This quasi experimental study included 40 skeletally matured patients was conducted from 05 February 2014 to 05 February 2018 in the department of Orthopedics, Mymensingh Medical College Hospital, Mymensigh, Bangladesh. The purpose of this study was to evaluate the efficacy of Ilizarov external fixator for treatment of infected gap non-uniting mid shaft tibia-fibula fracture which was initially open fracture Gustilo II to Gustilo III B. Uniaxial external fixators were replaced by to Ilizarov external fixators which multiaxial. Here male 30(75%), female 10(25%) with mean 28 years of age were analyzed in this study based on the inclusion criteria. Twenty eight (70%) fractures had right tibia-fibula while 12(30%) fracture had involved left tibia-fibula. Twelve (30%) patients had a grade II, grade III A- 18(45%), grade IIIB- 10(25%) open fracture tibia-fibula according to the Gustilo and Anderson classification. Initial mode of injury RTA was 28(70%), fall from height 8(20%), physical assault 4(10%). Mean interval between initial trauma and Ilizarov external fixator application was 4.4 months (ranges 4.2-4.8 months).Union or signs of union achieved in all cases in an average time of 17.12 weeks (range 14-20 weeks). The Ilizarov fixator was kept for an average period of 195 days (range 180-210 days). Minimal follow-up was 9 months after complete frame removal (average: 12 months, range: 9-18 months). Based on ASAMI scoring system, bony and functional results were assessed. The bony results were excellent in 24(60%), good in 12(30%), fair in 4(10%) and the Functional results were excellent in 18(45%), good in 16(40%), fair in 4(10%) and poor in 2(5%). In 16(40%) patients 20 wires had pin tract infection in this series. Most pin-tract infections healed well with regular dressing and oral antibiotics but in 8(20%) patients 8 affected loose wires were exchanged. Limb length discrepancy was 1.5cm in 18(45%) patients and 2.0cm in 22(55%) patients. The small sample sizes and short duration of follow-up were the study limitations. We need a life boat or life jacket during journey. As Orthopeadic Surgeon we are always in danger and Ilizarov method is the life boat technology in orthopedic surgery. It restores bone biology without disturbing the medullary cavity. To avoid repeated surgical intervention and to reduce the cost of treatment, we suggest that gap non-uniting infected tibia-fibula fracture which was primarily open should be fixed by Ilizarov external fixator than continuing treatment with indigenous uniaxial external fixator.