International Orthopaedics

, Volume 35, Issue 6, pp 915–923 | Cite as

Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures

  • Naveed Wani
  • Asif Baba
  • Khurshid Kangoo
  • Mohammad Mir
Original Paper


We evaluated the results of patients with Gustilo types II, IIIA and IIIB open tibial fractures managed early with the Ilizarov external fixator (IEF). Sixty patients (51 males, nine females; age range 20–62 years; mean age 32.8 years) with type II (11 patients), type IIIA (13) and type IIIB (36) tibial diaphyseal fractures underwent emergency debridement and minimal bone fixation (with external fixator), followed by definite fixation with the IEF after three to five days. Average duration of the hospital stay was 8.6 days. All fractures united with an average union time of 21.1 weeks (standard deviation [SD] 3.18) in type II, 21.7 weeks (SD 3.57) in IIIA and 24. 9 weeks (SD 5.14) in IIIB fractures. The difference between union time in type II and IIIA was not significant (p > 0.05), but that between IIIA (and also type II) and IIIB was significant (p < 0.05). The healing index in patients who underwent lengthening was 1.5 months/cm. The wounds in 27 patients were managed by delayed primary closure, in 19 patients with second intent (all IIIB), in 11 patients with skin grafting (mostly type IIIB fractures) and in three patients with musculocutaneous flaps. The most common complications of the procedure were pin tract infection and pain at the fracture site. Most of the patients were able to achieve good knee and ankle range of motion. Early application of the Ilizarov fixator constitutes an excellent management of open tibial fractures, especially types II, IIIA and IIIB, due to good functional and radiological results. Despite the technical difficulties and some complications (which are mostly minor) IEF may be the preferred method in open tibial fractures, especially types II and III.


  1. 1.
    Nicol SA (1974) Closed and open management of tibial fractures. Clin Orthop Relat Res 105:144–153CrossRefGoogle Scholar
  2. 2.
    Gustilo RB, Markow RL, Templeman D (1990) Current concept review: the management of open fractures. J Bone Joint Surg Am 72:299–303PubMedGoogle Scholar
  3. 3.
    Bilat C, Leutenegger A, Ruedi T (1994) Osteosynthesis of 245 tibial fractures, early and late complications. Injury 25:349–358PubMedCrossRefGoogle Scholar
  4. 4.
    Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746PubMedCrossRefGoogle Scholar
  5. 5.
    Tucker HL, Kendra JC, Kinnebrew TE (1992) Management of unstable open and closed fractures using the Ilizarov method. Clin Orthop 280:125–135PubMedGoogle Scholar
  6. 6.
    Court-Brown CM, Rimmer S, Prakash U et al (1998) The epidemiology of open long bone fractures. Injury 29:529–534PubMedCrossRefGoogle Scholar
  7. 7.
    Esterhai JL, Queenan J (1991) Management of soft tissue wounds associated with type III open fractures. Orthop Clin North Am 22:427–432PubMedGoogle Scholar
  8. 8.
    Giannoudis PV, Papakostidis C, Kouvidis G, Kanakaris NK (2009) The role of plating in the operative treatment of severe open tibial fractures: a systematic review. Int Orthop 33(1):19–26PubMedCrossRefGoogle Scholar
  9. 9.
    Bach AW, Hansen ST Jr (1989) Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthop Relat Res 241:89–94PubMedGoogle Scholar
  10. 10.
    Papaioannou N, Mastrokalos D, Papagelopoulos PJ et al (2001) Non-union after primary treatment of tibia fractures with external fixation. Eur J Orthop Surg Trauma 11:231–235CrossRefGoogle Scholar
  11. 11.
    Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC (2000) A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma 14:187–193PubMedCrossRefGoogle Scholar
  12. 12.
    Hupel TM, Weinberg JA, Aksenov SA, Schemitsch EH (2001) Effect of unreamed, limited reamed and standard reamed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma 15:18–27PubMedCrossRefGoogle Scholar
  13. 13.
    Kuhn S, Hansen M, Rommens PM (2007) Extending the indication of intramedullary nailing of tibial fractures. Eur J Trauma Emerg Surg 2:159–168CrossRefGoogle Scholar
  14. 14.
    Maurer DJ, Merkow RL, Gustilo RB (1989) Infection after intramedullary nailing of severe open tibial fractures initially treated with external fixation. J Bone Joint Surg Am 71(6):835–838PubMedGoogle Scholar
  15. 15.
    Joshi D, Ahmed A, Krishna L, Lal Y (2004) Unreamed interlocking nailing in open fractures of tibia. J Orthop Surg 12(2):216–221Google Scholar
  16. 16.
    Lalit M, Manish C, Jashan V, Kapoor S, Mehtani A, Dhaon BK (2000) The Ilizarov method in infected non-union of fractures. Injury 31(7):509–517CrossRefGoogle Scholar
  17. 17.
    Ilizarov GA (1989) Experimental studies of bone elongation. In: Coombs R, Green S, Sarmiento A (eds) External fixation and functional bracing. Orthotext, London, p 375Google Scholar
  18. 18.
    Hosny G, Fadel M (2003) Ilizarov external fixator for open fractures of the tibial shaft. Int Orthop 27(5):303–306PubMedCrossRefGoogle Scholar
  19. 19.
    Sidharthan S, Sujith A, Rathod AK, Pathak RH (2005) Management of high energy tibial fractures using the Ilizarov apparatus. Internet J Orthop Surg 2(2)Google Scholar
  20. 20.
    Ziran BH, Darowish M, Klatt BA, Agudelo JF, Smith WR (2004) Intramedullary nailing in open tibia fractures: a comparison of two techniques. Int Orthop 28(4):235–238PubMedCrossRefGoogle Scholar
  21. 21.
    Inan M, Tuncel M, Karaoğlu S, Halici M (2002) Treatment of type II and III open tibial fractures with Ilizarov external fixation. Acta Orthop Traumatol Turc 36(5):390–396PubMedGoogle Scholar
  22. 22.
    Dagher F, Roukoz S (1991) Compound tibial fractures with bone loss treated by Ilizarov technique. J Bone Joint Surg Br 73:316–321PubMedGoogle Scholar
  23. 23.
    Dendrios GK, Kontos S, Cyritsis E (1995) Use of Ilizarov technique for non-union of tibia associated with infection. J Bone Joint Surg Am 77(6):835–846Google Scholar
  24. 24.
    Cierny G, Byrd HS, Jones RE (1983) Primary versus delayed soft-tissue coverage for severe open tibial shaft fractures. Clin Orthop 178:54–63PubMedGoogle Scholar
  25. 25.
    Shtarker H, David R, Stolero J, Grimberg B, Soundry M (1997) Treatment of open tibial fractures with primary suture and Ilizarov fixation. Clin Orthop 335:268–274PubMedGoogle Scholar
  26. 26.
    Delong WG Jr, Born CT, Wei SY, Petrik ME, Ponzio R, Schwab CW (1999) Aggressive treatment of 119 open fracture wounds. J Trauma 46:1049–1054PubMedCrossRefGoogle Scholar
  27. 27.
    Olson SA, Finkemeier CG, Moehring HD (2001) Open fractures. In: Bucholz RW, Heckman JD (eds). Rockwood and Green’s fractures in adults, 5th edn. Lippincott Williams & Wilkins, pp 285–318Google Scholar
  28. 28.
    Thayur RM, Balasundaram R, Manjunath KS et al (2008) Outcomes of Ilizarov ring fixation in recalcitrant infected tibial non-unions—a prospective study. J Trauma Manag Outcomes 2:6. doi:10.1186/1752-2897-2-6 CrossRefGoogle Scholar
  29. 29.
    Inan M, Halici M, Ayan I, Tuncel M, Karaoglu S (2007) Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing. Arch Orthop Trauma Surg 127(8):617–623PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Naveed Wani
    • 1
  • Asif Baba
    • 2
  • Khurshid Kangoo
    • 1
  • Mohammad Mir
    • 1
  1. 1.Department of OrthopedicsGovernment Medical CollegeSrinagarIndia
  2. 2.Department of OrthopaedicsSKIMS Medical CollegeSrinagarIndia

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