Open tibial fractures

Open tibial fractures are both common and may be fraught with complications. Malunion, delayed union, nonunion, and infection are all seen regularly after open tibia fractures . The subcutaneous location of the tibia places the leg at risk for skin loss at the time of fracture. Delay in closure of open tibia wounds has been associated with an increased prevalence of late infection. With any exposed tendon or bone, wound coverage becomes a necessity.

Ilizarov External Fixator

The Ilizarov external fixator has long been established as an effective tool for treating difficult tibia fractures and it may prove to equally effective in dealing with the soft tissue aspect of these injuries. Utilizing com- pression at the fracture site will not only promote bone healing, but may allow closure of wounds that previously required flap coverage or amputation.

Functions of Ilizanov Fixator

Metaphyseal fractures with significant shaft extension and fractures with short periarticular fragments are examples of situations in which an Ilizarov frame is frequently employed.With comminuted, open fractures of the distal third of the tibia open reduction internal fixation and intramedullary nailing may have a limited role. With these fractures, Ilizarov external fixation may be used to achieve fracture union as well as wound closure. New methods employing the Ilizarov technique may provide distinct advantages regarding the soft tissues. These advantages may include fewer indications for rotational and free flap wound coverage, less need for amputation, fewer infections, and shorter treatment time. In addition the surgery is performed using percutaneous technique with limited exposure to minimize soft tissue trauma. Postoperatively the frame allows adjustability as well early weight bearing through axially dynamized stable fixation

The bone and soft tissue defect is treated with compression and shortening at the injury site with a synchronized distraction and lengthening at a level outside the zone of injury. This technique achieves union while simultaneously treating any preexisting or iatrogenic limb length discrepancy. A low energy percutaneous osteotomy is performed in the proximal metaphysis of the tibia. Compression and shortening are employed at the fracture/wound while simultaneous distraction and lengthening of the osteotomy occurs. The tibial wound may be closed acutely or subacutely with the aid of the compression that is occurring at the fracture site.

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