The Clinical Effectiveness Of Ilizarov Circular External Fixation In The Treatment Of Tibial Defects After Leg Wound Repaired

Objectives To investigate the clinical effectiveness of Ilizarov circular external fixation in the treatment of tibial defects after leg wound repaired.Methods We retrospective analysised 27 cases who used Ilizarov external fixation technique treat tibial defects after leg wound repaired from February 2009 to October 2014. There were 21 males and 6 females, aged from 16 to 55 years(mean, 32 years). After internal and external fixations of fracture, 19 patients of open fracture(Gustilo type III) had skin necrosis, bone exposure, and infection; after open reduction and internal fixation, 4 patients of closed fracture had skin necrosis and infection; and after limb replantation, 4 patients had bone exposure and limb shortening. Eight cases had limb shortening with an average of 3.5cm(range, 2~5cm) and angular deformity. All patients tibial bone defect with an average 7±2.2cm(range, 3~18cm) after their wound repaired at the first stage. Ilizarov circular external fixator was placed in all cases at 3 months after wound healing; According to the different individuals, 11 cases treated with Shortening-lengthening surgery, 16 cases received limb lengthening orthomorphia while 7 cases received double osteotomy bone transmission,Results All patients were followed up 1~4 years(mean, 1.7 years). Bone defects in 67 cases were rebuilt, a relatively balanced was reached with the normal limb length(abbreviated 2cm), The bone lengthening was 5~21 cm(mean, 9 cm). The time of bone healing and removal of external fixation was 10~39 months(mean, 13.2 months). The healing index was 35~65 days/cm(mean, 45 days/cm). The wounds of all the cases healed well without infection of ulceration. Tibial axial deviation occurred in 3 patients, and corrected after adjusting the external fixation. 3 patients by postoperative pin tract infection healed after dressing changes. Needle stretch induced skin pain in 3 cases, suspended traction 2 to 3 days, until the pain disappears. No neurovascular injury cases. The functions of weight-bearing and walking were recovered; 19 cases had normal gait, and 8 cases had claudication. And comparied between pre-operation and post-operation. Differences were statistically significant(P<0.05), the length of defected tibia and area of defected soft tissues were compared at 1, 3 and 6 months after external fixation and final follow-up. After operation, the ankle joint Kofoed score and knee joint ROM weresignificantly better than those before operation(P<0.05). During final follow-up, According to Johner-Wruth evaluation criteria, the excellent and good rate of each therapeutic plan was 85%. Excellent in 17 cases, Good in 5 cases, Poor in 1 case, the rate of Fracture healing was 81.5%, patients feel satisfactory to the Effect of appearance and function of lower leg.Conclusions For the tibial osteomyelitis bone defect with the merged skin defect, the trauma was small using Ilizarov technique, which can avoid several complicated operations and have a stable fracture fixation, that means patients can be early weightbearing and walk on foot. The treatment of tibial defect by Ilizarov technique is a longterm system which needs the joint efforts between doctors and patients. Doctors should have a well to communication with patients and their families before and after surgery In order to get the patients and their family members understand, prescribed slip and functional exercise can prevent various complications after operation.Although bone formation is slow, treatment time is long, check for many times and high incidence of complications after the treatment of lizarov technique, patients still feel satisfaction with the results.