title: The Ilizarov external fixator--a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients.
abstract: BACKGROUND
  In dislocated proximal tibial fractures, the most frequently used treatment is ORIF with screws and plates. Minimally-invasive techniques using external fixation are an alternative. The aim of this study was to analyse the clinical and radiological results using the Ilizarov technique in both uni- and bicondylar tibial fractures.
  
  
  METHODS
  Thirty consecutive patients with isolated fractures of the proximal tibia were treated with the Ilizarov technique, 11 Schatzker I-IV with 2-3 rings and 19 Schatzker V-VI with 3-4 tibial rings and a femoral, hinged, two-ring extension. Unrestricted weight-bearing was allowed. Pre and post-operatively, conventional radiographs, computerized tomography scans, post-operative pain assessments and complications were evaluated. The knee function was evaluated with the EQ-5D, NHP and KOOS scores, as well as self-appraisal.
  
  
  RESULTS
  All the fractures healed. Twenty-five patients achieved a range of motion better than 10-100º. The type I-IV fractures had a shorter operating time and hospital stay, as well as better knee flexion, and the self-appraisal indicated that they tolerated the treatment better. Pin infections occurred in 4% of the pin sites, but only two patients required debridement. Two patients developed compartment syndrome and underwent fasciotomy. No patient complained of functional knee instability. Two patients underwent a total knee arthroplasty because of residual pain. The overall result was judged as satisfactory in twenty-seven patients.
  
  
  CONCLUSIONS
  The Ilizarov method produces a good clinical outcome and is a valuable treatment alternative in proximal tibial fractures of all types.
authors.affiliation: Department of Orthopaedics, Central Hospital (Kärnsjukhuset), Skövde SE-541 85, Sweden. telmo.ramos@vgregion.se
authors.forename: Telmo
authors.initials: T
authors.lastname: Ramos
authors.forename: Carl
authors.initials: C
authors.lastname: Ekholm
authors.forename: Bengt I
authors.initials: BI
authors.lastname: Eriksson
authors.forename: Jón
authors.initials: J
authors.lastname: Karlsson
authors.forename: Lars
authors.initials: L
authors.lastname: Nistor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult