Aim and background: A systemic method for the application of Ilizarov fixators and on-table fracture reduction is described in this instructional article. This technique has been developed from the unit's practice in adult patients. The indications, underlying principles and rationale for the method are also discussed.
Technique: The basic concept involves the construction of a series of concentric, colinear rings aligned with the mechanical axis of the limb. An orthogonal ring block is initially placed on the proximal segment and extended distally. Wire to ring reduction techniques are used resulting in the contact, alignment and stability required for early full weight-bearing, free movement of knee and ankle, and subsequent healing.
Conclusion and clinical significance: Our step-by-step guide takes the reader through a systematic approach to surgery along with tips and tricks on how to achieve reduction and avoid the common pitfalls. With this method, it is possible to achieve an on-table reduction and correction of a multiplanar deformity without the use of expensive hexapod technology. This may allow less experienced users reproduce the technique with a shorter learning curve.
Mooney J, Hennrikus W, Flynn JM, et al. Rockwood and Wilkins’ fractures in children. 8th ed. vol. 1. Wolters Kluwer; 2015.
Foster PA, Barton SB, Jones SC, et al. The treatment of complex tibial shaft fractures by the Ilizarov method. J Bone Jt Surg Br 2012;94(12):1678–1683. DOI: 10.1302/0301-620X.94B12.29266.
Harwood P, Taylor DM. Segmental tibia shaft fractures – extra articular ilizarov reduction techniques. In: Giannoudis P, editor. Fracture reduction and fixation techniques. Cham: Springer International Publishing; 2020. p. 351–371.
Giannoudis V, Ewins E, Foster P, et al. Clinical and functional outcome following distal tibia fracture treated by circular external fixation. Orthop Proc 2017;99-B(SUPP_13):16. doi/abs/10.1302/1358-992x.99BSUPP_13.BLRS2017-016
BOA. Trauma BOASTs [Internet]. Available from: https://www.boa.ac.uk/standards-guidance/boasts/trauma-boasts.html.
BOA/BAPRAS. The management of severe open lower limb fractures; 2009. Available from: https://www.boa.ac.uk/wp-content/uploads/2014/05/BOAST-4-The-Management-of-Sever-Open-Lower-Limb-Fractures.pdf.
Brzobohatá H, Krajíček V, Velemínský P, et al. Three-dimensional geometry of human tibial anterior curvature in chronologically distinct population samples of Central Europeans (2900 BC – 21st century AD). Sci Rep 2019;9(1):4234. DOI: 10.1038/s41598-019-40625-3.
Timms A, Vincent M, Santy-Tomlinson J, et al. Guidance on pin site care. Royal College of Nursing; 2011. Available from: https://www2.rcn.org.uk/__data/assets/pdf_file/0009/413982/004137.pdf.
Catagni MA. Atlas for the insertion of transosseus wires and half-pins. North. 2003.
Nayagam S. Safe corridors in external fixation: the lower leg (tibia, fibula, hindfoot and forefoot). Strateg Trauma Limb Reconstr 2007;2(2–3):105–110. DOI: 10.1007/s11751-007-0023-7.
Henderson DJ, Rushbrook JL, Stewart TD, et al. What are the biomechanical effects of half-pin and fine-wire configurations on fracture site movement in circular frames? Clin Orthop Relat Res 2016;474(4):1041–1049. DOI: 10.1007/s11999-015-4652-8.
Messner J, Johnson L, Taylor DM, et al. Treatment and functional outcomes of complex tibial fractures in children and adolescents using the Ilizarov method. Bone Joint J 2018;100-B(3):396–403. DOI: 10.1302/0301-620X.100B3.BJJ-2017-0863.R1.
Johnson L, Messner J, Igoe EJ, et al. Quality of life and post-traumatic stress symptoms in paediatric patients with tibial fractures during treatment with cast or Ilizarov frame. Injury 2020;51(2):199–206. DOI: 10.1016/j.injury.2019.10.077.