Outcomes of Open Tibial Fracture Treatment Using Ilizarov Fixator and Vacuum-Assisted Wound Closure

Background: Tibial fractures represent the most frequently occurring fractures of long bones. Approximately 25% of tibial fractures are open fractures, and more than 50% are classified as high-energy Gustilo-Anderson type III fractures. The most common cause of open comminuted tibial fractures is high-velocity trauma. The most important goal when managing open tibial fractures is to get adequate stable fractures with clean soft tissue coverage. External fixation can guarantee stable fracture fixation as the metal is fixed to the bone away from the fracture site, which may lessen the risk of devascularization and infection. The Ilizarov ring fixator allows axial micromotion which provides for the union of fractures. It also allows immediate weight bearing. The key drawbacks of the Ilizarov technique include the psychological stress experienced by patients during recovery, the bulky nature of the apparatus, potential joint rigidity, frequent necessity for additional surgical procedures, extended healing times, and the risk of infections at the pin sites. The vacuum-assisted dressing helps eliminate excess interstitial fluid from the wound area, facilitating the care of contaminated injuries, reduces swelling and promotes blood flow, and allows a clean and vascularized wound bed that becomes ready for direct wound suturing or soft tissue coverage with a graft or a flap. This study aims to evaluate the effectiveness of the Ilizarov technique as a definitive treatment for open tibial fractures with vacuum-assisted closure of wounds.Patients and Methods: This prospective study included 14 patients with open fractures of both bones in the legs. The age of the patients ranged from 17 to 50 years with a mean of 34.7 years. There were five females and nine males. All fractures were fixed by Ilizarov. All wounds were covered by vacuum after debridement. Then, after confirmation of the improvement of the soft tissue condition, wounds were closed directly or covered with a skin graft.Results: At the end of the follow-up period, all patients achieved full union according to the Fernandez-Estev grading. According to the ASAMI criteria, six (42.9%) patients achieved excellent results, five (35.7%) patients achieved good results, and three (21.4%) patients achieved fair results. However, no patients had poor results.Conclusions: It is concluded that this study supports the previous series in the literature, which have demonstrated that the Ilizarov technique yields excellent results when used for the management of open comminuted tibial fractures. Vacuum provides very good results when used to manage open or unhealthy wounds, and this supports the previous series in the literature.