Effectiveness and risks of external fixation in fractures of the tibia: a meta-analysis of the Ilizarov and Taylor methods

Background. Fractures of the tibia remain one of the most common and at the same time most complex injuries of the musculoskeletal system. Their treatment is often complicated by significant soft tissue damage, open wounds, instability of fragments, and the risk of infectious complications. In such cases, external fixation methods are an important stabilizing tool that allows control over the position of fragments with minimal invasiveness. Among the main methods for external fixation in the treatment of tibial fractures, the classic Ilizarov apparatus and modern hexapod systems, such as the Taylor spatial frame (TSF), are most widely used. The purpose was to conduct a systematic comparison of the efficacy and safety of the Ilizarov method and the TSF in the treatment of tibial fractures, taking into account the time of fracture consolidation, the frequency of complications, the time of union, and the degree of deformity correction. Materials and methods. The search was conducted in the PubMed, Semantic Scholar, and Scopus databases from 2014 to 2025. A total of 105 studies were identified in all databases. All included studies had a retrospective cohort design. No randomized controlled trials meeting the PICO criteria were found. Results. The total number of observations was 723 patients (338 individuals using the Ilizarov method, 385 using the Taylor method). There was no evidence of a significant difference in the number of open and closed fractures. Despite the high heterogeneity (I2 = 92 %) of the studies, no significant difference was found between the systems in terms of fracture consolidation times. Healing times varied greatly depending on the location of the fracture, its complexity, and the initial condition. The Ilizarov group had a slightly higher, but not significant, fixation index. The difference in the risk of infection between the methods is not statistically significant. The magnitude of residual deformity was reported in two studies. The angle of residual deformity of the tibia in the Ilizarov group was 0.7° greater than in the TSF group, the difference is statistically significant. Conclusions. According to the meta-analysis, when comparing the efficacy and safety of the Ilizarov method and the TSF in the treatment of tibial fractures, no statistically significant differences were found between these systems in terms of fracture healing time or the number of complications. At the same time, the Taylor frame showed significantly better results in terms of final limb deformity. It should be noted that the accumulated clinical experience and improvement of recommendations for the use of both fixation methods, depending on the type, location, and complexity of the fracture, have almost eliminated the differences in the frequency of complications. It should be noted that although some authors provided data on the types and complexity of tibial fractures, the summary results were published without specific reference to these characteristics. Therefore, it is impossible to draw definitive conclusions about the superiority of one system or another in individual clinical cases. Given the significant variability of fractures, the effectiveness and safety of treatment methods can only be reliably determined if a sufficiently large amount of clinical data is available.