Comparative study of the burden associated with the management of open tibia shaft fractures using Ilizarov frame fixator and linear rail system in a resource poor country

Background: Management of open tibia shaft fractures is frequently laden with complications. Hence this places an enormous burden on the patient and the surgeon alike. The use of Ilizarov frame fixator and Linear rail system [LRS] as the definitive fixation device minimized the number of surgeries, length of hospital-stay and financial burden on the patient whilst achieving fracture union and reduced concomitant complications associated with open fracture care. The study objective is to determine and compare the union rate, non-union rate, associated complications encountered as well as the mean total cost implication in the management of open tibia shaft fractures using the Ilizarov frame fixator and Linear rail system [LRS] in Ibadan, Nigeria. Methods: This is a follow up study to our previous prospective study involving thirty (30) patients of both sexes, divided into two (2) groups; Ilizarov frame fixator group and LRS group. All patients had open tibia shaft fractures of Gustillo-Anderson Class [GA II-IIIB]. The union rate, non-union rate, associated complications noted while on the respective devices as well as the mean total cost implication of managing these open tibia fractures using the Ilizarov frame fixator and LRS respectively were all assessed. Results: The union rate in the LRS group was 86.7% while the non-union rate was 13.3%. In the Ilizarov group, the union rate was 93.3% while the non-union rate was 6.7%. In this study, pin tract infection was the most common complication associated with using both devices. The mean cost price for purchasing the LRS was shown to be N175,933.3±12,775.0 while that of the Ilizarov frame fixator was N216,000.00±42,895.0. The mean total cost implication for the management of open tibia shaft fractures using LRS and Ilizarov frame fixators were N455,960.0±46,967.3 and N505,614.3±113,345.9 respectively. There is no significant difference noted in the union rate, non-union rate, associated complications encountered as well as in the mean total cost implication in the management of these open tibia shaft fractures using the fixators under review. Conclusions: This study has shown that management of open tibial shaft fractures using either Ilizarov frame fixator or Linear rail system [LRS] is very cost effective especially in a resource poor country like Nigeria.