Clinical Study On Children's Fractures Of Tibia With Ilizarov External Fixator Treatment

Background: The tibial fractures is one of the most common fractures in children, The orthodox therapy include fixation by plaster,traction,operation and so on, there were multiform forte, demerit and a lot of limiting facts in every therapy. With the updated material, accelerating the space of life and so on,treatment of tibial fractures of children also progress. That as much as possible closed reduction and treatment of tibial fracture in children with Ilizarov fixator is minimally invasive, early weight-bearing, free from seasonal temperature and other factors. Ilizarov fixation is a three-dimentional structure of the external fixator and firmly fixed, while its alone distraction can play the role of stress or pressure,and it can play in weight-bearing walking cycle of axial micro features. To study on operation and curation and curative effects of surgical treatment of the tibial fracture in children with Ilizarov fixation was worthy to do.Objective: To summarize indications, operation technique, clinical curative effect, complications, and precautions of the treatment of tibial fractures of children by Ilizarov fixation, and to provide a suit of methods to cure these fractures.Methods:In the Children Hospital Affiliated to Soochow University, we collected 92 children who had been treated with Ilizarov fixation from January 2006 to August 2010, including 58 cases of male and 34 cases of female; 54 cases of right tibial fracture, 38 cases of left; 26 cases of proximal 1/3 tibial fracture, 29 cases of middle 1/3 the tibial fracture, 37 cases of distal 1/3 tibial fracture. Tibial fracture classification according AO: 13 cases of 42-A1 type, 31 cases of 42-A2 type, 21 cases of 42-A3 type, 17 cases of 42-B2 type, 10 cases of 42-C3 type; 74 cases of closed fracture, 18 cases of open fracture; Open fracture classification according Gustilo: 7 cases ofⅠtype, 6 cases ofⅡtype, 3 cases ofⅢa type, 2 cases ofⅢb type. Mean age of all patients was 7.2yr(range 3yr and 7mon～ 12yr).The average time from injury to operation is 2.7 days(range 3h～10ds). And according to different of the age,classification of fracture and site of the fracture, all fractures fixed with Ilizarov fixation,and comepared statistically the treatment result of intramedullary nail(81 cases) and plate fixation(47 cases) in tibial fracture of children.Results: All of the 92 cases were followed up, and the mean follow-up was 21 months. According to the Johner-Wruh's score standard, the excellent result (leg length inequality﹤1.0cm,malalignment﹤5°, no pain, no joint activity limitation, no limp,) were found in 73 cases; satisfactory result(leg length inequality﹤2.0cm,malalignment﹤10°, no pain, joint range of motion>80﹪, occasionally limp)in 15 cases; and middle result(leg length inequality 2～3cm, 20°>malalignment﹥10°, mild pain, joint range of motion>75﹪, slight limp)in 4 cases. poor result in 0 case. The excellent and good rates was 95.65﹪. All fractures healed in children, no nonunion, no Volkmann ischemic contracture, 2 cases belong to affected extremity be long>2.0cm, following up 1.5 year, leg length inequality<1.0cm. one case was ankle range of motion 47﹪, one case was knee range of motion 70﹪, and 2 cases recovered by exercise in half year, one case was ankle range of motion 70﹪, one case was knee range of motion 90﹪, one cases was still middle. The excellent and good rates was 97.82﹪. No broken and ununited cases,no pin tract infection in this team. 2 cases of all delayed union in open fracture.All the 92 patients were cured, and the time of bone healing was 5 to 10 weeks, 8 weeks on average.Conclusions: The treatment of tibial fracture in children with Ilizarov fixator has many forte, such as small hurting, fixation, fast healing, earlier exercise, and rare complication, short period in hospital, convenience to pull out fixator and easy tolerance. It′s suitable for all tibial fractures, especially open fractures and distal fractures.