Our clinical and radiological results in the treatment of bone transport with ilizarov external fixator in patients with segmental tibial defects. Is depression associated with poor outcomes?

Abstract

Objective: The aim of this study was to evaluate the clinical and radiological results of patients who underwent bone transport with Ilizarov external fixator in the treatment of tibial defects due to traumatic causes, and to investigate the factors that have a positive or negative effect on the results. Patients and Methods: From a total of 30 patients with tibial segment loss due to traumatic causes treated with bone transport with an Ilizarov external fixator between 2013 and 2020 in the Department of Orthopedics and Traumatology of the Faculty, 25 with adequate examinations and follow up were included in this study and were evaluated retrospectively. The patients were grouped according to the etiology of bone loss, demographic characteristics, Paley's pseudoarthrosis classification and Solomin's long bone defect classification. The results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) outcome criteria. Results: The 25 patients in the study comprised 20 males and 5 females with an average age of 44.80 ± 18.51 years. According to the Paley pseudoarthrosis classification, 16 (64%) patients were Type B1, 5 (20%) were Type B2, and 4 (16%) were Type B3. According to the Solomin long bone defect classification, 4 (16%) patients were Type B2, 14 (56%) were Type C1, and 7 (28%) were Type C2. In some patients, due to the fixation problem, early fixation was achieved with minimally invasive plate osteosynthesis or intramedullar nailing by removing the Ilizarov fixator after the necessary length and alignment was achieved for the purpose of early rehabilitation. Early fixation was achieved before consolidation was completed in 16 of 25 patients. Fixator duration was 360 ± 130.77 days in the group without additional fixation and external fixation index (EFI) was 61.63 ± 29.81 days/cm, while the fixator duration was 273.33 ± 116.82 days in the early fixation group, and EFI was 57.22 ± 29.05 day/cm. Complications were evaluated according to Paley's criteria. A total of 39 complications were recorded, the most common being pin tract infection. The ASAMI bone results were found to be excellent in 7 patients, good in 9, moderate in 4, and poor in 5. The functional results were excellent in 5 patients, good in 11, moderate in 4, and poor in 5. In addition, 5 (20%) of 25 patients whose results were evaluated had depressive illness. Moreover, the results of these patients were found to be poor according to the ASAMI criteria. Conclusion: The Ilizarov method is a very safe and successful option in the treatment of open fractures with tibial segment loss resulting from high-energy traumas. Nevertheless, when making the decision for treatment with this method, the patient's current depressive disorder should be taken into consideration in addition to the clinical problems of the patients.

Keywords

• bone transport
• distraction osteogenesis
• ilizarov external fixator
• tibial bone defect