International Orthopaedics - 2026-03-09 - Journal Article
Outpatient deformity correction: novel closed reduction technique transforms tibial trauma care.
Hosny G, Elmesalamy N, Awadallah S, Abdelnaser A
Topics
Key Takeaway
A single Ilizarov circular external fixator achieved union in 90% of AO/OTA 42C2-3 tibial fractures at a median of 150 days, with all deformity corrections performed outpatient without anesthesia.
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Summary
This retrospective series evaluated a novel closed reduction protocol using a single Ilizarov frame for high-energy comminuted tibial fractures (AO/OTA 42C2-3), with postoperative deformity corrections performed outpatient without anesthesia. Eighteen of 20 patients (90%) achieved union with one frame application; two had delayed unions resolving conservatively, and two (10%) sustained refractures requiring repeat Ilizarov treatment. Pin-tract infection rate was 10%, no amputations occurred, and modified ASAMI scores were predominantly excellent or good.
Key Limitation
The absence of a control group receiving intramedullary nailing or plate fixation makes it impossible to attribute the union rate, complication profile, or cost savings to the technique rather than patient selection or fracture biology.
Original Abstract
BACKGROUND
In an era of healthcare cost containment, this study introduces a novel closed reduction technique using the Ilizarov circular external fixator for comminuted tibial fractures (AO/OTA 42C2-3), minimizing operative interventions and costs compared to internal fixation.
METHODS
We conducted a retrospective analysis of 20 consecutive patients with high-energy tibial fractures managed with a single Ilizarov frame. Postoperative deformities (angulation, translation, rotation) were corrected painlessly in outpatient settings without anaesthesia.
RESULTS
Eighteen patients (90%) achieved union with one frame application; median time to union (injury to frame removal) was 150 days. Two patients had delayed union resolving conservatively. All injuries resulted from road traffic collisions (42C2/42C3). No amputations or compartment syndromes occurred. Pin-tract infections in two patients (10%) required wire exchange. No malunions necessitated reoperation, though two patients (10%) suffered refractures requiring repeat Ilizarov treatment. Per modified ASAMI scores, most achieved excellent/good functional outcomes.
CONCLUSION
This technique delivers reliable union with outpatient, anaesthesia-free deformity correction, avoiding internal fixation's risks (deep infection, compartment syndrome, malrotation) while optimizing cost-effectiveness. Multicenter validation is warranted.