On the treatment of tibial fractures using the Ilizarov fixator

The aim of this thesis was to analyse the results of the Ilizarov method in patients with different types of tibial fracture and compare them with conventional methods, in terms of primary union, complication rates, post-operative function, quality of life, and how the patients´ gait was affected during rehabilitation. Fifty-eight patients with isolated diaphyseal fractures (Study I) were randomised to treatment with either the Ilizarov method (IL) or locked intramedullary nailing (IM). Thirty consecutive patients with isolated proximal metaphyseal fractures (Study II – 11 classified as Schatzker type I-IV and 19 as Schatzker type V-VI) and 39 consecutive patients with isolated distal metaphyseal fractures (Study III – 21 extra-articular and 18 intra-articular) were treated prospectively using the IL. The follow-ups included clinical investigations, roentgen assessments, self-appraisals (VAS Pain and VAS Satisfaction, NHP and EQ-5D). In Studies II and III, we also used specific questionnaires: the KOOS and FAOS respectively. In Study IV, 85 patients from the earlier studies were included in a gait analysis study, using the medilogic® insole pressure technique. In Study I, in the IL and IM groups, nine and two patients respectively had open fractures. Twelve patients sustained major complications, four in the IL group and eight in the IM group (p=0.107). In the IL group, two patients developed pseudarthrosis and two malunion. In the IM group, two patients developed compartment syndrome, one had a deep infection, one hardware failure, one delayed union, one pseudarthrosis and two had a malunion. Superficial pin-site infections were observed in 16 patients in the IL group. The fractures were radiographically healed at an average of 12 weeks in both groups. At the one-year follow-up, there were differences in pain (VAS) and satisfaction (VAS) scores in favour of the IL treatment (p=0.03 and p=0.02 respectively). There were no differences between the groups with regard to range of motion (ROM) in the knee and ankle joints. Local tenderness and pain, mainly anterior knee pain, were registered in 19 patients in the IM group and one patient in the IL group at the one-year follow-up (p