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Dr. Muhammad Adeel
Babar Shahzad Sadiq
Muhammad Ali Usman
Dr Muhammad Tayab




Introduction: Distal tibial fractures pose significant challenges in orthopedic trauma management due to their complex anatomical characteristics and associated soft tissue injuries.

Objective: The main objective of the study is to find the management of distal tibial fractures by Ilizarov fixator with or without minimal internal fixation without minimal internal fixation.

Material and methods: This retrospective study was conducted at Orthopedic Unit, Ayub Teaching Hospital Abbottabad Pakistan from March 2023 to March 2024. Data were collected from 50 patients diagnosed with distal tibial fractures who underwent treatment using the Ilizarov fixator. Patient demographic information, fracture characteristics, treatment details, and postoperative outcomes are extracted from medical records, operative reports, and imaging studies.

Results: Data were collected from 50 patients.  Mean age of patients in group A was 42 ± 8 years and 45 ± 7 years in group B. The predominant mechanisms of injury were motor vehicle accidents (50%), followed by falls (30%) and sports-related incidents (20%). The statistical analysis revealed a significant difference in the time to fracture union between Group A (Ilizarov Fixator Alone) and Group B (Ilizarov Fixator + Minimal Internal Fixation), with a p-value of less than 0.05. However, there were no statistically significant differences in complications, functional recovery, or patient satisfaction between the two groups, as indicated by p-values exceeding 0.05.

Conclusion: It is concluded that both the Ilizarov fixator alone and in conjunction with minimal internal fixation demonstrate efficacy in managing distal tibial fractures. While the combined approach shows a significant advantage in accelerating fracture union, both modalities yield favorable outcomes with low complication rates and high patient satisfaction.

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1. Elgammal MA. Management of distal tibial fractures by Ilizarov fixator with or without minimal internal fixation. Al-Azhar International Medical Journal. 2021 Dec 1;2(12):7-13.
2. Hegde AS, Madegowda A, Khanna V, Rao S. Clinical and Radiological Outcome of Complex Proximal Tibia Fractures Managed with Hybrid/Ilizarov Fixator with or without Minimal Internal Fixation. Ortopedia Traumatologia Rehabilitacja. 2021 Aug 31;23(4):279-85.
3. Othman A, Laklouk MA, Azmy MM, Wali ElDeen ON. Evaluation the results of Ilizarov External Fixator in Management of Distal Tibial Fractures. Minia Journal of Medical Research. 2020 Jan 1;31(1):43-7.
4. Zayda A, Badr IT. Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator. Techniques in Foot & Ankle Surgery. 2024 Mar 1;23(1):12-20.
5. Bhowmick K, Gunasekaran C, Kandoth JJ, Ramasamy B, Jepegnanam TS. The Role of the Ilizarov Ring External Fixator in the Management of Tibial Fractures with Impending/Incomplete Compartment Syndrome. Revista Brasileira de Ortopedia. 2021 Dec 17;56:579-87.
6. Jeremic D, Grubor N, Bascarevic Z, Slavkovic N, Krivokapic B, Vukomanovic B, Davidovic K, Jovanovic Z, Tomic S. Comparative Analysis of Complication Rates in Tibial Shaft Fractures: Intramedullary Nail vs. Ilizarov External Fixation Method. Journal of Clinical Medicine. 2024 Mar 31;13(7):2034.
7. Shalabi MS, Ibrahim MA, Mohamed AA, Morsi MO. Management of Distal Tibial Intra-Articular Fractures by Using Ring External Fixators Assisted Arthroscopically. The Egyptian Journal of Hospital Medicine. 2021 Jan 1;82(1):56-60.
8. Rushdi I, Che-Ahmad A, Abdul-Ghani KA, Mohd-Rus R. Surgical management of distal tibia fracture: towards an outcome-based treatment algorithm. Malaysian orthopaedic journal. 2020 Nov;14(3):57.
9. Farhat MF, Nazim ZK, Osama M, Ahmad H, Razzaq B, Khan M. A Comparison of Functional Outcome of Open Reduction Internal Fixation Versus Ilizarov External Fixation in Complex Proximal Tibial Fractures: Randomized Controlled Trial. Journal of Islamabad Medical & Dental College. 2023;12(4):262-9.
10. ORTHOPAEDICS MO. A Comparative Study of Functional and Radiological Outcome in Management of Open Tibial Fractures by Ao External Fixator and Ilizarov External Fixator (Doctoral dissertation, RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES).
11. Kumar J, Siddiqui AA, Katto MS, Jamil M, Wasim MA, Yaqoob U. Treatment of high‐energy intra‐articular fractures of tibia with Ilizarov external fixator in adults: A tertiary centre experience. International Journal of Clinical Practice. 2021 Sep;75(9):e14488.
12. Borah PJ, Patowary C, Das A, Shirdinayak TS, Roy JP, Kumar S. Comparative Outcome of Hybrid External Fixator Versus Primary Ilizarov Fixator in the Treatment of Open Distal Tibia Extra-Articular Fractures. Indian Journal of Orthopaedics. 2022 Nov;56(11):2006-12.
13. Kawoosa AA, Mantoo SA, Ali N, Dar GN. Clinico-Radiological Results of Tibial Bicondylar Fractures Managed with Ilizarov Technique with or without Minimal Internal Fixation. Malaysian Orthopaedic Journal. 2022 Mar;16(1):18.
14. Roy A, Mukherjee D. A study on the outcome of open tibial fractures managed definitively by external fixator. International Journal of Orthopaedics. 2023;9(1):158-64.
15. Naude JJ, Manjra MA, Birkholtz F, Barnard AC, Tetsworth K, Glatt V, Hohmann E. Functional outcomes and quality of life following complex tibial fractures treated with circular external fixation: a comparison between proximal, midshaft, and distal tibial fractures. Strategies in trauma and limb reconstruction. 2021 Jan;16(1):32.
16. Oguzkaya S, Misir A, Kizkapan TB, Eken G, Ozcamdalli M, Basilgan S. A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures. European Journal of Trauma and Emergency Surgery. 2022 Apr 1:1-8.
17. Naveen DS, Devaraj P, Arjun VP. A prospective study on surgical management of complex distal metaphyseal fracture of tibia with hybrid external fixation. International Journal of Orthopaedics. 2021;7(4):755-9.
18. Corona PS, Pujol O, Vicente M, Ricou E, de Albert M, Cano DM, Cánovas CS, Ros JM. Outcomes of two circular external fixation systems in the definitive treatment of acute tibial fracture related infections. Injury. 2022 Oct 1;53(10):3438-45.
19. Hui T, Wang J, Yu Y, Dong H, Lin W. External fixator versus Ilizarov external fixator for pediatric tibial shaft fractures: A retrospective comparative study. Injury. 2024 Jan 21:111376.