High-Velocity Gunshot Wounds of the Tibial Plafond Managed With Ilizarov External Fixation: A Report of 13 Cases

OBJECTIVETo report the results of using Ilizarov fixation for the treatment of open tibial plafond fractures caused by high-velocity gunshot injuries. DESIGNRetrospective review of consecutive patients. SETTINGMilitary academic hospital. PATIENTSUsing the AO classification, three type C1, five type C2, and five type C3 open tibial plafond fractures due to high-velocity gunshot injuries were treated with irrigation, débridement, primary closure, and Ilizarov fixation. Eleven of the fractures were type IIIA, and the remaining two were type IIIB according to the Gustilo-Anderson classification. There were also multiple traumas in one case. METHODSPlafond fractures were treated by Ilizarov technique in all 13 cases. In three of the cases, additional osseous transport to eliminate a skeletal defect was performed. MAIN OUTCOME MEASURESResults were evaluated according to Bone's clinical grading system. RESULTSAverage follow-up was 38.4 months (range 26 to 50 months). Callus began to form in 21 to 35 days (average 27.9 days). The fractures united in 126 to 154 days (average 137.6 days), and the apparatus was removed from the limb at that time. There were six good, three fair, and four poor results. Minimal skin necrosis around the wound was seen in four cases, wound infection and purulent discharge were seen in two cases, and angular deformity was seen in two cases. Delayed union and reflex sympathetic dystrophy were not seen in any cases. Although tibiotalar narrowing was seen in four cases, no cases required tibiotalar arthrodesis or subsequent bony reconstruction at the time of their most recent follow-up. The average residual ankle range of motion was plantar flexion 18.5° and dorsiflexion 11.5°. CONCLUSIONSEarly aggressive débridement of nonviable tissues, stabilization with an Ilizarov external fixator, and either primary or delayed primary closure followed by early ankle range of motion and weight bearing is an alternative treatment method of these injuries.