Rajitha G, Yates P and Brankov B
Background: The literature suggests that the use of the Ilizarov frame is the last line of treatment of tibia fracture non-unions. However, there is a lack of clear guidelines for management of the 3-18% of persistent tibial fracture nonunion after management with Ilizarov method. An amputation rate of 4-10% is reported in this population. This paper describes the ‘Brankov pathway’ to manage this difficult scenario in order to achieve union.
Methods: Retrospective analysis of all tibia fractures managed with an Ilizarov frame by a single surgeon between 1st January 2009 and 1st January 2017 in Perth, Western Australia. Clinical and radiological fracture union was the final outcome of interest.
Results: 100% union of the 59 cases identified using our pathway. This includes 8 cases of non-union after Ilizarov frame use. These 8 cases initially had a ‘frame holiday’, 7 then progressed to an intramedullary nail and one had an open reduction and internal fixation. This series of 8 patients with non-union management post Ilizarov frame appears to be the largest series in the literature.
Conclusion: The ‘Brankov pathway’ enables earlier identification of non-union cases thus shortening the time spent in a frame for patients. In cases of non-union there are also benefits in earlier conversion of the frame to nail/ plate after a ‘frame holiday’. Recurrent infection is possible but less likely with this pathway.
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