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Original Article · Open access

Long-term results of treatment of Gustilo-Anderson type 3A-B tibia fractures due to combat-related high-energy ballistic injuries treated with external circular fixator: Experience of the Military Medical Academy

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Yusuf Erdem

Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara, Türkiye

ORCID: 0000-0002-8685-2356

Hakan Zeybek

Department of Orthopedics and Traumatology, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, İzmir, Türkiye

ORCID: 0000-0003-1525-9966

Cagri Neyisci

Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara, Türkiye

ORCID: 0000-0001-8481-7808

Eyyup Emre Bahtiyar

Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, Ankara, Türkiye

ORCID: 0000-0002-4200-4064

Ozgur Selim Uysal

Department of Orthopedics and Traumatology, Yüzüncü Yıl Hospital, Ankara, Türkiye

ORCID: 0000-0002-6433-7548

Mustafa Kurklu

Department of Orthopedics and Traumatology, Memorial Bahçelievler Hospital, İstanbul, Türkiye

ORCID: 0000-0002-4228-3016

Abstract

Objectives: The aim of this study was to evaluate the longterm outcomes of open tibia fractures treated using the Ilizarov external circular fixation (ECF) technique in the Military Medical Academy.

Patients and methods: Between January 1992 and December 2011, a total of 134 male military personnel (median age: 22.5 years; range, 18 to 36 years) with Gustilo-Anderson type 3 open tibia fractures treated with ECF were retrospectively analyzed. All patients underwent multiple surgeries and eventually Ilizarov fixation surgery. The radiological and functional outcomes were evaluated using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, and complications were noted.

Results: The median follow-up was 17.7 (range, 10 to 29) years. The median time to union was 4.7 (range, 3 to 8) months. All frames were removed from the limb, when union was observed. No re-fracture, limb length discrepancy more than 2.5 cm, or below-knee amputation after Ilizarov treatment was seen in any patient. Chronic osteomyelitis was observed at in 40% (n=54) of the patients at a median time ranging from 17 to 148 months. The overall ASAMI bone scores were excellent in 40 (30%), good in 20 (15%), fair in 20 (15%), and poor in 54 (40%) patients with osteomyelitis. The ASAMI functional scores were excellent in 40 (30%), good in 40 (30%), and fair in 54 patients (40%). No poor score was observed. Minor pin site infections were observed in 63 patients (47%).

Conclusion: Our long-term study results showed that all patients returned to their social life and were mobilized without support after treatment with the use of Ilizarov ECF method of open tibia fractures caused by high-energy ballistic injuries. However, complications such as pin tract infections and osteomyelitis after several years must be kept in mind in the treatment of comminuted bone fractures caused by firearms and ballistic missiles injuries.

Declarations

Ethics Committee Approval

The study protocol was approved by the Gülhane Training and Research Hospital Ethics Committee (date: 07.06.2023, no: 2023/50). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Informed Consent

A written informed consent was obtained from each patient.

Author Contributions

Idea/concept: Y.E., M.K.; Design, data collection and/or processing: Y.E., H.Z.; Control/ supervision: E.E.B., Ç.N.; Analysis and/or interpretation: H.Z., Ö.S.U.; Literature review: Y.E., H.Z., Ç.N.; Writing the article: Y.E., H.Z.,E.E.B.; Critical review: M.K., Ç.N., Ö.S.U.; References and fundings: H.Z., Ç.N.; Materials: Y.E., H.Z., M.K.; Other: E.E.B., Ö.S.U.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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