الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
As an alternative to extensive open methods, external fixator + MIO offers a new perspective of early functional treatment, weight bearing and a rare loss or reposition for these difficult fractures. The fixator offers the possibility of indirect reduction and stabilization, accurate alignment without soft tissue striping, early weight bearing,
and excellent functional results . These are very attractive fractures in this injury subset that made the external fixator the treatment of choice for these high energy fractures.. Minimal exposure and limited internal fixation can still be done if needed.
The advantages of using (circular wire as ilizarov) compared to traditional external fixation casts or monolateral fixators are numerous including stability, preservation of Vascularity, immediate joint motion, minimal operative risk, and minimal blood loss with early patient ambulation, reduced hospital stay, and decreased treatment costs.
This study demonstrate that the external fixator with or without supplement minimally invasive osteosythnthesis (MIO) is a reasonable and viable option in the treatment of severe distal tibia fractures especially those with soft-tissue or bony compromise.
Satisfactory reduction was possible through closed or limited approaches. Excellent to good results were obtained in over 70% in patients with distal tibial fractures (pilon fractures). Healing occurred without bone-grafting in most cases.
There were few complications. Most of these complications were minor and did not affect final outcome.
Based on the current study, the surgeon should understand that the severity of the soft tissue injury cannot be separated from the degree of skeletal involvement, but rather should be combined to give the surgeon the overall injury pattern. It is this pattern that is most significant in predicting the clinical results. Although the articular reduction is important, the surgeon should try to limit soft tissue damage and avoid additional complications at the risk of achieving a less than anatomic joint which may result in a good functional outcome for the patient.
The use external fixators as ilizarov requires technical experience. In order to improve
results we should follow the followings:
Select patients carefully as patients must be able to look after pin sites and follow a non-weight-bearing protocol postoperatively.
Use at least three transfixation wires (or 2 wires and a half pin) to ensure adequate articular fixation and decrease the risk of angulation with ilizarov technique.
Use limited internal fixation whenever possible .
Placing wires at least 1 cm from the joint line to avoid capsular penetration and increased risk of intra-articular infection with ilizarov technique.
Improve overall results by improving the accuracy of articular reduction and adding limited internal fixation.
Early ROM exercises to prevent joint stiffness and improve cartilage nutrition.
Avoid early weight bearing, which may lead to increased risk of joint depression or fracture angulation.
There is a define learning curve with the use and application of ilizarov frames. There was a clear trend toward improved results with increased experience during the study.
However inexperience can be supplement by careful preoperative planning.