[The treatment of comminuted midfoot fractures with distraction osteogenesis]

We evaluated the results of distraction osteogenesis with the Ilizarov circular external fixator in the treatment of comminuted fractures of the midfoot.

Four patients (1 female, 3 males) with comminuted midfoot fractures due to high energy trauma were treated with distraction osteogenesis performed by the Ilizarov circular external fixator. The mean age was 24 years (range 19 to 37 years). Fractures resulted from a traffic accident in one case, and from vehicle blast due to landmine explosion in three cases. The circular external fixator was applied for a mean of three months (range 2.5 to 4 months), during which the mean distraction was 10.5 mm (range 9 to 13 mm) at the fracture zone. The results were assessed according to the presence of pain and limping, radiographic measurements, and to the AOFAS (the American Orthopaedic Foot and Ankle Society) scoring system. The mean follow-up period was 58 months (range 33 to 81 months).

All the patients had limping for a month following the removal of the fixator. At the end of six months, limping disappeared in one patient, decreased in two patients, and remained as a sequela in one patient. Pain which occurred during walking after the removal of the fixator decreased and finally disappeared within 3 to 6 months in three patients, but remained in one patient. Radiographic assessments were made using the anteroposterior and lateral X-rays of the foot. The mean AOFAS score was 70.5 (range 50 to 89).

Distraction osteogenesis performed with the use of the Ilizarov circular external fixator may be an alternative in the treatment of comminuted foot fractures due to high energy traumas, where no other modality is likely to provide an anatomical reduction.