Functional and Radiological Outcome of Ilizarov Ring Fixator versus Limb Reconstruction System in Compound Tibial...

Open diaphyseal fractures of the tibia, particularly Gustilo-Anderson Grade II, IIIA, and IIIB, pose significant treatment challenges due to high contamination, soft-tissue damage, and compromised vascularity. External fixation remains a preferred method in such cases. This study compares the functional and radiological outcomes of the Ilizarov ring fixator and the limb reconstruction system (LRS) in managing these injuries.

This prospective, comparative single-center-based study was conducted from December 2023 to May 2025 on a total of 68 patients aged between 20 and 70 years with Grade II, IIIA, or IIIB compound tibial shaft fractures. Four patients were excluded at the time of final analysis, out of which, three patients were lost to follow-up and in one patient had premature removal of Ilizarov frame. Patients were randomized into two groups: Group A (Ilizarov, n = 32) and Group B (LRS, n = 32). Outcomes were assessed at 6 weeks, 3, 6, and 9 months/final follow-up using the association for the study and application of the method of Ilizarov criteria and radiological callus formation scores.

Both groups showed progressive improvement in bone and functional outcomes over time. At final follow-up, excellent bone results were noted in 43.8% patients of Group A and 37.5% of Group B, while excellent functional outcomes were achieved in 37.5% and 28.1% patients, respectively. Intergroup differences were statistically significant for functional results at the early follow-ups (P = 0.049 at 6 weeks) but became comparable by final follow-up.

Both the Ilizarov ring fixator and the LRS are effective in managing high-grade open tibial shaft fractures. We have achieved good to excellent results in terms of bony union and functional outcome in most of our patients in both Ilizarov and LRS groups, although Ilizarov scores significantly better.