Injury · 2025
Selective removal of ilizarov frames without a period of dynamisation appears to be safe, a retrospective study.
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Brown Natasha, King Samuel W, Bagshaw Oliver, Martin Taylor David, Foster Patrick, Harwood Paul
Аннотация
INTRODUCTION: The Ilizarov method is an established technique for complex cases. Decisions about circular frame removal are imprecise, with no fully reliable method to confirm union. Errors can lead to complications such as refracture, deformity, and non-union. Traditionally, radiological union is assessed by "dynamisation," a period of systematic frame destabilisation before removal. This study evaluates an institutional shift to selective dynamisation, where patients at perceived lower risk of non-union underwent same-day removal after destabilisation.
MATERIALS AND METHODS: A retrospective review was conducted on a continuous series of prospectively identified patients from the institutional frame database. All adults with tibial frames applied between April 2020 and February 2022 were included. Patients were grouped into dynamised and non-dynamised cohorts. The primary outcome was refracture within six weeks or non-union at any point after removal.
RESULTS: Among 207 patients, non-union or refracture rates did not differ significantly between non-dynamised and dynamised groups (3 [3.7%] vs 2 [1.7%], p = 0.38). Frame removal without dynamisation was non-inferior to removal with dynamisation (margin 5%). Mean frame time was 34 days shorter in the non-dynamised group (185 vs 151 days, p = 0.002). Treatment failure was more common in patients with a distraction gap vs no bone loss (14% vs 1%, p < 0.01) and in open vs closed fractures (7% vs <1%, p < 0.05), indicating higher risk in these subgroups.
CONCLUSION: Omitting outpatient dynamisation for tibial frames did not increase non-union or early refracture rates. In this cohort, dynamisation was 96% specific but only 25% sensitive for union. Outpatient dynamisation may benefit higher risk fractures, such as open fractures or those with bone loss. However, for most patients, removal without dynamisation appears safe and offers advantages: shorter frame time, fewer outpatient visits, and reduced radiation exposure.
MATERIALS AND METHODS: A retrospective review was conducted on a continuous series of prospectively identified patients from the institutional frame database. All adults with tibial frames applied between April 2020 and February 2022 were included. Patients were grouped into dynamised and non-dynamised cohorts. The primary outcome was refracture within six weeks or non-union at any point after removal.
RESULTS: Among 207 patients, non-union or refracture rates did not differ significantly between non-dynamised and dynamised groups (3 [3.7%] vs 2 [1.7%], p = 0.38). Frame removal without dynamisation was non-inferior to removal with dynamisation (margin 5%). Mean frame time was 34 days shorter in the non-dynamised group (185 vs 151 days, p = 0.002). Treatment failure was more common in patients with a distraction gap vs no bone loss (14% vs 1%, p < 0.01) and in open vs closed fractures (7% vs <1%, p < 0.05), indicating higher risk in these subgroups.
CONCLUSION: Omitting outpatient dynamisation for tibial frames did not increase non-union or early refracture rates. In this cohort, dynamisation was 96% specific but only 25% sensitive for union. Outpatient dynamisation may benefit higher risk fractures, such as open fractures or those with bone loss. However, for most patients, removal without dynamisation appears safe and offers advantages: shorter frame time, fewer outpatient visits, and reduced radiation exposure.