Clinical and Radiological Outcomes of Ilizarov Ring Fixation in the Management of Complex Tibial Deformities: A Prospective Observational Study

Abstract

Background: Complex tibial deformities are challenging reconstructive conditions that may involve angular, translational, rotational and length abnormalities, often associated with malunion, nonunion, bone loss, previous surgery or infection. Ilizarov ring fixation permits stable circular fixation and gradual multiplanar correction while facilitating compression, distraction, bone transport and limb-length restoration. Objective: To evaluate the clinical and radiological outcomes of Ilizarov ring fixation in patients with complex tibial deformities. Methods: This prospective observational study was conducted in the Department of Orthopaedic Surgery (Ilizarov and Deformity Correction), Kurmitola Multicare Specialized Hospital, Dhaka Cantonment, Dhaka, Bangladesh, over a period of 18 months from January 2025 to June 2026. A total of 70 patients with complex tibial deformities who underwent Ilizarov ring fixation were included.  Clinical and radiological assessments were performed before treatment and during follow-up. Functional outcome was evaluated using the Lower Extremity Functional Scale (LEFS), while bone and functional outcomes were assessed according to ASAMI criteria. Radiological parameters included mechanical axis deviation, coronal and sagittal deformity, limb-length discrepancy, and union or regenerate consolidation. Complications and additional procedures were also documented. Results: The mean age was 40.8±12.6 years and 70.0% of patients were male. Previous trauma was present in 82.9%, while multiplanar deformity was the commonest presentation (31.4%). Mechanical axis deviation decreased from 26.7±13.1 mm preoperatively to 7.2±5.9 mm at final follow-up (p<0.001). Coronal and sagittal deformities also improved significantly. Mean limb-length discrepancy decreased from 2.4±1.3 to 0.8±0.7 cm. Mean LEFS increased from 38.6±12.4 to 72.8±11.3. Excellent/good ASAMI functional and bone outcomes were achieved in 81.4% and 84.3%, respectively. Overall satisfactory union or consolidation occurred in 91.4%. Mean external-fixation duration was 6.3±2.1 months. Pin-site infection was the commonest complication. Conclusion: Ilizarov ring fixation provides effective deformity correction with substantial improvement in alignment, limb function, limb length and bone healing in complex tibial deformities. Despite prolonged fixation and pin-site complications, it remains a valuable limb-reconstruction technique.

Keywords: Ilizarov; Tibial Deformity; Circular External Fixation; Deformity Correction; LEFS; ASAMI; Bone Transport; Tibial Malunion.