Outcome of Two Ring Hybrid Ilizarov Fixator in the Management of Proximal Tibial Fractures in Adults.


  • Muhammad Badar Ud Din Zafir Associate Professor, Nishtar Medical University, Multan
  • Tariq Mahmood Associate Professor, Nishtar Medical University, Multan
  • Azmat Rasool Assistant Professor, Nishtar Medical University, Multan
  • Ahmad Awad Ahmad Assistant Professor, Nishtar Medical University, Multan
  • Muhammad Shafee Assistant Professor, Nishtar Medical University, Multan
  • Arif Mustafa Khan Assistant Professor, Nishtar Medical University, Multan
  • Khalil Ahmad Gill Professor (retired), Nishtar Hospital, Multan
  • Sohail Safdar PHRC Research Center, Nishtar Hospital, Multan


Fracture, Hybrid, Ilizarov, Schatzker, Tibia, Union.


Objective: To determine the functional and radiological outcome two ring hybrid Ilizarov fixator in the management of  proximal tibial fractures in adults.

Methods: This descriptive study was conducted in department of Orthopaedic surgery Nishtar Medical University Multan from 5th May 2018 to 24th June 2020. All adults patients with  proximal tibial fractures meeting the inclusion criteria were treated with two ring hybrid Ilizarov fixator. Post operative functional outcome was assessed with knee range of motion and Rasmussen functional knee score and graded as excellent, good, fair and poor. Radiological outcome was assessed with fracture healing on radiographs. Comparative analysis of results were done after stratification of age, gender, type of fracture and time since fracture and P value calculated with Chi square test and student-t test. P value < 0.05 was considered significant.

Results: The total number of patients in our study was 50.The mean age was 40.7 ± 10.16.Male patients were 45(90%) and female 5(10%). Shatzker type VI fractures were present in 30(60%) patients, Shatzker type V fractures in 11(22%), extra articular metaphyseal fractures in 5 (10%) and proximal one third shaft fractures in 4(8%) patients. All the fractures achieved union with mean union time 17.58±3.43 weeks. Functional outcome as per Rasmussen functional knee score was excellent outcome with more than 90° knee flexion in 32(64%) patients, good outcome and up to 90°flexion in 15(30%) and  fair outcome with 45°flexion at the knee in 3(6%) patients. Younger patients were able to tolerate early weight bearing than elderly (P=0.006) Patients with open fractures had lower Rasmussen score (P=0.043), decrease knee flexion (P=0.043), and increased pin tract infection (P=0.031).

Conclusion: Proximal tibial fractures treated with two-ring hybrid Ilizarov fixator is an effective technique as excellent functional and radiological outcome was achieved in majority of our patients.


Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br 1995; 77(3):417-421.

Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury 2006;37:475-484.

Ariffin HM, Mahdi NM, Rhani SA, Baharudin A, Shukur MH. Modified hybrid fixator for high-energy Schatzker V and VI tibial plateau fractures. Strat Traum Limb Recon. 2011;6:21–26.

El-Gafary K, El-adly W, Farouk O, Khaled M, Abdelaziz MM. Management of high-energy tibial plateau fractures by Ilizarov external fixator. Europ Orthop Traumatology. 2014;5(1):9-14.

Venkatesh G, Sunil, G. Management of Tibial Metaphyseal Fractures by Hybrid External Fixator. Open J Orthop.2014;4:84-89.

Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN. High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res. 2011;6: 35-40.

Sales JG, Soleymaopour J, Ansari M, Afaghi F, Goldust M. Treatment results of bicondylar tibial fractures using hybrid external fixator. Pak J Biol Sci. 2013;15; 16(10):491-5.

Akhtar A, Shami A, Sarfraz M. Management of high-energy tibial plateau fractures by Ilizarov external fixator. Ann Pak Inst Med Sci 2012;8(3):188-191.

Musahl V, Tarkin I, Kobbe P, Tzioupis C, Siska PA, Pape HC, et al. New trends and techniques in open reduction and internal fixation of fractures of the tibial plateau. J Bone Joint Surg 2009;91:426-433.

Biggi F, Di Fabio S, D’antimo C, Trevisani S. Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury 2010;41(11):1178-1182.

Rasmussen PS. Tibial condylar fractures: impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am). 1973;5:1331–1350

Spiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR. Ilizarov principles of deformity correction. Ann Royal Coll Surg Eng 2010;92(2):101-115.

Roberts CS, Dodds JC, Perry K, Beck D, Seligson D, Voor MJ. Hybrid external fixation of the proximal tibia: strategies to improve frame stability. J Orthop Trauma 2003 Jul 1;17(6):415-20-24.

Kumar A, Whittle AP. Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 2000;14(5):339-44-48.

Wu WY, Xu WG, Wan CY, Fang M. Preoperative plan with 3D printing in internal and external fixation for complex tibial plateau fractures. Orthop Surg 2019;11(4):560-568.

Iliopoulos E, Galanis N. Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature. SAGE Open Med 2020;8:205-209.

Prabhakar S, Mohan G. A prospective study of hybrid external fixation for proximal tibial fractures. Intel J Orthop 2018;4(3):91-94.

Siddalingamurthy G, Verma A. To assess the union time and pin track infection rate in ilizarov fixator using the Russian and rancho hybrid fixation technique. Ind J Orthop Surg 2020 ;4(3):282-285.

Krupp RJ, Malkani AL, Roberts CS, Seligson D, Crawford CH, Smith L. Treatment of bicondylar tibia plateau fractures using locked plating versus external fixation. Orthopedics 2009 ;32(8):167-171.

Conserva V, Vicenti G, Allegretti G, Filipponi M, Monno A, Picca G, et al. Retrospective review of tibial plateau fractures treated by two methods without staging. Injury 2015;46(10):1951-1956.

Sarad R, Aggarwal RK, Wadi MKS. To evaluate the outcome of Ilizarov ring fixator using hybrid technique in Tibial trauma. International Journal of Orthopaedics Traumatology & Surgical Sciences.2020;6(1):55-62.

Nawaz S, Afghan S, Lodhi R. Outcome of Using Hybrid Ilizarov External Fixator in The Treatment of Schatzker Type V and VI Tibial Plateau Fracture. P J M H S 2017; 11(1):432-434.




How to Cite

Muhammad Badar Ud Din Zafir, Tariq Mahmood, Azmat Rasool, Ahmad Awad Ahmad, Muhammad Shafee, Arif Mustafa Khan, Khalil Ahmad Gill, & Sohail Safdar. (2021). Outcome of Two Ring Hybrid Ilizarov Fixator in the Management of Proximal Tibial Fractures in Adults. Journal of Pakistan Orthopaedic Association, 33(02), 47–52. Retrieved from http://jpoa.org.pk/index.php/upload/article/view/531