Predictors of Functional Recovery Following Primary Ilizarov External Fixation in Compound Distal Third Tibial Fractures
Abstract
Abstract Introduction: Compound distal third tibial fractures are difficult to manage because of limited soft-tissue coverage and injury to local biology. This study examined whether routinely recorded patient and fracture characteristics were associated with functional recovery after primary Ilizarov external fixation. Materials and Methods: This prospective observational secondary analysis included 30 consecutive skeletally mature patients treated at a tertiary center in central India between April 2024 and October 2025. The primary outcome was the final ASAMI outcome category; the 9-month American Orthopaedic Foot and Ankle Society (AOFAS) score, frame duration, and recorded complications were secondary outcomes. Univariable associations were examined using correlation and group-comparison tests. Results: The cohort comprised 29 men and 1 woman, with a mean age of 40.8 ± 13.6 years (range, 19–60). Gustilo–Anderson Grades II, IIIA, and IIIB accounted for 8, 15, and 7 cases, respectively; Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) types 42 and 43 accounted for 20 and 10 cases. Final ASAMI outcomes were excellent in 7 patients (23.3%), good in 21 (70.0%), and fair in 2 (6.7%); no poor outcomes were recorded. The mean final AOFAS score was 84.9 ± 9.6, and the mean frame duration was 121.5 ± 16.1 days. Five patients (16.7%) had a recorded superficial pin-site complication. ASAMI outcome was not significantly associated with compound grade (P = 0.890), AO/OTA type (P = 0.526), or mechanism of injury (P = 0.821). AOFAS score was not significantly associated with age, mechanism, AO/OTA type, compound grade, frame duration, or recorded pin-site complication. Compound grade was associated with frame duration (P = 0.030). Conclusion: Most patients had good-to-excellent recorded ASAMI outcomes. No statistically significant associations were detected between the tested baseline characteristics and ASAMI category; however, the small sample and sparse outcome cells limit inference. Larger, adequately powered studies with prespecified analyses are required.