Ilizarov Circular Fixation for High-Velocity Firearm Injuries Causing High-Energy Tibial Fractures: A Prospective Cohort Study

Abstract

High-velocity gunshot tibial fractures present major reconstructive challenges owing to extensive contamination, soft-tissue devitalisation, and segmental bone loss that render early internal fixation hazardous. We aimed to document outcomes of a structured Ilizarov-based protocol for this injury type and describe a reproducible treatment framework for resource-constrained settings. Between January 2019 and December 2023, we prospectively enrolled 20 adult male patients with open tibial fractures from high-velocity firearm injuries at three Cairo trauma centres; all were treated definitively with an Ilizarov circular external fixator, with distraction osteogenesis and fibular autografting were employed selectively for segmental bone loss. The primary outcome was fracture union rate; secondary outcomes included fixation duration, surgical burden, and complications. Mean age was 29.7 ± 8.4 years. Fourteen fractures (70%) were Gustilo-Anderson type IIIA and six (30%) type IIIB; bone defects were present in 50% after debridement. Union was achieved in 19 of 20 patients (95%), and the single non-union resolved after frame revision and supplementary grafting. Mean fixation duration was 12.3 ± 7.28 months. Superficial pin-tract infection (Checketts-Otterburn Grade 1 or 2) occurred in 17 patients (85%) and deep surgical site infection in one (5%); ankle stiffness, axial malalignment, and limb length discrepancy each affected a minority of patients. structured Ilizarov protocol can reliably achieve union in Gustilo type III gunshot tibial fractures with an acceptable complication profile; these findings are descriptive and do not establish superiority over alternative fixation strategies but support the Ilizarov circular frame as a suitable option for high-grade contaminated injuries in resource-limited environments.