Two-Stage vs Single-Stage Ilizarov Application in High-Risk Patients: Impact on Early Complications and Resource Utilization
Lukas Fischer, Arnd Viehöfer, Carmen Castroviejo, Alexandros Tsolakidis, Flamur Zendeli, Andreas Flury, Stephan WirthBackground:
Patients treated with an Ilizarov external fixator often feature risk factors that impair wound healing such as diabetes, peripheral arterial disease, obesity, and renal insufficiency. A 2-staged approach, with initial bony correction (Kirschner wire or hybrid) followed by delayed Ilizarov application by 5 days, is intended to support wound healing by allowing for reduction of soft tissue swelling and enhancing postoperative wound care. We hypothesized that this method is associated with fewer wound complications but increased use of resources.
Methods:
A retrospective review of 98 cases treated with an Ilizarov fixator (2004-2024) was conducted. Surgical management included 2-stage (n = 53, 54%) and single-stage (n = 45, 46%) procedures. Baseline characteristics and risk factors for compromised wound healing were recorded. Patients were stratified into 3 subgroups to enable comparative analysis: infection-related reconstructions (IRR), Charcot arthropathy (CA) and other applications. Preoperative presence of infection and ulceration was recorded. Primary endpoints were rates of impaired wound healing and wound revisions within 3 months post removal. Secondary endpoints were hospital length of stay after bony fixation, and total hospitalization costs.
Results:
Wound revision rates were significantly lower in the 2-stage group (9% vs 36%; OR 5.3, 95% CI 1.8-17.9;
Conclusion:
Two-stage Ilizarov ring fixator application in high-risk foot and ankle surgery was associated with lower rates of impaired wound healing and wound revisions, particularly in CA and infection cases, without increasing hospital stay or costs.