Study Summary

68 patients with Grade II, IIIA, or IIIB compound tibial shaft fractures were randomized between December 2023 and May 2025. Four patients were excluded at final analysis, leaving 64 patients analyzed. Patients were randomized into the Ilizarov group and limb reconstruction system (LRS) group. The outcomes of interest were the Association for the Study and Application of the Method of Ilizarov (ASAMI) bone and functional scores, complications (pin-site infection, nonunion, limb length discrepancy), bone defect measurement, and external fixator index. Outcomes were assessed at 6 weeks, 3 months, 6 months, and final follow-up (minimum 9 months). Overall, the results of the study demonstrated that both Ilizarov and LRS groups showed progressive improvement in bone healing and functional recovery over time. However, the Ilizarov group consistently showed superior functional outcomes at early follow-ups and better radiological maturation. Both techniques achieved high rates of union and good to excellent overall outcomes by final follow-up, though Ilizarov demonstrated comparatively stronger early and overall performance.