"Not to mention estimated completion dates are generally fantasies"
Not true here. The main trouble ticket system that runs everything is remedy. If you want anything you file a ticket. If you see something wrong, you file a ticket. Tickets have service level agreements and must be completed within a certain time (different priorities have different SLAs). We do use tickets to manage feature requests and it tends to make sure stuff gets done in a timely manner.
Its not good for coordinating large scale project management, but for lots of isolated items its OK.
Excel is the best tool I've found for managing projects so far. I am working on a better mac based tool for my own use though.