Tibial pilon fractures treated with a periarticular external fixator: retrospective study of 47 cases

Background:The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures.Methods:We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation.Results:We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixationConclusion:Temporary stabilization with external fixator in ‘tripolar’ configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases.

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Functional results of compound extra articular tibial pilon fractures managed with hybrid external fixator

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211395 ◽

2021 ◽

Author(s):

Gagandeep Singh Raina ◽

Sanjeev Gupta ◽

Mohammad Azharuddin ◽

Zubair A. Lone ◽

Manoj Kumar

Keyword(s):

External Fixator ◽

Subcutaneous Tissue ◽

Treatment Options ◽

Distal Tibia ◽

Functional Results ◽

Clinical Findings ◽

Definitive Treatment ◽

Tibial Pilon ◽

Hybrid External Fixator ◽

Pilon Fractures

Background: Distal tibia fractures are difficult to treat. It is often difficult to assess the potential risk of surgical complications because of the variations in the clinical findings. Less subcutaneous tissue, limited blood supply and no muscle insertions are the factors that tend to make the healing of the soft tissue more complex. Compounding presents a great challenge for the treating surgeon regarding the treatment options.Methods: A total of 23 patients were included in the study based on the inclusion and exclusion criteria and were managed by hybrid external fixator as definitive treatment. They were kept in follow up for at least 6 months and were assessed using Ovadia and Beal’s objective and subjective scoring.Results: All patients achieved fracture union with 82% patients reporting excellent to good functional outcome. Pin site infections and ankle stiffness were most common complications.Conclusions: A very good outcome is achieved in compound extra articular tibial pilon fractures with the hybrid fixator technique. Adequate stability is provided and hence early motion and ambulation can be started.

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External Fixation in the Treatment of Tibial Pilon Fractures: Comparison of Two Frames in Torsion

Foot & Ankle International ◽

10.3113/fai.2007.0823 ◽

2007 ◽

Vol 28 (7) ◽

pp. 823-830 ◽

Cited By ~ 5

Author(s):

Aaron T. Scott ◽

John R. Owen ◽

Vishal Khiatani ◽

Robert S. Adelaar ◽

Jennifer S. Wayne

Keyword(s):

External Fixation ◽

External Fixator ◽

Statistical Significance ◽

Testing Machine ◽

Distal Tibia ◽

Materials Testing ◽

Pilon Fracture ◽

Tibial Pilon ◽

Torsional Testing ◽

Pilon Fractures

Background Ankle spanning external fixation has become the initial treatment of choice for complex tibial pilon fractures. Many fixator designs exist, but their biomechanical performance has not been studied extensively for this application. The goal of the present study was to compare the torsional performance of two commercially available frames, the Orthofix XCaliber and the Howmedica Hoffmann® II. Methods The XCaliber and the Hoffmann® II were each applied to six fresh cadaver lower extremities and were loaded in a materials testing machine. Strain gauges were attached to the anteromedial cortex of the distal tibia, and each specimen underwent torsional and axial load testing, with and without the external fixator. A simulated pilon fracture was created, and torsional testing was repeated. Results Results indicated that the XCaliber was significantly more rigid in internal rotation than the Hoffmann® II, before (49%) and after (41%) creation of the pilon fracture. Despite the XCaliber's increased rigidity relative to the Hoffmann® II (22% to 31%) in external rotation, statistical significance was not attained. Both fixators reduced strain (25% to 85%) at the anteromedial cortex upon torsional testing, but no significant differences between the two frames were noted. Conclusions The present study demonstrates that the XCaliber has mechanical advantages over the Hoffmann® II in terms of torsional rigidity for a tibial pilon fracture. Clinical Relevance Increased rigidity of the XCaliber could potentially lead to decreased time to union, and a lower incidence of pin loosening and would prove beneficial in a setting in which the external fixator is used as the definitive fixation.

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Is the proximity of external fixator pins to eventual definitive fixation implants related to the risk of deep infection in the staged management of tibial pilon fractures?

Injury ◽

10.1016/j.injury.2019.09.016 ◽

2019 ◽

Vol 50 (11) ◽

pp. 2103-2107 ◽

Cited By ~ 2

Author(s):

Jeffrey M. Potter ◽

Quirine M.J. van der Vliet ◽

John G. Esposito ◽

Michael F. McTague ◽

Michael Weaver ◽

...

Keyword(s):

External Fixator ◽

Deep Infection ◽

Tibial Pilon ◽

Pilon Fractures

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Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases

MUSCULOSKELETAL SURGERY ◽

10.1007/s12306-018-0550-z ◽

2018 ◽

Vol 103 (1) ◽

pp. 83-89 ◽

Cited By ~ 2

Author(s):

M. Scaglione ◽

F. Celli ◽

F. Casella ◽

L. Fabbri

Keyword(s):

External Fixator ◽

Tibial Pilon ◽

Hybrid External Fixator ◽

Pilon Fractures

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Clinical Value of Computer-Assisted Taylor Three-dimensional External Fixation in the Treatment of Tibiofibular Fracture (Preprint)

10.2196/preprints.20711 ◽

2020 ◽

Author(s):

Hongfeng Sheng ◽

Weixing Xu ◽

Bin Xu ◽

Hongpu Song ◽

Di Lu ◽

...

Keyword(s):

Retrospective Study ◽

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Theoretical Basis ◽

New Technology ◽

Three Dimensional ◽

Computer Assisted ◽

Clinical Value

UNSTRUCTURED The retrospective study of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures provides a theoretical basis for the application of this technology. The paper collected 28 patients with tibiofibular fractures from the Department of Orthopaedics in our hospital from March 2015 to June 2018. After the treatment, the follow-up evaluation of Taylor's three-dimensional external fixator for the treatment of tibiofibular fractures and concurrency the incidence of the disease, as well as the efficacy and occurrence of the internal fixation of the treatment of tibial fractures in our hospital. The results showed that Taylor's three-dimensional external fixator was superior to orthopaedics in the treatment of tibiofibular fractures in terms of efficacy and complications. To this end, the thesis research can be concluded as follows: Taylor three-dimensional external fixation in the treatment of tibiofibular fractures is more effective, and the incidence of occurrence is low, is a new technology for the treatment of tibiofibular fractures, it is worthy of clinical promotion.

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