scholarly journals Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yash P. Chaudhry ◽  
Efstratios Papadelis ◽  
Hunter Hayes ◽  
Philip F. Stahel ◽  
Erik A. Hasenboehler
Keyword(s):  
Fracture Fixation ◽  
Complication Rate ◽  
Wound Complication ◽  
Ankle Arthrodesis ◽  
Pilon Fracture ◽  
Eligibility Criteria ◽  
Tibial Pilon ◽  
Mesh Terms ◽  
The Mean ◽  
Pilon Fractures

Abstract Background Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries. Methods A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications. Results The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group. Conclusions At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

scholarly journals Should Complex Comminuted C3-Type Tibial Pilon Fractures Be Fused or Fixated? A Systematic Review

2021 ◽  
Author(s):  
Yash Paul Chaudhry ◽  
Efstratios Papadelis ◽  
Hunter Hayes ◽  
Philip F. Stahel ◽  
Erik A. Hasenboehler
Keyword(s):  
Fracture Fixation ◽  
Complication Rate ◽  
Wound Complication ◽  
Ankle Arthrodesis ◽  
Pilon Fracture ◽  
Eligibility Criteria ◽  
Tibial Pilon ◽  
Mesh Terms ◽  
The Mean ◽  
Pilon Fractures

Abstract Background: Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed (1) treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and (2) primary ankle arthrodesis as a management option for these types of complex injuries.Methods: A systematic literature search was performed on PubMed from 1990-2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures.The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications.Results: The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group.Conclusions: At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

scholarly journals Fractures of The Tibial Plafond: Does the Presence or Absence of a Fibular Fracture Predict Future Morbidity?

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Henry Boateng ◽  
Chinenye Nwachuku ◽  
Kempland C. Walley ◽  
Justin W. Walker ◽  
Rhett MacNeille ◽  
...  
Keyword(s):  
Outcome Measurement ◽  
Statistical Significance ◽  
Ankle Arthrodesis ◽  
Pilon Fracture ◽  
Type B ◽  
Inclusion Criteria ◽  
Patient Counselling ◽  
Anatomic Reduction ◽  
Type C ◽  
Pilon Fractures

Category: Trauma Introduction/Purpose: Surgical management pilon fractures continue to be a challenge for orthopedic surgeons. Despite a staged protocol, anatomic reduction, and stable fixation, many patients will require secondary procedures including ankle arthrodesis to treat painful post-traumatic arthritis. Some investigators have correlated the absorbed energy at the time of the injury with the natural history of the pilon fracture despite the quality of the surgical reconstruction. We hypothesize that the presence of an intact fibula in association with an OTA Type C pilon fracture may be a marker for a strict axial compression mechanism resulting in more severe cartilage compression and a poor late outcome. No studies to date have correlated the presence of an intact fibula to pilon fracture outcome. Methods: An IRB approved 7-year retrospective study was performed at three Level I Trauma Centers. Inclusion criteria included all adult patents (=18) with isolated OTA type B or C pilon fractures from 2008 through 2014. All patients were treated in a staged fashion with initial external fixation by fellowship-trained orthopedic traumatologists. The primary outcome measurement was ankle arthrodesis. Secondary measurements included infection. Binary logistic regression models were used to evaluate prognostic factors of arthrodesis and infection. A total of 239 patients met inclusion criteria for a complete case analysis. Results: It was found that OTA Type C pilon fractures (OR (95% CI): 6.34 (0.80, 49.98), p=0.08), intact fibulas (OR (95% CI): 1.39 (0.43, 4.53), p=0.58), and open injuries (OR (95% CI): 2.19 (0.56, 8.55), p=0.26) were more likely to result in eventual arthrodesis compared to OTA Type B pilon fractures, fractured fibulas, and closed injuries, respectively. However, none of these unadjusted bivariate associations were statistically significant. An intact fibula was significantly less likely to result in infection compared to having a fractured fibula (OR (95% CI): 0.26 (0.08, 0.90), p=0.03), however this effect was no longer significant after accounting for open versus closed injury status (Adjusted OR (95% CI): 0.35 (0.10, 1.26), p=0.11). Conclusion: The results of this study suggest an adverse relationship for closed complex pilon fractures with an intact fibula. This was especially pronounced in C type injuries in comparison to type B injuries with a 6.34 odds ratio of subsequent fusion. The data approached statistical significance and may have clinical relevance in the decision making and patient counselling for managing these fractures. Pilon fractures historically have had poor outcomes and a higher rate of secondary surgeries which was surprisingly low in our current study. Further study needs to determine if this observation correlates with improved patient outcomes.

scholarly journals PO 18143 - AO type 43C tibial pilon fractures

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. S29
Author(s):  
Kelly Cristina Stéfani ◽  
Vinicius Quadros Borges ◽  
Gabriel Ferraz Ferreira ◽  
Leonardo Vinícius De Matos Moraes
Keyword(s):  
Cartilage Damage ◽  
Treatment Protocol ◽  
Anatomical Reconstruction ◽  
Pilon Fracture ◽  
Tibial Pilon ◽  
Tibial Pilon Fracture ◽  
Osteosynthesis Material ◽  
Soft Tissue Involvement ◽  
Final Treatment ◽  
Pilon Fractures

Objective: The objective of this study was to prospectively evaluate operated cases of AO type 43C tibial pilon fracture and to assess factors that might influence functional outcomes during the late postoperative period.  Methods: Patients were classified according to the OTA/AO Classification using X-ray and computed tomography (CT) scans. Patients with type 43C fractures were included in this study. A total of 98 tibial pilon osteosynthesis surgeries were performed, and 35 cases were selected for this study based on the inclusion criteria. The treatment protocol established was based on the Tscherne Classification.  Results: We observed that immediate skin complications might be a prognostic factor for the late removal of osteosynthesis material (mean = 2 years postoperation) because an association was found between skin complications and the removal of osteosynthesis material. We observed a high incidence of late arthritis complications in both groups, which indicates that post-traumatic arthritis associated with 43C pilon fractures is practically certain.  Conclusion: No differences were found between the groups when correlating the American Foot and Ankle Score (AOFAS), the degree of arthritis, and skin complications; therefore, complications did not determine the outcomes of tibial pilon fracture. Although the cartilage damage that occurs at the time of injury is a significant mediator of the clinical outcome, more important factors affect the final treatment outcome. In our study, these factors were the treatment protocol based on soft tissue involvement, anatomical reconstruction of the joint, and rigid internal fixation with early range of motion.

Ankle Arthrodesis Using Antegrade Intramedullary Nail for Salvage of Nonreconstructable Tibial Pilon Fractures

Orthopedics ◽  
2009 ◽  
Vol 32 (8) ◽  
pp. 611-614 ◽  
Author(s):  
Takahiro Niikura ◽  
Masahiko Miwa ◽  
Yoshitada Sakai ◽  
Sang Yang Lee ◽  
Keisuke Oe ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Ankle Arthrodesis ◽  
Tibial Pilon ◽  
Pilon Fractures

scholarly journals Foot Loading Analysis of Intraarticular Tibia Pilon Fracture

2021 ◽  
Author(s):  
Anil Agar ◽  
Adem ŞAHİN ◽  
Seyit Ali Guclu ◽  
Deniz Gülabi ◽  
Cemil Erturk
Keyword(s):  
Functional Results ◽  
Pilon Fracture ◽  
Plantar Pressure Distribution ◽  
Functional Scores ◽  
The Mean ◽  
Foot Loading ◽  
Gait Function ◽  
Pilon Fractures ◽  
Loading Analysis

BACKGROUND: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of treatment and adverse effects on gait function. The aim of the study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis and plantar pressure distribution in patients with tibia pilon fractures. METHODS: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January 2015 and January 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria, ankle functional scores with the Teeny-Wiss score, and ankle arthrosis with the Takakura classification. In the last follow-up of the patients, foot loading analysis was performed and the results of the patients were evaluated for their relation with postoperative reduction quality, ankle functions and ankle arthrosis. RESULTS: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range 19-78). The mean follow-up was 34.3 months (range 24 - 58). The mean Ovadia-Beals score was 12.35 {plus minus} 4.6 in the postoperative plain radiographs of the patients; the mean Teeny-Wiss score in the last follow-up was 76.82 {plus minus} 17.69, and the Takakura score was 1.47 {plus minus} 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior and 52.42% on the posterior of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial of the ankle and 57.85% loaded on the lateral of the foot. CONCLUSION: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.

scholarly journals Fractures of the Tibial Plafond: Does the Presence or Absence of a Fibular Fracture Predict Future Morbidity?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0013
Author(s):  
Henry Boateng ◽  
Kempland C. Walley ◽  
Chinenye Nwachuku ◽  
Vince Lands ◽  
Justin W. Walker ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Pilon Fracture ◽  
Type B ◽  
Inclusion Criteria ◽  
Patient Counselling ◽  
Fibula Fracture ◽  
Anatomic Reduction ◽  
Type C ◽  
Open Injuries ◽  
Pilon Fractures

Category: Trauma; Ankle Introduction/Purpose: Surgical management pilon fractures continue to be a challenge for orthopedic surgeons. Despite a staged protocol, anatomic reduction, and stable fixation, many patients will require secondary procedures including ankle arthrodesis to treat painful post-traumatic arthritis. Some investigators have correlated the absorbed energy at the time of the injury with the natural history of the pilon fracture despite the quality of the surgical reconstruction. We hypothesize that the presence of an intact fibula in association with an OTA Type C pilon fracture may be a marker for a strict axial compression mechanism resulting in more severe cartilage compression and a poor late outcome. No studies to date have correlated the presence of an intact fibula to pilon fracture outcomes. Methods: An IRB approved 7-year retrospective study was performed at three Level I Trauma Centers. Inclusion criteria included all adult patients (>=18) with isolated OTA type B or C pilon fractures from 2008 through 2014. All patients were treated in a staged fashion with initial external fixation by fellowship-trained orthopedic traumatologists. The primary outcome measurement was ankle arthrodesis. Secondary measurements included infection. Binary logistic regression models were used to evaluate the prognostic factors of arthrodesis and infection. Results: A total of 239 patients met inclusion criteria for analysis: 33-patients (13.81%) had open injuries, 155 (64.85%) had a C type pilon fracture and 157 fractures (65.69%) presented with an associated fibula fracture. Only 12 patients (5.02%) progressed to ankle arthrodesis. The incidence of fusion in the intact fibula group was 5 (6.10%) similar to that of 7 (4.46%) of patients with an associated fibula fracture. It was found that OTA Type C pilon fractures (OR (95% CI): 6.34 (0.80, 49.98), p=0.08), intact fibulas (OR (95% CI): 1.39 (0.43, 4.53), p=0.58), and open injuries (OR (95% CI): 2.19 (0.56, 8.55), p=0.26) were more likely to result in eventual arthrodesis compared to OTA Type B pilon fractures, fractured fibulas, and closed injuries, respectively. Conclusion: The results of this study suggest an adverse relationship for closed complex pilon fractures with an intact fibula. This was especially pronounced in C type injuries in comparison to type B injuries with a 6.34 odds ratio of subsequent fusion. The data approached statistical significance and may have clinical relevance in the decision making and patient counselling for managing these fractures. Pilon fractures historically have had poor outcomes and a higher rate of secondary surgeries which was surprisingly low in our current study. Further study needs to determine if this observation correlates with improved patient outcomes. [Table: see text]

Lateral Transfibular Approach to Tibial Pilon Fractures: A Case Report

2019 ◽  
Vol 109 (6) ◽  
pp. 459-462
Author(s):  
Bilgehan Tosun ◽  
Ozgur Selek
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Distal Tibia ◽  
Lateral Part ◽  
Pilon Fracture ◽  
Tibial Pilon ◽  
Tibial Pilon Fracture ◽  
Second Year ◽  
Pilon Fractures

We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.

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

2007 ◽  
Vol 28 (7) ◽  
pp. 823-830 ◽  
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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