Temporary Stabilization with External Fixator in ‘Tripolar’ Configuration in Two Steps Treatment of Tibial Pilon Fractures

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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Outcome of complex tibial pilon fractures definitively treated with external fixator

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204578 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1145

Author(s):

Meryem Lemsanni ◽

Youssef Najeb ◽

Rachid Chafik ◽

Mohamed Madhar ◽

Hanane Elhaoury

Keyword(s):

Minimally Invasive ◽

External Fixation ◽

Case Series ◽

High Energy ◽

Definitive Treatment ◽

External Fixators ◽

Minimally Invasive Osteosynthesis ◽

Tibial Pilon ◽

Pilon Fractures

Background: Complex tibial pilon fractures are typically sustained with high-energy mechanisms and they are often associated with severe soft tissue compromise that can frequently results in severe complications. The purpose of this prospective case series was to evaluate the radiological and clinical outcomes after the use of external fixation combined with minimally invasive osteosynthesis, as primary and definitive treatment of complex tibial pilon fractures.Methods: A prospective study was undertaken during the period from March 2012 to June 2016. A total number of 109 patients with complex tibial pilon fractures were managed in our institution and included in the study. All the patients were treated with external fixation and minimally invasive osteosynthesis. The mean follow-up period was 47 months (31-60 months). Clinico-radiological progression of fracture union as well as the functional outcome were studied.Results: Eighty fractures resulted from traffic accidents and type 43-C3 fracture according to AO/OTA classification was the most common. Seventy-eight were open fractures and 94 patients had associated distal fibular fractures. All patients were treated with monolateral external fixators for definitive management. The average time to union was 14 weeks (range 9-19). Eleven patients (10%) suffered superficial pin tract infection. One patient developed septic arthritis and evidence of radiological osteoarthritis was present in ten cases (9%) at final follow-up. The American orthopaedic foot and ankle society (AOFAS) score was 84.4±8.1, translating to good clinical results.Conclusions: This review concludes that external fixation, combined with minimally invasive osteosynthesis, consistently produces good functional results without serious complications.

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