Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

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Early Limited Internal Fixation of Diaphyseal Extensions in Select Pilon Fractures: Upgrading AO/OTA Type C Fractures to AO/OTA Type B

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e31817e49b8 ◽

2008 ◽

Vol 22 (6) ◽

pp. 426-429 ◽

Cited By ~ 20

Author(s):

Robert P Dunbar ◽

David P Barei ◽

Erik N Kubiak ◽

Sean E Nork ◽

M Bradford Henley

Keyword(s):

Internal Fixation ◽

Type B ◽

Type C ◽

Pilon Fractures

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Open distal tibial pilon fractures treated with "one-stage" external fixation method

Acta chirurgica iugoslavica ◽

10.2298/aci1501013m ◽

2015 ◽

Vol 62 (1) ◽

pp. 13-18

Author(s):

Sasa Milenkovic ◽

Milan Mitkovic ◽

Milorad Mitkovic ◽

Ivan Micic ◽

Sonja Stamenic ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Major Complication ◽

Functional Results ◽

High Energy ◽

Fixation Method ◽

Wound Irrigation ◽

One Stage ◽

Tibial Pilon ◽

Pilon Fractures

Introdiction: Open distal tibial pilon fractures are considered as hard injuries, caused by high-energy axial load. Different treatment methods of these injuries are described in the literature. Authors of this paper are presenting own experience and results in the method of ?one-stage? external fixation with or without limited internal fixation of the fracture. Material and methods: All the patients had emergent surgical treatment in 4 to 8 hours after the hospitalisation. Surgical protocol included wound irrigation, debridement, fracture reduction and external fixation in type A fractures. Type B and type C fractures were treated by ?bridging? external fixation with limited internal fixation. In the cases where wound had not been possible to close primarily additional surgical procedures (soft tissue defects coverage) were performed. Results: Final functional outcome was excelent in 5(31,25%) patients, good in 6 (37,5%) patients, moderate in 3(18,75%) patients and bad in 2 (12,5%) patients (according Karlsson Score). Final anatomical and functional results were in correlation with the type of primary injury. One case of septic pseudoarthrosis and three cases of late ankle arthrosis were found as a major complication. Conclusion High-energy open distal tibial pilon fractures are still considered as a challange and significant surgical problem. The method of external fixation with or without limited internal fixation, as ?one-stage? method, was approved in clinical practice to give excelent and good final functional and anatomical results. Though final functional results were in correlation with degree of the injury, described method gives good outcome results and further clinical application will surely approve its clinical significance.

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Treatment of Type C Pilon Fractures by External Fixator Combined With Limited Open Reduction and Absorbable Internal Fixation

Foot & Ankle International ◽

10.1177/1071100713480344 ◽

2013 ◽

Vol 34 (4) ◽

pp. 534-542 ◽

Cited By ~ 6

Author(s):

Liangyu Zhao ◽

Yongchuan Li ◽

Aimin Chen ◽

Zhiling Zhang ◽

Jiang Xi ◽

...

Keyword(s):

Internal Fixation ◽

External Fixator ◽

Open Reduction ◽

Type C ◽

Pilon Fractures

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Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

Journal of International Medical Research ◽

10.1177/0300060518776099 ◽

2018 ◽

Vol 46 (7) ◽

pp. 2525-2536 ◽

Cited By ~ 3

Author(s):

Xueliang Cui ◽

Hui Chen ◽

Yunfeng Rui ◽

Yang Niu ◽

He Li

Keyword(s):

Postoperative Complications ◽

Internal Fixation ◽

Bone Healing ◽

Open Reduction ◽

Lower Risk ◽

Meta Analysis ◽

Two Stage ◽

Superficial Infection ◽

Tibial Pilon ◽

Pilon Fractures

Objectives Two-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures. Methods We conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis. Results The two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups. Conclusion Two-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures. Level of evidence 2.

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Treatment of Tibial Pilon Fractures with Two-Staged Delayed Open Reduction and Internal Fixation

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2005.40.2.188 ◽

2005 ◽

Vol 40 (2) ◽

pp. 188 ◽

Cited By ~ 1

Author(s):

Hong Moon Sohn ◽

Jun Young Lee ◽

Sang Ho Ha ◽

Sung Min Choi

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Tibial Pilon ◽

Pilon Fractures

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00001 ◽

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.

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