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

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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Lateral Transfibular Approach to Tibial Pilon Fractures: A Case Report

Journal of the American Podiatric Medical Association ◽

10.7547/17-212 ◽

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.

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

The Open Orthopaedics Journal ◽

10.2174/1874325001610010049 ◽

2016 ◽

Vol 10 (1) ◽

pp. 49-55 ◽

Cited By ~ 1

Author(s):

Walter Daghino ◽

Marco Messina ◽

Marco Filipponi ◽

Massè Alessandro

Keyword(s):

External Fixation ◽

External Fixator ◽

Mechanical Stability ◽

Open Reduction Internal Fixation ◽

Definitive Treatment ◽

X Rays ◽

Tibial Pilon ◽

Therapeutic Problem ◽

Temporary Stabilization ◽

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

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2021.103148 ◽

2021 ◽

pp. 103148

Author(s):

Yohan Legallois ◽

Fabien Baudelle ◽

Pierre Lavignac ◽

Matthieu Garcia ◽

Pierre Meynard ◽

...

Keyword(s):

Retrospective Study ◽

External Fixator ◽

Tibial Pilon ◽

Pilon Fractures

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

10.21203/rs.3.rs-401625/v1 ◽

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.

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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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