A Comparison of Functional Outcome of Intra Articular Distal Tibial Pilon Fracture Treated by One Stage vs Two Stage Surgically

Introduction: The study was conducted to evaluate clinical and functional outcomes of comminuted pilon of distal tibial fractures after surgical management and fixation by modalities available ranging from temporary external fixation, simple distal tibial plates to moderate plating system and intra medullary nails for fibula. Methodology: Total 24 cases with intraarticular distal tibial pilon fracture were randomly divided in to two group. One group was managed by one stage procedure and second group was operated by two stage procedure. Results: From this study we infer that patient who had undergone one stage procedure had shorter hospital stay. In present study we observed that arthrosis, superficial infection and arthritis was higher in two stage procedure. Assessed by Ovadia Beals Evaluation Score - Objective Evaluation as well as subjective evaluation. Furthermore, the rate of complications was also identical. However, functional outcome assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score revealed that the patients underwent one stage procedure had better functional outcome. Conclusion: Considering the better functional outcome and the shorter hospital stay, we preferred using one stage operative procedure in better skin condition, less soft tissue damage, closed fracture of type b and C AO/OTA Pilon fractures.

Effect of locking compression plate and anatomical plate internal fixation in treatment of closed tibial Pilon fracture and its influence on lower limb functional rehabilitation / 临床外科杂志

Objective To investigate the effect of locking compression plate(LCP)and anatomi-cal plate(AP)in the treatment of closed tibial Pilon fracture and its influence on lower limb functional re-habilitation.Methods A total of 82 patients with closed tibial Pilon fractures were randomly divided into LCP internal fixation group(LCP group,n=41)and AP internal fixation group(AP group,n=41).The perioperative indexes and the incidence of postoperative complications were compared between the two groups.The ankle function was evaluated by American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale(AOFAS-AHS),the lower limb function was evaluated by Lysholm scale,the serum levels of inter-leukin-1β(IL-1β)and interleukin-6(IL-6)were detected.Results The intraoperative blood loss,opera-tion time,hospitalization time,first ground time,fracture healing time were(103. 34 ± 11. 34)ml, (47.65 ± 7.89)min,(9.01 ± 2.23)d,(5.31 ± 1.27)d,(16.23 ± 2.12)weeks in LCP group respective-ly,the AP group were(132.25 ± 34.41)ml,(60.54 ± 11.23)ml,(11.43 ± 2.57)d,(6.23 ± 1.56)d, (23.12 ± 3.31)weeks,respectively.The LCP group were significantly lower than AP group(P<0.05);The excellent rate of ankle function of LCP group was 95.12%,significantly higher than 82.93% in the AP group(P<0.05);The incidence of postoperative complications was 4.88% in the LCP group,which was significantly lower than 29.27% in the AP group(P<0.05);At 3,6 and 12 months after operation, the AOFAS-AHS scores in the LCP group were(69.52 ± 4.18)points,(78.89 ± 6.73)points and (87.23 ± 6.34)points respectively,the AP group were(65.09 ± 4.45)points,(70.13 ± 5.34)points and (76.69 ± 5.91)points respectively,the LCP group were significantly higher than AP group(P<0.05);At 3,6 and 12 months after operation,the Lysholm scores were(77.12 ± 6.43)points,(82.12 ± 7.81)points and(86.19 ± 8.11)points in LCP group,AP group were(67.25 ± 5.56)points,(72.21 ± 7.23)and (77.12 ± 7.54)points,the LCP group was significantly higher than AP group(P<0.05).At 3 d and 4 weeks after operation,the serum levels of IL-1β in LCP group were(0.37 ± 0.09)pg/ml,(0.19 ± 0.06) pg/ml,while in AP group were(0.45 ± 0.13)pg/ml,(0.27 ± 0.09)pg/ml;the serum levels of IL-6 in LCP group were(201.23 ± 30.12)ng/L,(102.23 ± 25.21)ng/L,while in AP group were(246.71 ± 41.23)ng/L,(158.95 ± 25.21)ng/L.The AP group were significantly lower than those in AP group(P<0.05).Conclusion LCP and AP in treatment of closed tibial Pilon fractures have a significant effect,but LCP can reduce the surgical trauma,shorten the operation time and postoperative recovery time,to a cer-tain extent,improve the ankle and lower limb function,and reduce the postoperative fixation fracture heal-ing and other complications.

One-stage management of open distal tibial Pilon fractures / 中南大学学报(医学版)

Objective To explore the operative method of open distal tibial pilon fractures, and to evaluate the outcome of ankle joint function postoperatively. Methods From March 2003 to March 2007, 24 patients with open Pilon fractures were treated with one-stage open reduction and internal fixation (18 males and 6 females) . The average age was 37. 6 years (14 ～ 53 years) . All 24 patients had open fracture, 12 of whom combined fibular fracture. According to AO comprehensive classification system, the fractures was classified as C1 in 4, C2 in 9, and C3 in 11. According to Gustilo-Anderson classification method, the fracture was classified as Type Ⅰ in 3, Type Ⅱ in 5, Type Ⅲ A in 4, Type Ⅲ B in 10, and Type Ⅲ C in 2. All tibial pilon fractures were treated by radical debridement, one - stage open reduction and internal fixation. Soft tissue defection was covered by a vascularized flap and continually washed by pipes under the flap. Results All patients were followed-up at an average of 2. 3 years(1～3.8 years) after the surgery. All the fractures healed at an average of 22. 3 weeks (16 ～54 wk) postoperatively. According to the scoring system of Con-roy, 17 were excellent (62. 5%), 4 good (25%), and 3 poor (12.5%), The excellence rate was 87.5% . According to the ankle score of Teeny and Wiss, there were 11 excellent (37. 5%), 7 good (37.5%), 3 fair (16.7%), and 3 poor (8.3%) and the excellence rate was 75% . Conclusion One-stage management for open Pilon fracture has the advantages of fewer complications, lower infectious rate, and better ankle joint function.

Arthroscopically Assisted Limited Open Reduction and Ilizarov External Fixation of Tibial Pilon Fractures

PURPOSE: To evaluate the clinical results of the pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation. MATERIALS AND METHODS: This is a retrospective study of the clinical result, bone union, complication and postoperative ankle function of 22 pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation between January 1999 to March 2004. RESULTS: Clinical follow up averaged 16 months, with an average age of 39.2. All patients with type 1 and 2 fracture had excellent or good score by Ovadia and Beals criteria. Closed fractures healed within 13 weeks and open fractures within 16 weeks after surgery in average. Average range of motion of the ankle was 12o dorsiflexion (0~20 degree) and 25o plantar flexion (15~35 degree). CONCLUSION: Minimal soft tissue dissection and anatomical reduction are very important factor for minimizing complication and satisfactory ankle function. So, arthroscopically assisted limited open reduction and Ilizarov external fixation is an effective treatment option for tibial pilon fractures.

Treatment of Tibial Pilon Fractures: Ilizarov Method vs Conventional Methods / 대한정형외과학회잡지

The tibial pilon fracture has been described as difficult fracture to manage. We have reviewed 23 cases of tibial pilon fractures from Mar. 1987 to Feb. 1993 at our hospital. 1. The fractures were classified into five types according to the system of Ovadia and Beals and the methods of treatment were divided into two groups; 9 cases were treated with Ilizarov device(Group I). 6 cases out of Group I were type 3, 4 and 5. Other methods were performed in 14 cases(Group II). 8 cases out of Group II were type 3, 4, and 5. 2. In type 3, 4 and 5 fractures, there were 86 per cent good and fair radiographic results in Group I and 63 per cent good and fair results in Group II. 3. Satisfactory results were obtained by the treatment of Ilizarov method especially in type 3, 4 and 5 fractures. The advantages of Ilizarov device were its primary reduction with ligamentotaxis, easy open reduction due to proximal and distal stabilization, minimal soft tissue injury and minimal internal fixation.

A Comparison of using Interlocking IM Nail versus Plate Fixation in Humeral shaft fractures / 대한정형외과학회잡지

The tibial pilon fracture has been described as difficult fracture to manage. We have reviewed 23 cases of tibial pilon fractures from Mar. 1987 to Feb. 1993 at our hospital. 1. The fractures were classified into five types according to the system of Ovadia and Beals and the methods of treatment were divided into two groups; 9 cases were treated with Ilizarov device(Group I). 6 cases out of Group I were type 3, 4 and 5. Other methods were performed in 14 cases(Group II). 8 cases out of Group II were type 3, 4, and 5. 2. In type 3, 4 and 5 fractures, there were 86 per cent good and fair radiographic results in Group I and 63 per cent good and fair results in Group II. 3. Satisfactory results were obtained by the treatment of Ilizarov method especially in type 3, 4 and 5 fractures. The advantages of Ilizarov device were its primary reduction with ligamentotaxis, easy open reduction due to proximal and distal stabilization, minimal soft tissue injury and minimal internal fixation.

Total Knee Arthroplasty in Charcot's Joints / 대한정형외과학회잡지

Four total knee arthroplasties were performed in 3 patients with the diagnosis of classical Charcot's joints associated with syphilis during past 4 years from 1985 to 1988. All patients had positive reaction in serology test(VDRL, TPHA). We corrected the bone loss and severe joint instability with allograft or autogenous bone grafting and ligament balancing. The knee score was increased from preoperative 37 points to postoperative 87.3 points. We expect that total knee arthroplasty may be the alternative treatment to the conservative treatment or knee arthrodesis in Charcots joints.

A Clinical Study of the tibial Pilon Fractures / 대한정형외과학회잡지

Fractures of the tibial pilon are the severe injuries to the ankle joint resulted from axial compression, shear and/or rotational forces. The mangement has been notoriously difficult due to the comminution of the distal tibia, articular incongruity and soft tissue trauma. The advocated treatment sequence of fibular reconstruction, restoration of the articular suface, bone grafting of defects and the use of an anterior or medial neutralization plate, early movement and delayed weight bearing, were performed recently and the best results have been obtained. The results of treatment of 18 cases were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital and Chong ju Lee Rha Hospital from Mar. 1982 to Aug. 1989. The results were as follows. 1. The most frequent type of fracture was type III according to Ruedi and Allgower's classification. 2. The operative treatment was performed with plates and screws in fourteen cases. 3. The overall good and fair results were 72%.