Use of an articulated and spanning external fixator for Pilon fractures / 中华创伤骨科杂志

ABSTRACT

Objective To introduce our experience of treating Pilon fractures with an articulated and spanning external fixator. Methods From February 2002 to June 2004, 19 patients with high energy Pilon fractures (21 sides) were treated with a T- shaped unilateral articulated and spanning external fixator in our department. The fixators were placed medial1y across the ankle joint, and the fixation of fracture was enhanced by a combined use of limited internal fixation. The main causes of injury were traffic accidents and high altitude falling. The distal 2 pins were inserted into the talus and the tuberosity of calcaneus so that the subtalar joint was treated as an axis during ankle movement. At approximately postoperative 2 or 3 weeks, the articular hinge was released and the patient began ankle exercises. The clinical outcomes and complications were investigated and the postoperative X- ray examinations of the ankle were also evaluated. Results 19 patients were followed up for a mean period of 13 months. No infection of wound or pin site, no neurovascular complication or no nonunion was found. According to Baird & Jackson ankle joint scoring system, their functional evaluation of the ankle scored from 72 to 98 (averaging 92). Clinical results were excellent in 4, good in 12, fair in 3 and poor in 2. Reduction of the articular surface was anatomic in 16, fair in 3 and poor in 2 according to Burwell & Charnley classification. Conclusions External fixation with an articulated and spanning fixator combined with limited internal fixation is a satisfying technique to treat Pilon fractures. This technique can restore anatomical articular surface, allow early ankle joint motion, effectively decrease complications of both wound and bone healing, and prevent ankle joint stiffness after fixation.