Tibial pilon fracture, results of limited internal fixation

ABSTRACT

Intra-articular fractures of the tibial plafond [pilon fractures] are a combination of an ankle and distal tibial metaphyseal fracture; usually with intra-articular comminution. They are considered among the most challenging of orthopaedic problems. The optimum treatment of these fractures remains controversial. Eighteen patients [19 - 54 y.] with 18 tibial pilon fractures were operated upon. There were 4 fractures [22.2%] type II; and 7 fractures [38.9%] type III Ruedi and Allgower classification. Another four fractures [22.2%] were type IV and the remaining three fractures [16.7%] were type V; Ovadia and Beals added other types. Eleven fractures [61.1%] were open type I, II or IIIA Gustilo and Anderson classification. Treatment was limited open reduction with small direct incisions over the main fractures fragments and with the least needed dissection and with minimal internal fixation of both the tibia and the fibula. Only two patients [11.1%], who had an intact fibula, had fixation of their tibiae only. Only inter fragmentary screws [ +/- K. wires] were used for fixation. Bone-grafting of structurally deficient metaphyseal areas was done in seven [38.9%] cases. Post-operative below knee bracing was used for 4 - 6 weeks. Early mobilization and early weight bearing were always aimed. Bone healing was achieved in all cases [in 6 - 18 weeks; average 10.3 w]. At a minimum of two years of follow-up postoperatively, [range 24 to 33 months with an average of 28 m.], the range of motion was excellent in 6 patients [33.3%], good in nine [50%], fair in two [11.1%], and poor in one [5.6%]. The final clinical score was excellent in 7 patients [38.9%], good in another 7 patients [38.9%], fair in 3 patients [16.6%] and poor in one patient [5.6%]. Limited open reduction with minimal internal fixation is a satisfactory method for treatment of pilon fractures. It is associated with good final outcome, significant reduction in bone healing time, delayed union incidence and reoperation rate; with few reported complications