Acute management of complex tibial pilon fractures (AO/OTA 43-C)

Abstract

Background In pilon fracture management, careful soft tissue handling is as relevant as the treatment of the bony injury itself. It is crucial to spare the extraosseous vessels during surgery as best as possible. Minimally invasive plate osteosynthesis has attracted great interest in the management of distal tibia fractures and can be used as an alternative to staged approach. Patients and methods From January 2009 to December 2013, 32 pilon fractures (AO/OTA 43-C) in 30 patients were treated by acute minimally invasive plate osteosynthesis with distal tibia anatomical locked plates within an average 1.3 days of injury. The mean follow-up time was 30.8 months (24–48 months). Immediate postoperative reduction was assessed, and rating of the symptoms and functional abilities of each patient was done according to American Orthopaedic Foot and Ankle Society ankle-hind foot score. Results Satisfactory immediate postoperative radiograph articular reduction was achieved in 90.9% (n=29) ankles. There is no statistically significant difference (P>0.05) between immediate postoperative reduction and reduction at the final follow-up. Bony union was achieved in all cases after an average of 4.6 months (3–8 months). The mean American Orthopaedic Foot and Ankle Society ankle-hind foot score at final follow-up was 79. Excellent clinical result was achieved in 21 (65.6%) ankles, good in nine (28.1%) ankles, and poor in two (6.3%) ankles. Complications include one deep infection and two ankle arthrodesis. Conclusions Acute minimally invasive approach combined with locking plates for the treatment of complex pilon fractures decreases complications associated with disruption of the soft tissue envelope and associated osseous complications and allows quicker return to function. Level of evidence: Level IV, case series.