Gelenkerhaltende Rekonstruktion fehlverheilter Pilon-tibiale-Frakturen

Abstract

Malunions and nonunions after tibial pilon fractures regularly lead to progressive development of painful posttraumatic ankle arthritis and malposition of the hindfoot with severe functional impairment. The ideal solution of secondary anatomic reconstruction with joint preservation will be possible in carefully selected cases only. Prerequisites for successful reconstruction are intact cartilage, sufficient bone quality, residual function and good patient compliance.Over a period of 21 years, we have treated 14 patients aged 28 to 50 years with corrective intra-articular osteotomy and secondary reconstruction for malunited pilon fractures. 3 patients had an additional non-union or focal necrosis. Revision surgery was needed for one non-union, one avascular necrosis of the tibial metaphysis, and in 3 cases of hardware protrusion. At 5 years follow-up, radiographic signs of posttraumatic arthritis were noted in all cases. The clinical result was excellent in one, good in 9, fair in 2 and poor in 2 patients. Ankle fusion was done in the latter 2 patients.Anatomical reconstruction of malunited tibial pilon fractures is a viable treatment option in selected patients.