Abstract
BackgroundManagement of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction.MethodsTwenty-five patients according to Tscherne/Oestern FxCO-I closed fracture and FxOI open fractures classification after Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis.ResultsTwenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3–36).ConclusionsLarge autologous ilium with periosteum in combination with ORIF can be performed for tibiotalar joint reconstruction. This experimental procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up.Level of evidenceLevel III, retrospective cohort study.
Highlights
Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon
Large autologous ilium with periosteum in combination with open reduction and internal fixation (ORIF) can be performed for tibiotalar joint reconstruction
This experimental procedure reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures in short follow-up
Summary
Management of Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture presents numerous challenges to the orthopaedic surgeon. Pilon fractures are associated with a high risk of would complications, and predispose the patient to developing post-traumatic osteoarthritis of the tibiotalar joint. The management of these fractures present numerous challenges to the orthopaedic surgeon, for the Rüedi-Allgöwer III or AO/OTA type C3 pilon fracture, which represents severely comminuted fractures with impaction of the distal tibia and are heterogeneous in both injury pattern and treatment [4, 5]. There is a paucity of studies reporting the use of a large autologous ilium with periosteum for tibiotalar joint reconstruction in pilon fractures, and long-term outcomes following such treatment
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