Management of Distal Tibial Intra-Articular Fractures by Using Ring External Fixators Assisted Arthroscopically

Abstract

Background: Tibial pilon fractures are relatively uncommon injuries, representing only 1% of all fractures of the lower limb and 5% to 10% of those of the tibia. Frequent comminution and the thin soft-tissue envelope in the area make the treatment of these fractures challenging. The tibial pilon is characterised by a total absence of muscle coverage and marginal vascularity. Therefore, even moderate trauma often results in extensive soft-tissue damage. Objective: The aim of this present study was to evaluate the arthroscopic assisted (Ilizarov) ring external fixation of distal tibial intra articular (pilon) fractures. Patients and methods: This was a prospective study conducted between February 2012, April 2015 on thirty patients with closed, and Gustilo Types I & II open fractures of pilon fractures of the distal tibia who were admitted to Zagazig University Hospitals. During a period of two years, all cases were treated by Ilizarov fixators with or without limited internal fixation and assessment of intra-articular reduction tibial plafond by arthroscopy. Results: Nineteen patients had right-sided injury, eleven patients had left sided injury and one patient had bilateral injury. At the time of injury, the youngest patient was 19 years old and the oldest was 6o years. The results in relation to pain as distributed according to the fracture. It is noted that the excellent results were with type I & II fracture, while the fair and poor results were with type II and III fracture. Conclusion: The present study provided information on the use and the role of ankle arthroscopy in assisting and evaluation (the value, advantages, techniques of ankle arthroscopy and ring external fixators) of distal tibial intra- articular reduction after pilon fracture. The study showed that this technique might be a good method to manage the pilon fractures.