Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction.

Huasong Luo,Kebin Liu,Songming Peng,Yang Yi,Liaobin Chen,Jien Zhang

doi:10.1186/s40064-016-3601-7

Abstract

ObjectiveThe aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator.MethodsThirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system.Results Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%.ConclusionArthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.

Highlights

Tibial pilon fractures affect weight-loading on the articular surface and metaphysis; these severe injuries comprise about 5–10% of all lower limb fractures, and have high complication rates (McFerran et al 1992)
The surgical treatment of tibial pilon fractures includes open reduction and internal fixation, limited internal fixation combined with external fixation, minimally invasive treatment, and fusion of the ankle joint
Sirkin et al (2004) used open reduction and internal fixation to treat high-energy tibial fractures in a twostage protocol according to the characteristics of the soft tissue injury

Summary

Introduction

Tibial pilon fractures affect weight-loading on the articular surface and metaphysis; these severe injuries comprise about 5–10% of all lower limb fractures, and have high complication rates (range 11.4–54%) (McFerran et al 1992). The surgical fixation method is determined according to the extent of the fracture and displaced articular surface, as well as the condition of the soft tissue. For the treatment of pilon fractures, Watson emphasized that minimally invasive separation of soft tissue protects the blood supply of the fractured bone and provides indirect reduction. Luo et al SpringerPlus (2016) 5:1923 the surgical approach on the basis of the condition of the injured soft tissue, and recommended the use of limited exposure and stabilization with small wire circular external fixators. Thirteen patients with tibial pilon fractures underwent definitive treatment with limited open reduction and internal fixation with external fixators under arthroscopic guidance at our hospital from November 2010 to December 2013.

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Conclusion