New minimally invasive view of tibial pilon fractures: Experience of the A4 orthopaedic traumatology department at CHU Ibn Rochd in Casablanca

Abstract

Tibial pilon fractures are rare and serious fractures, given their complexity and therapeutic difficulty. Closed-focus osteosynthesis is an interesting alternative for treating these fractures. In order to assess the clinical and radiological results of treating tibial pilon fractures with closed-focus osteosynthesis, we conducted a retrospective descriptive study of a series of 80 tibial pilon fractures treated at the Traumatology-Orthopedics Department A4 of CHU Ibn Rochd in Casablanca, over a period from January 2017 to December 2022. The mean age in our study was 42.5 years, with a M/F sex ratio equal to 3. Etiological circumstances were dominated by high-energy mechanisms, including falls from a high place in 43% and MVAs in 42% of cases. Clinical diagnosis was guided in 100% of cases by functional impotence, pain and localized swelling. We performed an ankle radiograph in front and side views, complemented by a CT scan, in all our patients to confirm the diagnosis and classify the different fracture types. Surgical treatment with closed-focus osteosynthesis was performed by combined treatment in 50% of cases; external fixator in 20% of cases; and minimally invasive treatment under arthroscopy in 30% of cases. According to CAFFINIERE criteria, functional and radiological results were good and satisfactory in 80.57% of cases, and poor in 19.43%. Complications included algodystrophy in 28.75% of cases, infection in 10%, joint stiffness in 13.75%, pseudarthrosis in 11.25%, arthrosis in 11.25% and callus in 7.5%. Finally, analysis of our results showed that the majority of our patients treated with closed-focus osteosynthesis had good functional, clinical and radiological results, demonstrating the effectiveness of this surgical method in tibial pilon fractures.