Abstract
Objective: Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. Method: In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). Results: Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. Conclusion: Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study.
Highlights
Intra-articular fractures with involvement of the posterior tibial plafond usually bear a worse long-term prognosis and pertain a higher risk of degenerative changes.[1,2] The mechanism of injury has two components: a vertical compressive component and a torsional component, both individually having the potential to displace a posterior malleolar fragment
At the 24th month of follow-up, the functional outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.[1,13,14]
All ten patients were available for follow-up at an average of 36.2 months
Summary
Intra-articular fractures with involvement of the posterior tibial plafond usually bear a worse long-term prognosis and pertain a higher risk of degenerative changes.[1,2] The mechanism of injury has two components: a vertical compressive component and a torsional component, both individually having the potential to displace a posterior malleolar fragment. In 1996, Huber et al.[5] used “trimalleolar pilon fractures” to describe displaced posterior malleolar fractures with cranial migration of the talus and articular impaction of the distal tibia. During a 3-year period from January 1, 2007, to December 31, 2009, 157 consecutive patients with ankle fractures underwent operative treatment at our institution Of these fractures, 10 fractures in 10 patients with impaction of the posterior tibial plafond were identified as posterior pilon fractures by CT scans and were treated with buttress plating. After satisfactory fracture reduction was achieved and confirmed with intraoperative fluoroscopy, an appropriately sized buttress plate (1/3 tubular plate, small profile T-type plate, etc.) was screwed to the posterior surface of the distal tibia to fixate the posterior malleolus and prevent its secondary migration. At the 24th month of follow-up, the functional outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.[1,13,14] The visual analogue scale (VAS) (0, pain-free; 10, the most unbearable pain) was used to evaluate pain at fracture site during rest, active movement, and weight-bearing walking.[2,14,15,16] The radiological evaluation was performed using osteoarthritis-score (OA-score).[2,10,14] A score of 0 was a normal joint; a score of 1 was assigned to the presence of osteophytes without joint space narrowing; a score of 2 was assigned to joint space narrowing with or without osteophytes; and a score of 3 was assigned with sub or total disappearance or deformation of the joint space
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