Results of staged posterior fixation in the treatment of high-energy tibial pilon fractures

Abstract

Summary High-energy pilon fractures are difficult injuries to treat. They often involve displaced posterior malleolar fragments. With the advent of staged management for treatment of these injuries, the posterior fragment(s) are difficult to address in a delayed fashion through standard anterior incisions. The goal of the current study is to evaluate the role for staged fixation of the posterior aspect of the tibia, and fibula if fractured, through a posterolateral approach with later reconstruction of the anterior fragments through traditional anterior exposures. Eighteen patients with high energy pilon fractures (16 OTA 43C.3 and 2 OTA 43C.2) were treated with this approach. Patients were evaluated at a minimum of 24 months following surgery. The average arc of motion at the ankle joint was 34.3 ± 7.4 o . The quality of reduction was determined by post-operative computed tomography. Eleven patients had 2 mm of incongruity at the level of the joint. Functional outcomes were assessed using the AOFAS ankle and hindfoot score and the MFS. The average AOFAS score was 83.8 and the average MFS score was 84.7. This technique allows for improved articular reduction with encouraging clinical and functional outcome results.