Significance of stabilizing the ankle lateral column in treatment of pilon fractures

Abstract

Objective To evaluate the significance of stabilizing the ankle lateral column in the treatment of pilon fractures. Methods Eighteen pilon fractures (13 males and 5 females) with injury to ankle lateral column were managed from July 2005 to January 2008. Their average age was 41.3 (range, 23 to 50) years. AO classification: 3 cases of Bltype, 5 cases of B2 type, 3 cases of C1 type, and 7 cases of C2 type. Patients with closed injury underwent fibular reduction and fixation through posterolateral incision fol-lowed by the Chapnt tubercle reduction and fixation through modified anterointernal incision. The articular surface of ankle middle column and bone fragments of medial column were reduced according to the Chaput tubercle. For patients with open fracture, severe soft tissue injury, or multi-injury, we adopted staged man-agement. All patients underwent immediate fibular fixation and placement of a medial spanning external fixator. The ankle medial column was first fixed only temporally with K wire or screws. Next, patients underwent removal of the external fixator and formal open reduction and internal fixation of pilon fractures. Results Fourteen patients were followed up after surgery, but 4 patients were lost. The mean follow-up was 18.4 (range, 8 to 30) months. All the 14 bone fractures united. In evaluation of the articular surface reduction, 9 cases had anatomic reduction, 4 cases had fair result and 1 case poor. In evaluation of ankle function, 6 cases were excellent, 3 cases good, 4 cases fair and 1 case poor. One case of open Pilon fracture was infected after external fixation which was changed into internal plate fixation following treatment with gentamycin-released beads for 7 weeks. The infection was controlled and the bone reunited. Conclusion Restoring stability of the ankle lateral column is extremely important in the treatment of pilon fractures. Key words: Tibiai fractures; Ankle joint