The role of capsuloligamentotaxis and minimally invasive percutaneous osteosynthesis with rigid and dynamic unilateral external fixation of the intra-articular pilon fracture

Abstract

Fractures of the tibial pilon are severe injuries which can be accompanied by articular impaction, comminution and soft tissue injury. Soft tissue injury with already existing skin damage can further complicate the method of treatment. In these cases, the method of unilateral or circular external fixation can be used as an alternative method of treatment. Minimally invasive percutaneous osteosynthesis with spanning rigid and dynamic unilateral external fixation as aone-stage method has been used for the treatment of intra-articular pilon fractures. We report acase of apatient with an intra-articular pilon fracture with chronic venous insufficiency and venous ulcer, who was injured after falling from aheight and who had emergency surgery based on capsuloligamentotaxis and percutaneous osteosynthesis with aspanning unilateral external fixator. The patient was mobilized postoperatively for walking without weight bearing on the injured leg. The initial rigid spanning external fixation was transformed into dynamic fixation to enable ankle joint movements 8weeks after surgery. The external fixator was removed 4.5months after surgery and the Kirschner wire and screws were removed 7months after surgery. The final functional result 1year after the injury was good and motion of upper ankle joint was moderately restricted without pain. Swelling occurred after walking for longer distances.