Tibial pilon fracture treatment with staged open reduction and internal fixation with LCP versus primary hybrid fixation: A randomized prospective study

Abstract

Introduction: Distal tibial fractures remain one of the most substantial therapeutic challenges for orthopedic traumatology. Despite the advances that have been made in management, these fractures can be challenging to deal with, especially when associated with significant soft-tissue injury. Treatment of pilon fractures ranges from nonoperative to various operative options. Among operative, the two most controversial methods include the Staged procedure using open reduction internal fixation and using a primary hybrid fixator. Objective: This study aims to compare the outcomes of tibial pilon fracture treatment with staged open reduction and internal fixation with LCP and primary hybrid fixation and evaluate its results. Material & Methods: This Prospective Randomized comparative study was done in a tertiary level health care center. The patients were included in the study after fulfilling inclusion and exclusion criteria. The patients were then randomized in either of the two groups and treated accordingly by a single orthopaedic surgeon to avoid the bias. Follow-up was done after 3 weeks and then reviewed every one month up to 6 months. At 6 months IOWA score was assessed. Fracture union was assessed based on clinical and radiographic criteria. Clinically the ability to fully weight bear with no pain at the fracture was considered to represent the clinical union. Results: According to the IOWA ankle score, 32% in group A and 40% in group B had an excellent results, 40% in group A and 52% in group B had a good results, 20% in group A and 8% in group B had a fair result and 8% had a poor result in group A due to deep infections (osteomyelitis) in bone. The mean IOWA Ankle Score at the Final follow-up in Group A was 82.64±10.27 and of Group B was 86.96±5.07, which was non-significant. In terms of functional results, the excellent result was observed in 8 patients in Group A and 10 in Group B. Conclusion: The management of pilon fracture with both of them procedure were equally effective, but aims was to reduce surgical tissue trauma, deep infection and preservation of periosteal vascular integrity and osteogenic fracture haematoma all cause early union, which was much more possible by hybrid fixator group.