Treatment of Pilon fracture malunion with distal tibiaI osteotomy and reconstruction

Abstract

Category: Ankle Introduction/Purpose: To evaluate the clinical outcomes of distal tibial osteotomy and alignment reconstruction for pilon fracture malunion. Methods: Between January 2010 and May 2012. 15 cases of pilon fracture malunion were treated with super-malleolar extra-articular osteotomy and alignment reconstruction. They were 12 males and 3 females with an average age of 30.8 years(from 24 to 39 years). The pre-operative X-ray and CT scan showed varus deformity in 9 cases anti valgus in 2 cases. There were 4 cases of anterior impact of the distal tibia and 4 cases of tibiotalar subluxation. All the patients complained about ankle pain, deformity, limited range of motion(ROM)and walking difficulty. X-ray was taken routinely to confirm the bone healing during post-operative follow-up. Scores of visual analogue scale(VAS), American Orthopaedic Foot & Ankle Society(AOFAS)and The Short Form-36(SF-36), ankle ROM and complications were also recorded. Results: 13 cases obtained all average follow-up of 23. 8 months (from 19 to 48 months)and 2 were lost to the follow-up. Bony union was achieved after an average of 3.8 months(from 3 to 7 months). The average VAS score declined significantly from 5.1±3.2 preoperatively to 1.4±0.8 postoperatively (P<0.05). A complete pain relief was achieved in 8 cases. The AOFAS ankle and hindfoot score, SF-36 score, ankle ROM at the last follow-up were improved significantly compared with the preoperative ones (P<0.05). No implant failure, soft tissue complications or occurred during the follow-up. Conclusion: Distal tibial osteotomy and alignment reconstruction is an effective treatment of Pilon fracture malunion, as this strategy can restore the lower limb alignment, relieve pain and decrease the rate of long-term post-traumatic arthritis.