Treatment Of Tibial Pilon Fractures Research Articles

Posterior Approaches in the Treatment of Tibial Pilon Fractures

Posterior Approaches in the Treatment of Tibial Pilon Fractures

Arthroscopic Ankle Arthrodesis with Circular External Fixator: Case Report

Category: Ankle Arthritis; Arthroscopy; Trauma Introduction/Purpose: One of the options for the surgical treatment of tibial pilon fracture is the circular external fixator. Similar results are found in the literature, with good outcomes in relation to a low incidence of infection, osteomyelitis and soft tissue injuries compared to open reduction and internal fixation. Even so, evolution to a probable arthrodesis occurs in 3-27% of cases, showing that the prognosis for this type of fracture is dismal. Options for performing joint fusion include open arthrotomy with joint decortication and internal fixation (plates and/or screws), in addition to arthroscopic joint preparation, a method that has been gaining popularity since 1983, in its first description. Fusion through circular external fixation is an excellent option that has shown good results in the literature. Methods: Patient with left tibial pilon fracture. Uniplanar external fixation was performed in the emergency room, with subsequent conversion to transarticular circular external fixation. After 4 months of review, the patient has evidence of tibiotarsal arthrosis. It was decided to perform arthrodesis using the arthroscopic technique, performing joint compression with circular external fixation, already installed in the patient. Spinal anesthesia was performed on the patient and the Smarch tourniquet was used. First, access to the anteromedial portal, trocar and optic passage was obtained, and the intermediate dorsal cutaneous branch of the superficial peroneal nerve was identified laterally, and the anterolateral portal was constructed. Through these portals, a 4.5mm Shaver blade was used to perform curettage and joint debridement, in addition to curettes and osteotomes. In addition to arthroscopic control, fluoroscopic observation was also performed for adequate joint preparation.Finally, joint compression was performed with the device already installed. Results: The patient presented complete consolidation of the tibio-tarsal arthrodesis. At the moment (2 years and 10 months postoperatively) the patient does not use crutches/gait accessories, does not limit his daily activities due to foot problems, does not have difficulty going down and up stairs, has good ankle alignment, plantigrade foot, has no joint pain and can walk long distances. Conclusion: This work showed a technique rarely reported or cited in the orthopedic literature, not presenting any article as an original description. Supported by the description of the procedure by the robust final functional results of the patient in question, this report establishes the basis for the widespread method and new works to emerge to enrich the debate and study around arthroscopic ankle arthrodesis using the Ilizarov method.

A new surgical strategy for the treatment of tibial pilon fractures with MIPO facilitated by double reverse traction repositor

The present study aims to introduce a technique combining double reverse traction repositor (DRTR) with minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of pilon fractures and to observe the efficiency of this approach during a short-term follow-up period. From January to December 2018, patients with pilon fractures who were treated by MIPO with DRTR were reviewed. The demographic and fracture characteristics, surgical data, and prognostic data of 24 patients were extracted. In all 24 patients, closed reduction was achieved with the MIPO technique, and excellent functional and radiological outcomes were observed. The average duration of surgery and intraoperative blood loss were 95.0 ± 14.2 min and 152.1 ± 52.1 ml, respectively. A mean of 16.0 ± 1.9 intraoperative fluoroscopies were conducted. At the 12-month follow-up evaluation, the average AOFAS score was 85.2 ± 5.1. Anatomic or good reduction was observed in 23 (95.8%) patients. The mean ranges of motion of dorsiflexion and plantarflexion were 11.0 ± 2.7 and 32.7 ± 11.1, respectively. Two patients with deep venous thrombosis and one patient with wound non-purulent exudate were noted. Additionally, the wounds healed after routine dressing change. No other complications, including skin necrosis or delayed, non-union or malunion, were observed. The new strategy combining DRTR with MIPO in the treatment of pilon fractures allowed excellent radiological and clinical outcomes and a low postoperative complication rate to be achieved in a short-term follow-up period. Further large sample and comparative studies should be conducted to validate our results.

Fibula fixation in the treatment of tibial pilon fractures – Is it really necessary?

BackgroundThere is a lack of consensus about the role of fibula fixation in these complex fractures, with only two clinical studies in the literature. We hypothesize that the fibula fracture need not be fixed in the tibial pilon fractures if primary stability can be achieved with tibial fixation alone. MethodsWe reviewed 79 patients with operatively treated tibial pilon with associated fibula fractures from 2007 to 2017 and divided them into two groups; patients with fibula fracture fixation and those without fixation. The primary outcome measure was any mechanical complications. Secondary outcomes were wound complications and other morbidities. ResultsThere were 54 (68.4%) patients with fibula fixation and 25 (31.6%) patients without fixation. There were no statistically significant differences in mechanical complications between the two groups. However, patients without fibula fixation were noted to have more wound complications (44% vs 25.9%, p = 0.108) although this was not statistically significant. In terms of removal of implant (ROI), there were no differences noted in patients with or without fibula fixation (33.3% vs 28%, p = 0.796). There were also no significant differences in ROI for those fixed with plate and screws when compared to those fixed with Rush rod and K wire within the group with fibula fixation. ConclusionFibula fixation in the treatment of tibial pilon fractures is not routinely necessary and does not result in decreased mechanical complications such as malunion, delayed union, nonunion and implant failure. Fibula fracture fixation should be reserved for cases where it may aid reduction or provide additional stability.

External fixator supplemented with screw fixation versus staged open reduction and internal fixation tibial pilon fracture

Background: The present study aims to compare the results of primary tibial pilon injury . Objective: Our work aims to compare the clinical and radiological outcomes of two different surgical techniques for treatment of tibial pilon fractures. Patients & Methods: Those who matched completely with inclusion criteria were included until fully gaining required sample size. Prospective comparative controlled study using the foot and ankle outcome questionnaire of AAOS. The study was carried on patients with distal tibial fractures that are types 43 (B&C1, C2, C3) OTA classification of distal tibial fractures. patients divided for two groups according to surgical technique: group (A):(30) patients managed with primary external fixator with screws. group (B):(30) patients Managed with staged ORIF. Results: Group B showed a higher AAOS Foot and Ankle Normative score and AAOS foot and ankle core scale standardized mean and shoe comfort standardized mean and shoe comfort normative score and SF36 physical functioning% than Group A. Group A showed a less time interval from injury till fixation than Group B. From statistical point of view the two groups showed no significant difference regarding incidence of acquired complications. Conclusion: The two-stage ORIF gained a reduced risk of postoperative complications related to superficial infections, and bone healing problems. The ORIF 2 stage has several advantages, such as the ability to handle soft tissues including the periosteum, tendons(PTT), and ligaments that may be contained within fragmented fracture .

Should the location of distal tibial plating be influenced by the varus or valgus fracture pattern of tibial pilon fracture?

Operative treatment of tibial pilon fracture is challenging. There is a lack of consensus and only one clinical study on the optimal location of distal tibial plating for fixation of pilon fractures based on varus or valgus fracture patterns. We hypothesize that complications rates, specifically mechanical complications, are not influenced by the location of the tibial plating in the fixation of pilon fractures with respect to varus or valgus fracture patterns. Sixty-nine patients who had single plating for tibial pilon from 2007 to 2017 were recruited. They were divided into two groups, transverse fibular fracture (varus fracture pattern) and comminuted fibular fracture (valgus fracture pattern). Our primary outcome measure was any mechanical complications as a result of the location of plating (medial vs lateral) on varus or valgus fracture patterns. There were 38 (55.1%) patients with varus fracture pattern and 31 (44.9%) patients with valgus fracture pattern tibial pilon fractures. In the varus fracture pattern group, mechanical complications were not significantly different between the two plating locations (27.3 vs 33.3%, p > 0.05). Notably, there were more fibula fixations performed in patients with medial plating (74.1 vs 45.5%, p = 0.092) when compared those with lateral plating in the varus fracture pattern group. There were also no statistically significant differences found although 10 (40%) out of 25 patients had mechanical complications in the medial plating group compared to 1 (16.7%) out of 6 patients with lateral plating (p = 0.383) in the valgus fracture pattern group. There were no differences in mechanical complications for medial vs lateral plating in tibial pilon fracture based on varus or valgus deforming forces. As much as we should consider the fracture patterns and deforming forces when deciding on plating location, other factors such as careful soft tissue management and fragment-specific fixation should be prioritized.

What are the Risk Factors for Deep Infection in OTA/AO 43C Pilon Fractures?

To determine the risk factors for deep infection in OTA/AO 43C pilon fractures. Retrospective, case-control study. Single institution, Level 1 trauma center. All patients with 43C pilon fractures treated over a 5-year period with follow-up to bony union. One hundred fifty of 169 of identified patients met inclusion criteria. Operative treatment of tibial pilon fracture. Deep infection; patient demographics, Gustilo-Anderson classification, location of open fracture wounds, surgical approaches. The overall rate of deep infection was 16.7%. Body mass index, tobacco use, and diabetes were not associated with deep infection. The rate of Gustilo-Anderson type 3A and 3B fractures was significantly higher in those with infection, but the overall open fracture rate was not significantly different between the groups. Medial and anterior open fracture wound location was significantly associated with deep infection, whereas lateral open fracture wound location was not. In closed fractures, anteromedial and anterolateral approaches were not significantly associated with infection, but posterolateral approach was associated with deep infection. Segmental bone loss and the need for soft tissue coverage were the only independent risk factors for deep infection. High-grade open pilon fractures are at risk of deep infection, and medial/anterior open fracture wounds are particularly vulnerable to developing deep infection. The anteromedial/anterolateral surgical approaches should be selected based on a complete understanding of the fracture pattern and soft tissue injury; however, the posterolateral approach to the tibia should be used with some caution. Ultimately injury factors (segmental bone loss and need for soft tissue coverage) seem to be the most important variables in driving deep infection, and a complete understanding of the bone and soft tissue injury is needed to manage these injuries effectively. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Contemporary Strategies in Pilon Fixation.

The treatment of tibial pilon fractures has evolved substantially over the past decades due to ever-increasing high-energy injuries. Open reduction and internal fixation of these intra-articular fractures requires an appreciation for a number of basic principles: respect the soft tissues, understand the fracture pattern, use safe surgical approaches, and provide stability that allows for early motion of the ankle. Surgical strategy should be customized based on the fracture pattern, access needed for fracture visualization and reduction, and status of the soft tissues. Given the ability to obtain an accurate stable reduction, smaller implants are typically adequate using multiple small incisions. We view this surgical tactic as continuing the evolution of complex fracture treatment whose origins lie in the influences of pioneers such as Dr Sigvard T. Hansen Jr.

Does Surgical Approach Influence the Risk of Postoperative Infection After Surgical Treatment of Tibial Pilon Fractures?

To determine whether a particular surgical approach or combination of approaches is a risk factor for infection. Retrospective review. Two Level-1 trauma centers. Five hundred ninety pilon fractures in 581 patients (66% male) with a median age of 45 years were identified. Open reduction internal fixation of pilon fractures. Postoperative deep surgical site infection and risk factors for postoperative deep infection. The most common primary surgical approach was medial (54%), followed by anterolateral (25%), anteromedial (11%), posterolateral (8%), and posteromedial (2%). A dual approach to the distal tibia was used in 18% of the cases. The overall deep infection rate was 19%. There was no association between primary surgical approach and development of infection (P = 0.19-0.78). Independent risk factors for infection were smoking (hazard ratio, 2.1; P < 0.001) and need for soft tissue coverage (hazard ratio, 6.9; P < 0.001). Surgical approach does not appear to be a significant risk factor for postoperative infection after open reduction internal fixation of distal tibial pilon fractures. When treating tibial plafond fractures, surgeons should select the approach they feel best addresses the specific fracture pattern. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evolution in Management of Tibial Pilon Fractures.

Tibial plafond, or pilon, fractures can be some of the most difficult fractures to manage. As they are often associated with high-energy trauma, both the soft tissue involvement and the comminuted fracture pattern pose challenges to fixation. Furthermore, the complex anatomy and trauma to the cartilage at the time of injury predispose pilon fractures to poor functional outcomes and high rates of posttraumatic arthritis. This review will discuss the recent developments in the treatment of tibial pilon fractures. Historically, surgical management of pilon fractures has been associated with high rates of complications, including wound complications, infections, nonunions, and even the need for amputation. In response, staged protocols were created. However, recent studies have called this into question, demonstrating low wound complications with early definitive fixation. Additional studies are evaluating adjuvants to minimize wound complications, including the use of vancomycin powder and oxygen supplementation, while another study challenges the 7-cm myth regarding the distance needed between skin incisions. Additional research has been focused on alternative methods of managing these complex, and sometimes non-reconstructable, injuries with the use of external fixation, minimally invasive internal fixation, and primary arthrodesis. Tibial pilon fractures remain difficult to treat for even the most skilled orthopedic trauma surgeons. With improvements in surgical techniques and implants, complication rates have declined and outcomes have improved; however, the overall prognosis for these injuries often remains poor.

Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases.

The treatment of tibial pilon fractures is a surgical challenge due to the particular anatomical and vascular characteristics of this area, and the severity of the injury that can compromise soft tissues. Nowadays there is no gold-standard treatment for these fractures. We reviewed 75 patients with tibial pilon fracture type C (AO classification) treated with hybrid external fixation (Stryker TenXor®). The surgical technique was reported. We evaluated clinical (Tornetta's score, VAS score, range of motion) and radiographic outcomes. In 71 cases, the first surgical treatment was definitive. Instead, in four cases, it was necessary a second surgical procedure to achieve fracture healing. We obtained 44% excellent, 40% good, 7% discrete, and 9% bad results. We found a 30% of superficial infections of the pin site, resolved with oral antibiotic treatment (amoxicillin and clavulanic acid). We never had deep infections, no neurovascular injury, and no cases of secondary amputation. Although not statistically significant, we noticed a correlation between longer recovery times and trauma severity, with slower recovery in open or grade III fractures or when associated with other fractures. According to the recent literature, we think that the best treatment for non-articular fracture is the internal osteosynthesis within 6h or after 6days from trauma. In articular fractures, the elective treatment is the two-step management. In complicated articular fractures (Tscherne > 2, open, comminuted type III) is highly indicated the external fixation combined with minimal internal synthesis.

Buttress plate fixation alone or combined with hollow screws for treatment of posterior tibial pilon fractures

Objective To study the effect of buttress plate fixation alone or combined with hollow screw fixation of posterior tibial pilon fractures. Methods A retrospective case series analysis was made on 28 cases of posterior tibial pilon fractures admitted from February 2010 to February 2015. There were 18 males and 10 females, aged from 20 to 65 years (mean, 40.5 years). Klammer classification was type 1 in 10 cases, type 2 in 12 and type 3 in 6. Denis-Weber classification was type B in 26 cases and type C in 2 cases. Fourteen cases had buttress plate fixation, 4 hollow screw fixation through posterior-anterior approach, and 10 buttress plate fixation combined with hollow screws. Fracture reduction, function recovery, incidence of complications, and range of motion of ankle joint were detected after operation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale, Kellgren-Lawrence grading for osteoarthritis and visual analogue scale (VAS) were applied to evaluate clinical efficacy at the final follow-up. Results Operation incision healed by first intention. Anatomic reduction and rigid stabilization were noted in all, except that two cases presented one millimeter gap in the posterior articular surface. Duration of follow-up was 13 to 36 months (mean, 20.6 months). Time to fracture healing was 6 to 10 weeks after operation (mean, 7.5 weeks). No deep incision infection or lower extremity deep venous thrombosis occurred after operation. One case developed epidermal necrosis, and resulted in scar healing by strengthening the dressing. One case developed fibula tendon irritation symptom, and disappeared after the removal of internal fixation. One case developed skin irritation symptom because of the overlong screw, and disappeared after the removal of the screw. One case developed osteoarthritis because of the mild displacement of fracture bone in the process of fixation. One case developed toe flexion deformity two months after operation. AOFAS scale was (88.6±6.4)points at the final follow-up, and differed significantly from that before operation [(32.2±1.3)points] (P<0.05). Kellgren-Lawrence grading zero was noted in 24 cases, grading Ⅰ in 2, grading Ⅱ in 1, and grading in 1. VAS was (0.8±0.3)points at the final follow-up, and differed significantly from that before and after operation [(8.5±1.5)points and (6.3±1.0)points, respectively] (P<0.05). Conclusion Anatomical reduction of posterior tibial pilon fractures can be received by buttress plate fixation alone or combined with hollow screws, which can reduce the complications and attain excellent clinical outcomes. Key words: Tibial fractures; Ankle; Fracture fixation, internal

Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction.

ObjectiveThe aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator.MethodsThirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system.Results Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%.ConclusionArthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.

Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures

ObjectivesTo determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. DesignRetrospective, multicentre study. Patients/ParticipantsAdult patients with tibial pilon fractures treated with hybrid external fixation. InterventionFracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator. Main outcome measurementsFracture union, complications, functional outcome (Mazur Ankle Score). ResultsUnion was obtained in 159 fractures at an average of 125days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin‐track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures. ConclusionsHybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally‐invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications. Level of evidenceLevel IV Case series.

Temporary Stabilization with External Fixator in 'Tripolar' Configuration in Two Steps Treatment of Tibial Pilon Fractures.

Background:The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures.Methods:We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation. Results:We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixationConclusion:Temporary stabilization with external fixator in ‘tripolar’ configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases.

Limited incision of locking plate internal fixation in the treatment of tibial Pilon fractures

Objective To study the clinical effect of limited incision of locking plate internal fixation in the treatment of patients with fracture of tibial Pilon. Methods 92 patients with fracture of tibial Pilon were selected as the research subjects, they were randomly divided into control group and observation group, 46 cases in each group.The patients of the two groups were treated with limited incision fixation scheme, the control group implemented anatomic plate internal fixation, the observation group was given locking plate internal fixation.The clinical curative effect and recovery were analyzed in the two groups. Results The excellent and good rate of recovery of fracture end of the observation group was 93.48%, that of the control group was 71.74%, the difference was statistically significant (χ2=8.6245, P 0.05), after treatment, VAS score declined, but the observation group was lower than the control group (all P<0.05).In the observation group, the incidence rate of complications such as stiff joints, postoperative infection, broken screws was 8.70%, which of the control group was 28.26%, the difference was statistically significant (χ2=6.925 4, P<0.05). Conclusion Tibial Pilon fractures treated with limited open locking plate internal fixation solution has significant curative effect, high safety, can promote patients recovery, it is of great significance to improve the prognosis and worthy of clinical promotion. Key words: Tibial fractures; Fracture fixation, internal; Bone wires

Treatment of pilon fractures of Ruedi-Allg（o）wer types II and III via anterior intermediate incision with L-shaped anatomical locking compression plate

Objective To observe the therapeutic results of treating pilon fractures of Riedi-Allg(o)wer types Ⅱ and Ⅲ via the anterior intermediate incision with an L-shaped anatomical locking compression plate (LCP).Methods From January 2011 to June 2013,18 patients with pilon fractures of Ruedi-Allg(o)wer types Ⅱ and Ⅲ received surgery in our department.They were 13 males and 5 females,aged from 23 to 76 years (average,48.1 years).Eight cases were type Ⅱ and 10 cases type Ⅲ; 12 cases were closed and 6 cases open; 4 cases had concomitant ankle dislocation.For open fractures,fibular reduction and internal fixation plus a medial spanning external fixator was performed at the first stage,followed by tibial open reduction and internal plating after removal of the external fixator (10 days on average) at the second stage.For closed injury,we adopted staged therapy.The patients underwent fibular reduction and internal fixation through the posterolateral incision,followed by reduction and fixation of the chaput tubercle through the anterior intermediate incision.The articular surface of the middle ankle column and bone fragments of the medial column were reduced the way as for the chaput tubercle,and fixated with an L-shaped anatomical LCP at the tibial metaphysis.Results All patients were followed up for an average of 12 months (from 6 to 24 months).According to the Burwell-Charnley radiological criteria,anatomical reduction was achieved in 14 cases,and fair reduction in 4.All the fractures healed after a mean period of 14 weeks.According to the Mazur clinical criteria,ankle functions were rated as excellent in 10 cases,good in 6,and fair in 2.Conclusions In staged treatment of tibial pilon fractures of Ruedi-Allg(o)wer types Ⅱ and Ⅲ,reduction and fixation with anatomical L-shaped anatomical LCP via the anterior intermediate incision can result in stable fixation,a high rate of bone union,limited incision-related complications and satisfactory functional recovery.Restoring stability of the ankle lateral column is extremely important in the treatment of tibial pilon fractures. Key words: Tibial; Fracture fixation, internal; Bone plates; Dislocations

Arthroscopic treatment in split depression-type tibial pilon fracture.

Treatment of tibial pilon fractures is complicated and often very invasive. Partial fractures with a depressed component raise the question of the choice of surgical technique. Minimally invasive surgical reduction under arthroscopic guidance appears to be a promising alternative in this type of fracture. We describe a technique for arthroscopically assisted treatment of a split depression tibial pilon fracture.

Limited open reduction and internal fixation with anatomical locking compression plate for treatment of tibial Pilon fractures

Objective To investigate methods and clinical effects of limited open reduction of ankle articular surface and locking compression plate (LCP) placement using minimally invasive plate osteosynthesis (MIPO) in managing tibial Pilon fractures.Methods Twenty-one patients with tibial Pilon fractures treated between August 2009 and August 2011 were involved in the study,including 16 males and 5 females,at age of 21-68 years (average 42.3 years).According to AO/OTA classification,12 patients were with type 43B fractures and nine with type 43C fractures.There were two patients with open fractures (both Gustilo-Anderson type Ⅰ fractures).Limited open reduction of ankle articular surface plus LCP placement using MIPO were performed.Early functional training without weight-bearing was carried out postoperatively.Results Nineteen patients were followed up for 12-24 months (average 14 months).According to Burwell-Chamley' s radiological evaluation system,17 patients obtained anatomical reduction of articular surface and two patients obtained moderate reduction,but they all had bony healing.Ankle function evaluated by Mazur' s criterion were excellent in seven patients,good in 10 and fair in two,with excellence rate of 89％.Conclusion Limited open reduction combined with LCP internal fixation can successfully construct articular anatomic relationship,decrease soft tissue dissection and attain solid fixation in treatment of Pilon fractures and further facilitate functional recovery of the affected extremity in coordination with early functional exercise. Key words: Tibial fractures ; Skeletal tracting reposition; Fracture fixation, internal; Locking compression plate; Pilon fracture

Analyses of relevant influencing factors in the treatment of tibial pilon fractures

To explore the relevant influencing factors of surgical outcomes for closed tibial pilon fractures. From April 2005 to May 2011, 52 consecutive closed tibial pilon fractures were treated by the same surgical team. There were 35 males and 17 females with a mean age of 40.0 years. According to the Ruedi-Allgower classification, the fracture types included type I (n = 13), type II (n = 22) and type III (n = 17). All patients were evaluated by the scores of American Orthopedic Foot and Ankle Society (AOFAS) and Burwell-Chamley. Postoperative complications were also recorded. The primary influencing factors of clinical outcomes were determined with regards to fracture types, reduction, complications and outcomes. The average follow-up period was 14.1 months (range: 6 - 28). The mean healing time was 5.5 months (range: 4.0 - 11). The reduction status: anatomical (n = 20), functional (n = 24) and poor (n = 8). Ankle function was excellent (n = 12), good (n = 26), fair (n = 9) and poor (n = 5). Incidence of complication was 30.8% (n = 16), including incision skin necrosis (n = 5), superficial soft tissue infection (n = 4), deep infection (n = 1) and posttraumatic arthrosis (n = 6). No significant differences (P > 0.05) existed in the occurrence of incision skin necrosis, superficial infection and deep infection between the outcomes of excellent/good and fair/poor groups while posttraumatic arthrosis rate had significant difference (P = 0.005) between two groups. The quality of reduction was an independent risk factor of final clinical outcomes. The quality of reduction, types of fracture and occurrence of posttraumatic arthrosis are risk factors of final outcomes for closed tibial pilon fractures.