Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation

Carbonell-Escobar, Rafael; Rubio-Suárez, Juan Carlos; Ibarzábal-Gil, Aitor; Rodríguez-Merchán, E. Carlos

doi:10.1016/j.jcot.2017.05.014

Cited by 34 publications

(23 citation statements)

References 25 publications

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“…16 Carbonell-Escobar et al in their study concluded that incidence of fair and poor functional outcome (AOFAS) was obtained in patients with a suboptimal quality of reduction (>2 mm articular step-off). 21 Similarly Korkmaz et al concluded that the most important factor determining the functional outcome in pilon fractures was the fracture reduction quality. 22 Even our study results also highlights that the quality of reduction is the prime factor determining the functional outcome.…”

Section: Discussionmentioning

confidence: 98%

Radiological parameters determining outcome in pilon fractures treated by minimally invasive plate osteosynthesis

Appusamy¹,

Ramachandran

Kumbakrishnakumar³

2019

Int J Res Orthop

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Background: Tibial pilon fractures are one of the challenging fractures to manage in the field of orthopaedics due to its complex fracture patterns as well as associated soft tissue injury. Minimally invasive plate osteosynthesis (MIPO) technique aims to reduce the surgical trauma to the surrounding soft tissues and hence maintain a more biologically favourable environment for fracture healing. The purpose of the study is to analyse the various factors especially radiological parameters determining functional outcome in pilon fractures treated by MIPO technique.Methods: This is a prospective study conducted from June 2015 to May 2018. The study included 46 patients (33 males, 13 females) with pilon fractures treated by minimally invasive plate osteosynthesis. All patients were followed for average period of 2 years. Functional outcome was assessed using American Orthopedic Foot and Ankle Score (AOFAS).Results: Among 46 patients, 21 patients (45.65%) had excellent, 16 patients (34.78%) had good and 6 patients (13.04%) had fair functional outcome. The quality of reduction was the most important parameter determining the functional outcome. We found that patients with higher lateral distal tibial angle (LDTA), anterior distal tibial angle (ADTA) and length of lateral malleolus (LLM) had better functional outcome than patients with lower values. The timing of surgery had no significant influence on the functional outcome of the patients.Conclusions: We like to conclude that apart from the quality of fracture reduction, radiological parameters like ADTA, LDTA, and LLM also play a crucial role in determining the functional outcome in pilon fractures.

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Section: Discussionmentioning

confidence: 98%

Radiological parameters determining outcome in pilon fractures treated by minimally invasive plate osteosynthesis

Appusamy¹,

Ramachandran

Kumbakrishnakumar³

2019

Int J Res Orthop

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“…Historically, the infection rate following operative treatment of tibial pilon fractures used to be unacceptably high, with up to 50% ( 13 , 24 , 28 ). This changed significantly with the introduction of the two –staged treatment protocol of tibial pilon fractures, which led to reported infection rates of ~9–19% in recent studies ( 45 , 82 , 83 ). The most common complications after operative treatment of tibial pilon fractures are summarized in Table 1 .…”

Section: Additional Treatment Of Soft Tissuementioning

confidence: 99%

Management of Pilon Fractures—Current Concepts

et al. 2021

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Tibial pilon fractures were first described by Étienne Destot in 1911. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Therefore, long -term outcome is often poor and correct initial management crucial. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures.

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“…Duckworth AD et al [13] 8 % 8% -----Carbonel Escobar et al [18] 13% ---10% 13 % -Howard JL et al [19] Sirkin M et al [20] 5-17 % ------…”

Section: Secondary Arthritis Stiffnessmentioning

confidence: 99%

Functional outcome following treatment of distal tibia fractures using locking compression plate

Abhishek¹,

Shekar²,

Prakashappa³

2018

Int. J. Orthop. Sci.

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Aims and ObjectivesTo Study functional outcome, efficacy and safety of distal tibia fracture by locking compression plate fixation. Methods: This was a prospective study consists of 25 consecutive cases of distal end tibia both intrarticular and extraarticular fracture selected after applying inclusion and exclusion criteria operated with LCP fixation at Sanjay Gandhi institute of trauma and Orthopaedics from June 2015 to June 2017. Functional outcome was assessed using American orthopedic foot and ankle society score (AOFAS) and visual analogue scale (VAS) at 3, 6 and 12 months postoperatively. Results: At 12 months, the mean AOFAS was 84.24. Five patients (20%) had score more then 90 (excellent), 11(44%) had score between 81-90 (good), 8(32%) had score between 71-80(fair) and 1(4%) had score less then 70 (poor). Mean AOFAS score improved from 71.36 (at 3 month) to 79.96 (at 6 month) and 84.24 (at 1 year). Mean VAS score at the end of 1 year followup was 22.4.VAS score was calculated after activity of daily life (i.e. walking on level ground) 18(72%) patients had mild pain. 4(16 %) had no pain and 3 (12%) had moderate pain after activity. No patient had severe pain. 17(68 %) cases in the study had fracture union without any complications. 8 (32 %) cases had postoperative complications ranging from superficial wound infection to delayed union and secondary arthrosis. Conclusion: Distal tibia fractures are challenging injuries not only because ankle joint has very low thresh hold for anatomic and bio mechanical aberrations but also due to huge importance of soft tissue in its healing. A constant balance has to be maintained to get antomical reduction with minimal soft tissue handling. In a closed fracture of distal end tibia, low profile LCP using MIPPO technique is currently best option for such a fracture.

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Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation

Abstract: IV (case series).

Cited by 34 publications

References 25 publications

Radiological parameters determining outcome in pilon fractures treated by minimally invasive plate osteosynthesis

Radiological parameters determining outcome in pilon fractures treated by minimally invasive plate osteosynthesis

Management of Pilon Fractures—Current Concepts

Functional outcome following treatment of distal tibia fractures using locking compression plate

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