Ankle joint salvage and reconstruction by limited ORIF combined with an Ilizarov external fixator for complex open tibial pilon fractures (AO 43-C3.3) with segmental bone defects

Abstract

Background Open pilon fractures combined with sizeable segmental bone defects are rare, difficult to treat, and often result in the loss of ankle joint function. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures and sizeable segmental bone defects treated by limited ORIF combined with an Ilizarov external fixator. Methods We conducted a retrospective analysis of open pilon fractures with sizeable segmental bone defects treated by limited ORIF combined with the Ilizarov external fixator strategy between July 2014 and August 2019. All patients were included for assessments of fracture healing and infection rates. Ankle functional outcomes were assessed in all patients according to the Paley criteria and American Orthopedic Foot and Ankle Society Score (AOFAS) at least 24 months post-injury. Results All patients were followed up for a mean of 41.09 months. The mean bone defect size was 5.64 ± 1.21 cm. The average EFI and BTI were 1.56 ± 0.28 months/cm and 11.12 ± 0.74 days/cm, respectively. According to the Paley evaluation system, the success rate of ankle joint reconstruction was 64% (7/11). The mean score based on the AOFAS functional assessment was 77.73 ± 8.87. Five patients showed posttraumatic arthritis, one of whom required ankle arthrodesis. Three patients developed pin site infections, and one patient developed a deep infection after bone grafting. Conclusion The strategy of limited ORIF combined with an Ilizarov external fixator can restore ankle function in most patients with complex open tibial pilon fractures. Ankle stiffness, pin tract infection, and traumatic arthritis were the most common complications associated with this therapy.

The clinical application of minimally invasive surgery for tibia fracture with traction reduction device on lower limb fracture

“…The operation complications of tibia fractures are infection, incision necrosis, bone nonunion, and so on [8][9]. The minimally invasive surgery has many advantages, such as reduce the injuries to vascularity of bone and soft tissue, could reduce the complications [10]. But it has some disadvantages,such as having more di culty in reduction, demanding higher technique.…”

Open tibial pilon fracture with an extensive osteochondral defect: Staged reconstruction

“…Multi-fragmented open tibial pilon fractures associated with bone loss to gunshot wounds are typically related to high energy mechanisms and significant soft tissue injuries (1) . Therefore, the main objective of treating these complex fractures is to avoid soft tissue necrosis, minimize postoperative infection, and preserve the joint surface (6) .…”

“…There are a few reports in the literature due to the low incidence of this situation (1,2) . In the final stage of treatment, reconstruction and repair of the articular surface using autograft, allograft, or fresh osteochondral allograft are reported (3,4) .…”