Multifragmentary Tibial Pilon Fractures: Midterm Results After Osteosynthesis with External Fixation and Multiple Lag Screws

Abstract

Osteosynthesis of intraarticular tibial pilon fractures is preferably achieved using locking plates via a minimally invasive technique. If combined with severe soft tissue damage there is a high risk of wound-healing deficits after plate osteosynthesis. Thus our aim was to find an alternative method of treatment for those cases with combined soft tissue injuries.We report on five cases with comminuted fractures of the joint surface combined with critical soft tissue condition that were treated with lag screws and external fixation (AO) applied across the ankle joint. All five patients were followed up, undergoing clinical and radiological examination.Using this approach we achieved fracture healing of comminuted fractures without further complications. Clinical follow-up after an average of 55.6 (36–75) months revealed a mean AOFAS score of 81 (62–100).We therefore propose combined treatment using lag screws with external fixation as a practical treatment option for those fractures for which lag screws combined with a locking plate are not feasible or when there is a high risk of wound-healing deficits due to severe soft tissue damage.

Clinical outcome and changes in gait pattern after pilon fractures

“…These are overall satisfactory results. Ketz et al found an average of 76.4 and 85.2 points in the AOFAS score in their groups of type C2 and C3 fractures, respectively, after plate osteosynthesis using different approaches; Kiene et al described a mean AOFAS score of 81 points after a combination of external fixation and lag screws [19,20]. Our study has some limitations: It was a retrospective single-centre study, and different fracture patterns were treated using different stabilisation techniques, including angular stable plates and external fixators as required.…”

Physical Therapy in the Pre and Post the Transtibial Amputation

“…Where is caused by trauma of high kinetic energy, where the metaphyseal-epiphyseal fragments impacted are solid metaphyseal. He is also known as axial compression and usually caused by trauma falling from great heights or traffic accident [5,6]. It is usually associated with severe soft tissue injuries associated with foot and ankle edema great causing bleeding from blisters, predisposing to infection [12].…”

“…The fall caused a physeal fracture of the fibula and left tibia with intra-articular involvement, (fractures of the tibial pilon, type III) [5], which is a relatively uncommon fracture therefore affects only 1% of the fracture of the lower limbs [6,7]. Following the classic protocol of this type of fracture, surgery was indicated immediately with the need to metallic syntheses.…”

The Tibial Pilon Fractures: Are there Problems?

“…Davidovitch et al describe that both ORIF and EF appear to be comparable for treatment of TPF fractures with regard to final range of ankle motion, development of arthritis and hind foot scores [8]. Kiene et al propose combined treatment using lag screws with external fixation as a practical treatment option for those fractures for which lag screws combined with a locking plate are not feasible or when there is a high risk of wound-healing deficits due to severe soft tissue damage [9]. Wang et al show that in the treatment of closed tibial plafond fractures; both two-staged ORIF and LIFEF offer similar results [10].…”