Tibial Pilon Fractures: A Comparison of Treatment Methods

Pugh, Kevin J.; Wolinsky, Philip R; McAndrew, Mark P.; Johnson, Kenneth D.

doi:10.1097/00005373-199911000-00022

Cited by 177 publications

(130 citation statements)

References 18 publications

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“…For the external fixation group, no two-staged protocol was undertaken in this study and external fixation was always a definitive device. Similar to many other authors, we found that definitive external fixation provided more malunion, stiffness or pain than ORIF [6,8,10]. Thus, we believe that external fixation should be preferentially used in two-staged protocols as a temporary device before ORIF or limited internal fixation [1,5].…”

Section: Discussionsupporting

confidence: 87%

“…Many osteosynthesis techniques can be used for these fractures such as; traditional open reduction and internal fixation (ORIF), external fixation with or without limited internal fixation, intramedullary nailing or, more recently, minimally invasive plate osteosynthesis (MIPO) [5][6][7][8][9]. All of these techniques have advantages and disadvantages and there is no consensus concerning the management of these fractures [2,10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distal tibia fractures: management and complications of 101 cases

Joveniaux

Ohl

Harisboure

et al. 2009

International Orthopaedics (SICOT)

148

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Distal tibia fractures are complex injuries with a high complication rate. In this retrospective and multicentre study we attempted to detail complications and outcomes of this type of injury in order to determine predictive factors of poor results. Between 2002 and 2004, 104 patients were admitted for 105 distal tibia fractures. One hundred patients (101 fractures) were reviewed with an average follow-up of 19 months (range, 12-46). Internal fixation, external fixation, limited internal fixation (K-wires or screws), intramedullary nailing and conservative treatment were used. Outcome parameters included occurrence of complications, radiographic analysis, evaluation of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and measures of the ankle range of motion. The average functional score was 76 points (range, 30-100 points), and complications occurred in 30 patients. Predictive factors of poor results were fracture severity, complications, malunion and the use of external fixation. We believe that external fixation must be reserved for trauma with severe skin injury, as a temporary solution in a two-staged protocol. For other cases, we recommend ORIF with early mobilisation.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Distal tibia fractures: management and complications of 101 cases

Joveniaux

Ohl

Harisboure

et al. 2009

International Orthopaedics (SICOT)

148

View full text Add to dashboard Cite

show abstract

“…22 Pugh et al studied outcome using an ankle spanning unilateral frame, an ankle sparing ring hybrid fixator and ORIF in fractures of tibial plafond finding no difference in rate of complications and union in the three groups. 23 Bone et al concluded that cross ankle fixators which completely immobilize the ankle joint have not been detrimental to patient. 7 In our study, functional range of ankle movement was maintained in all patients.…”

Section: Discussionmentioning

confidence: 99%

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

Goel

Elhence

2017

Int J Res Med Sci

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Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

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“…A previous study showed its ability to serve as a concise and reliable communication tool in a research capacity [37]. In a similar fashion, the Tscherne system serves as an effective guide for predicting treatment and prognosis [6,7,9,12,22,30,38]. This has important implications in fracture care, where factors such as polytrauma and severe soft tissue injury may preclude primary definitive fixation.…”

Section: Purposementioning

confidence: 99%