Combined minimally invasive external and internal fixation in the treatment of pilon fractures | ||||
| The Egyptian Orthopaedic Journal | ||||
| Volume 49, Issue 3, July 2014, Page 259-265 PDF (1.4 MB) | ||||
| DOI: 10.4103/1110-1148.148198 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Ahmed Sh. Rizk; Mohamad S. Singer; Mohamad E. Al-Ashhab | ||||
| Abstract | ||||
| Background Pilon fractures are challenging to treat as they are typically intra-articular fractures with proximal extensions and often associated with fibular fracture and extensive soft tissue damage. There is no universally agreed treatment method. To achieve an optimal outcome, there should be anatomical reconstruction of the joint, restoration of tibial alignment, and stabilization of the fracture to facilitate union. The choice of treatment must take into consideration not only the stabilization of the fracture but also the soft tissue injury that is a frequent cause of subsequent complications. Minimally invasive techniques using closed reduction and percutaneous fixation combined with monoplanar external fixators have the advantage of minimizing soft tissue compromise and preserving the vascularity of the fracture fragments, thus shortening the time for union and decreasing the need for bone grafting. Aim The aim of the study was to assess the efficacy of monoplanar external fixators combined with lag screws in restoring and fixing the articular surface as a definitive treatment for either open or closed tibial pilon fractures using the principles of minimally invasive fixation techniques. Patients and methods This was a prospective study that included 15 patients with pilon fractures of different types evaluated on the basis of the degree of involvement of the articular surface and the condition of the soft tissue envelop around the fracture. All patients were evaluated clinically and radiologically before surgery and followed up until complete union of the fractures and healing of the soft tissue. Evaluation was based on radiological union, alignment, and ankle joint function using the Iowa Ankle Scoring System. Results All fractures united (15/15 cases), representing 100% of cases in this study, with an average time of 17 weeks (range 12–21 weeks) after fixation, with near anatomical restoration of the articular surface in 12/15 cases, representing 80% of cases. Acceptable alignment was seen in both the coronal and sagittal planes in 14/15 cases, representing 93.6% of cases in this study. There was no limitation of joint motion except in two cases (2/15 cases), representing 13.3% of cases in this study. No neurovascular complications or deep soft tissue infection occurred until the last follow-up. Conclusion Minimally invasive reduction and percutaneous fixation of the articular surface with lag screws combined with monoplanar external fixators in tibial pilon fractures is advantageous for minimizing soft tissue compromise and preserving the vascularity of the fracture fragments, thus shortening the time for union and decreasing the need for bone grafting. | ||||
| Keywords | ||||
| high-energy trauma; Minimally invasive fixation; Pilon fractures; soft tissue preservation | ||||
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