Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques

You-Jin Kim; Hong-Geun Jung; Joo-Hong Lee; Woo-Sup Byun; Sung-Tae Lee

doi:10.12671/jkfs.2007.20.1.6

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Kim, Jung, Lee, Byun, and Lee: Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques

Original Article

Journal of the Korean Fracture Society 2007; 20(1): 6-12.

Published online: 14 June 2016

DOI: https://doi.org/10.12671/jkfs.2007.20.1.6

Comminuted Pilon Fractures: Comparative Outcome Analysis according to Surgical Techniques

You-Jin Kim, M.D., Hong-Geun Jung, M.D., Ph.D.^*, Joo-Hong Lee, M.D., Woo-Sup Byun, M.D., Sung-Tae Lee, M.D., Ph.D.^*

Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea.

^*Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea.

Address reprint requests to: Hong-Geun Jung, M.D., Ph.D. Department of Orthopedic Surgery, Konkuk University School of Medicine, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea. Tel: 82-2-2030-7609, Fax: 82-2-2030-7630, jungfoot@hanmail.net

Abstract

Purpose

To evaluate the overall surgical outcome of the tibial pilon comminuted fractures and perform the comparative analysis between the limited internal fixation-external fixation group and the delayed open reduction-internal fixation (ORIF) group.

Materials and Methods

From June 1997 to June 2004, 17 tibial pilon comminuted fractures were treated with the limited internal fixation-external fixation (6 cases) or the delayed open reduction-internal fixation (11 cases). The average age of the patients was 47.7 years (range: 41~63 years), male was fourteen patients, female was three. Follow-up period was average 33.6 months (range: 12~84 months). The clinical outcomes were evaluated by using AOFAS ankle-hindfoot score and patient satisfaction was also evaluated.

Results

AOFAS score at final follow-up was 80.4 points, and 88% of the patients were satisfied with the results. AOFAS scores of the external fixation group and the delayed ORIF group were average 77.0 points and 82.2 points respectively, which did not show the statistical difference (p>0.05). Bony union was achieved at average 16.0 weeks. There were 18 complications such as skin necrosis.

Conclusion

We have achieved relatively encouraging functional results and high patient satisfaction for pilon comminuted fractures, without significant result difference between the two surgical techniques.

Keywords: Tibia, Pilon fracture, External fixation, Delayed open reduction

Figures and Tables

Fig. 1

(A) This 43 year-old male had a fall injury and sustained a Ruedi-Allgower type III open pilon fracture.

(B) The CT scan shows severe comminution of tibia plafond with displaced articular fragments.

(C) The fracture was treated by external fixation and minimal internal fixation with multiple screws.

(D) At postoperative 15 months, the patient complained of ankle pain due to traumatic arthritis with AOFAS score 64 points.

Fig. 2

(A) Initial radiograph shows type III severely comminuted pilon fracture of a 42 year-old male.

(B) As the 1st stage treatment, the pilon fracture was realigned and stabilized by external monofixator, with the fibular fracture being fixed with plate and screw.

(C) Coronal and sagittal images of CT scan show displaced articular fragments of the tibia plafond.

(D) Two weeks since 1st operation, open reduction and internal fixation with dual plate were performed with allogenic bone graft. At postoperative 12 months, the patient showed stiff ankle with mild degree pain and final AOFAS score of 85 points.

Table 1

Distribution of open fractures and soft tissue injury patterns in closed fractures

^*LIF+EF: Limited internal fixation with external fixation, ^†ORIF: Open reduction and internal fixation.

Table 2

Associated injuries

Table 3

Demographic data of the patients

^*MVA: Motor vehicle accident, ^†ORIF: Open reduction and internal fixation, ^‡LIF+EF: Limited internal fixation with external fixation, ^§v. satisfied: Very satisfied, ^∥MRSA: Methicillin resistant staphylococcus aureus, ^¶CRPS: Complex regional pain syndrome.

Table 4

Postoperative complications

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