The Results of Two Stage Surgical Treatment of Pilon Fractures

Hong Moon Sohn; Jun Young Lee; Sang Ho Ha; Sang Hong Lee; Gwang Chul Lee; Kwang Hyo Seo

doi:10.12671/jkfs.2012.25.3.177

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Sohn, Lee, Ha, Lee, Lee, and Seo: The Results of Two Stage Surgical Treatment of Pilon Fractures

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2012; 25(3): 177-184.

Published online: 16 July 2012

DOI: https://doi.org/10.12671/jkfs.2012.25.3.177

The Results of Two Stage Surgical Treatment of Pilon Fractures

Hong Moon Sohn, M.D., Jun Young Lee, M.D., Sang Ho Ha, M.D., Sang Hong Lee, M.D., Gwang Chul Lee, M.D., Kwang Hyo Seo, M.D.

Department of Orthopedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Jun Young Lee, M.D. Department of Orthopedic Surgery, Chosun University Hospital, 365, Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

Received 16 August 2011 Revised 12 February 2012 Accepted 25 April 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the good results of two-stage treatment in pilon fractures.

Materials and Methods

A retrospective study of 23 patients among 30 patients with pilon fractures from March 2006 to November 2008, who underwent two-stage treatment of pilon fractures with a minimum of 24 months follow-up. The mean follow-up period was 28 months (24~41 months). In the first stage of the operation, open reduction of the articular surface and external fixation were performed after minimal incision. As the soft tissue healed, locking compression plate fixation was performed with the Minimally invasive plate osteosynthesis. Radiographic evaluation was graded by the criteria of Burwell and Charnley, and functional assessment of the ankle was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.

Results

The fractures were united within 16 weeks (12~30 weeks). The radiologic results showed anatomical reduction in 18 cases and a mean AOFAS score of 81. The mean range of ankle motion was 44 degrees. There were four complications: 1 case of wound infection and 3 cases of ankle osteoarthritis.

Conclusion

Two-stage treatment of pilon fractures is a good treatment method because it is designed to obtain early anatomical reduction, definitive stable fixation, low rates of soft tissue complication, and good range of ankle motion.

Keywords: Tibia, Pilon fracture, Two-stage treatment

Figures and Tables

Fig. 1

Twenty-three patients were classified by pre-operative simple X-ray and computed tomography scan using the Rüedi-Allgöwer16) classification in this study.

Fig. 2

Distribution of soft tissue injury patterns is shown in this figure using the Tscherne and Goetzen20) classification in this study.

Fig. 3

(A) This 47-year-old male had a fall injury and sustained a Rüedi-Allgöwer type III pilon fracture. The fracture was treated by external fixation with three screw fixation using anteromedial approach (arrow) to the tibial plafond.

(B) This 41-year-old male had a motor vehicle accident and sustained a Rüedi-Allgöwer type III pilon fracture. The axial computed tomography scanning demonstrate a communited articular injury that is composed of three major articular components and central impacted fragment (black arrow). The fracture is treated by external fixation with three screw fixation using anterolateral approach (white arrow) to tibial plafond.

(C) As in the first stage treatment, the pilon fracture was realigned and stabilized by an external mono fixator, with the fibular fracture being fixed with a plate and screw.

Fig. 4

(A) Two weeks after the first operation, closed reduction and internal fixation with locking compression plate (Synthes, Oberdorf, Switzerland) were performed.

(B) At post-operative 36 months, the patient underwent the removal of the implant. The post-operative radiographs show good alignment and good ankle articulation.

Fig. 5

Last follow-up photographs show good ankle range of motion in 41-year-old male patients who underwent two stage treatment of pilon fracture.

Table 1

Patient data for 23 cases of two stage treatment of pilon fractures

R-A: Ruedi-Allgower, F/U: Follow-up, TA: Traffic accident, M: Male, F: Female.

Table 2

Burwell-Charnley classification7)

Table 3

Post-operative complications

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