The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures

Suenghwan Jo; Jun Young Lee; Boseon Kim; Kang Hyeon Ryu

doi:10.12671/jkfs.2017.30.2.75

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Jo, Lee, Kim, and Ryu: The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures

Original Article

Journal of the Korean Fracture Society 2017; 30(2): 75-82.

Published online: 18 April 2017

DOI: https://doi.org/10.12671/jkfs.2017.30.2.75

The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures

Suenghwan Jo, M.D., Ph.D., Jun Young Lee, M.D., Ph.D., Boseon Kim, M.D., Kang Hyeon Ryu, M.D.

Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea.

Correspondence to: Jun Young Lee, M.D., Ph.D. Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University School of Medicine, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea. Tel: +82-62-220-3147, Fax: +82-62-226-3379, leejy88@chosun.ac.kr

Received 3 November 2016 Revised 16 December 2016 Accepted 14 March 2017

(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/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the usefulness of an additional, 2.7 mm mini-locking plate for tibial pilon fractures.

Materials and Methods

We studied 21 patients (14 males and 7 females), who were treated with a 2.7 mm mini-locking plate via the anterolateral approach for tibial pilon fractures between September 2012 and April 2014. The mean age was 43.85 years, and the mean follow-up period was 16.6 months. The radiologic outcomes were graded by the Burwell and Charnley modified system and clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score.

Results

The mean union period was 14.3 weeks. At the final follow-up, radiologic results showed 16 excellent results, 4 fair results, and 1 poor result. The average VAS was 3.4 points; the average AOFAS score was 81.8 points. During the follow-up period, there were three cases of posttraumatic osteoarthritis and one case of superficial skin infection.

Conclusion

Additional anterolateral, 2.7 mm mini-locking plate may be a good treatment method to manage tibial pilon fractures.

Keywords: Distal tibia fracture, Tibia plafond fracture, Pilon fracture, Locking plate

Figures and Tables

Fig. 1

Fluroscopic image, 3.5 mm locking compression plate distal anterolateral plate is not contoured to the anatomy of tibia.

Fig. 2

(A) A 47-year-old man suffered a traffic accident and sustained Rüedi-Allgower type III Pilon fracture. (B) The photographs show poor soft tissue condition and a bullous hemorrhagic lesions around the fracture site. (C) As the 1st stage treatment, the Pilon fracture was realigned and stabilized by an external fixator, using ligament taxis. The postoperative radiograph shows restoration of the tibial length, joint spanning, and articular surface reduction. (D) Intraoperative fluoroscopic image for articular surface reduction through the anterolateral approach using a 2.7 mm minilocking compression plate. Thereafter, the medial distal locking plate under Carm guidance (Synthes®) through limited medial approach was applied. (E) Intraoperative photographs. (F) Immediate postoperative radiographsdemonstrate a satisfactory articular reduction and restoration of distal tibial alignment.

Fig. 3

(A) A 17-year-old female experienced a fall-down injury and sustained a Rüedi-Allgower type II Pilon fracture. (B) The computed tomography scan shows comminution of tibia plafond with displaced articular fragments, especially anterolateral aspect of the tibia. (C) The patient underwent closed reduction and external fixation. (D) The surgical incision of the anterolateral and limited medial approach to metaphysis and ankle joint have been marked on the right ankle. (E) Immediate postoperative radiographs demonstrate a satisfactory articular reduction and restoration of the distal tibial alignment by locking compression plates (Synthes®) in the 2nd-staged operation. (F) At postoperative 13 months, the implant was removed. (G) The patient showed a mild stiff ankle with no pain, with a final American Orthopaedic Foot and Ankle Society score of 75 points.

Table 1

Patient Demographics

Case No.	Age (yr)/sex	Mechanism of injury	RA classification	Open fracture	Union time (wk)	Final F/U (mo)
1	14/M	Slip down	II	-	10	20
2	43/M	Fall down	III	-	14	15
3	57/M	Direct injury	II	-	11	18
4	55/F	Fall down	II	-	15	15
5	20/F	Fall down	II	-	11	12
6	73/M	Fall down	III	O	16	18
7	73/M	MVA	III	O	17	22
8	27/M	Fall down	II	-	14	13
9	38/M	Slip down	III	-	14	15
10	40/M	MVA	III	-	12	11
11	39/F	Fall down	III	-	21	36
12	34/M	Fall down	II	-	13	20
13	17/F	Fall down	II	-	13	18
14	47/M	MVA	III	-	16	12
15	36/M	Fall down	II	-	12	15
16	51/M	Fall down	III	-	14	14
17	43/F	Fall down	III	-	15	15
18	65/F	Slip down	II	-	16	17
19	55/F	MVA	II	-	13	15
20	54/M	Fall down	III	O	19	12
21	40/M	Fall down	III	-	14	15
Mean	43.85	-	-	-	14.3	16.6

RA: Rüedi-Allgower, F/U: follow-up, M: male, F: female, MVA: motor vehicle accident.

Table 2

Radiologic Results, Clinical Outcomes and Postoperative Complications

Case No.	AOFAS score	Radiologic result	Complication
1	98	Anatomical	-
2	80	Fair	Osteoarthritis
3	82	Fair	Osteoarthritis
4	84	Anatomical	-
5	78	Anatomical	-
6	60	Fair	-
7	87	Anatomical	-
8	87	Anatomical	-
9	85	Anatomical	-
10	90	Anatomical	-
11	70	Fair	-
12	89	Anatomical	-
13	75	Anatomical	-
14	88	Anatomical	-
15	92	Anatomical	-
16	87	Anatomical	-
17	91	Anatomical	-
18	79	Anatomical	-
19	82	Anatomical	-
20	48	Poor	Osteoarthritis Superfical skin infection
21	86	Anatomical	-
Mean	81.8	-	-

AOFAS: American Orthopaedic Foot and Ankle Society.

Notes

^{Financial support} None.

^{Conflict of interests} None.

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