Objectives: To evaluate the outcomes of neglected pilon fractures
treated by the Ilizarov fixator and to determine whether this
technique was successful in avoiding an ankle arthrodesis.
Design: Retrospective case series.
Setting: Level I university trauma center.
Patients: Between January 2003 and March 2015, 18 patients
(mean age of 42.17 years) with an untreated pilon fracture with late
presentation (.1 month) were evaluated. Six patients were women
and 12 were men. The mean duration from trauma to management
was 11.17 weeks (range: 7–15). All fractures were OTA/AO 43 type
C. Four cases were open fractures.
Intervention: Closed fracture reduction, correction of deformity,
and restoration of alignment by the Ilizarov fixator.
Main Outcome Measurements: The radiographs were evaluated
for tibial alignment, quality of reduction, and development of
arthrosis. The American Orthopaedic Foot and Ankle Society
(AOFAS) Ankle-Hindfoot Scale was used for functional assessment.
Results: The follow-up period ranged from 18 to 168 months
(mean; 38.00). The quality of reduction was excellent in 2 cases,
satisfactory in 13 cases, and poor in 3 cases. The external fixator
period averaged 29.06 weeks (range: 6.1–7.5 months). All fractures
healed without deep infection. Ankle dorsiflexion and plantar flexion
averaged 8.67 and 25.67 degrees, respectively, in 15 cases. Arthrodesis
was performed for the remaining 3 cases. The mean AOFAS
Ankle-Hindfoot score was 82.67. One case had mild anterior translation,
and another 1 had a procurvatum of 5 degrees. Arthrosis
developed in 6 ankles.
Conclusions: A satisfactory outcome was achieved after management
by the Ilizarov fixator while avoiding arthrodesis in most cases
of this series of neglected pilon fractures. |
