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 which is a frequent cause of subsequent complications. Minimally invasive techniques using closed reduction and percutaneous fixation combined with mono planner external fixators have the advantage of minimizing soft tissue compromise and preserve the vascularity of the fracture fragments, so shorten the time for union and decreases the need for bone grafting. Aim of the work: Assess the efficacy of mono planner external fixators combined with lag screws 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: A prospective study included 15 patients of pilon fractures of different types according to 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 till complete union of the fractures and healing of the soft tissue. Evaluation 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 at an average time of 17 weeks (range 12 to 21 weeks) after fixation with near anatomical restoration of the articular surface in (12/15 cases) representing 80% of cases. Acceptable alignment 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 2 cases (2/15 cases) representing 13.3 % of cases in this study. No neurovascular complications or deep soft tissue infection till the last follow up. Conclusion: Minimally invasive reduction and percutaneous fixation of the articulr surface by lag screws combined with mono planner external fixators in tibial pilon fractures are advantageous in minimizing soft tissue compromise; preserving the vascularity of the fracture fragments; so shortens the time for union and decreases the need for bone grafting. Keywords: pilon fractures, high energy trauma, soft tissue preservation, minimally invasive fixation. |
