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 that is a frequent cause of subsequent
complications. Minimally invasive techniques using closed reduction and percutaneous fixation
combined with monoplanar external fixators have the advantage of minimizing soft tissue
compromise and preserving the vascularity of the fracture fragments, thus shortening the time
for union and decreasing the need for bone grafting.
Aim
The aim of the study was to assess the efficacy of monoplanar external fixators combined with
lag screws in 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
This was a prospective study that included 15 patients with pilon fractures of different types
evaluated on the basis of 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 until complete union of the fractures and healing
of the soft tissue. Evaluation was 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, with an average
time of 17 weeks (range 12–21 weeks) after fixation, with near anatomical restoration of the
articular surface in 12/15 cases, representing 80% of cases. Acceptable alignment was seen
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 two cases (2/15 cases), representing
13.3% of cases in this study. No neurovascular complications or deep soft tissue infection
occurred until the last follow-up.
Conclusion
minimally invasive Percutaneous plate fixation technique is an effective method of stabilization for closed tibial shaft fractures achieving good bone alignment and protecting soft tissues, leading to higher union rates with good functional outcome. Conventional non-locked plates applied through the medial approach decreases the surgical time and the risk of post-operative compartmental syndrome. |
