Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Abstract

Background: Posttraumatic arthritis of tibiotalar joints after AO/OTA type C3 pilon fractures, especially in young patients with a significant osteochondral defect in the tibial plafond joint surface, is a challenging situation. We report a joint-preserving technique using autologous osteochondral graft in combination with ankle distraction and supramalleolar osteotomy (SMOT), if necessary, to improve its outcome. Methods: Seventeen patients with an average age of 32.1 years with Takakura grade 1 to 3A posttraumatic arthritis of the tibiotalar joint after AO/OTA type C3 pilon fractures received osteochondral autograft transplantation, ankle distraction, and SMOT, when supramalleolar malalignment was present, between February 2010 and November 2015. The visual analog scale (VAS), Short-Form 36 (SF-36) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and ankle range of motion were used for outcome analysis. Radiographic assessment of any SMOT and the apparent joint space was performed. Fourteen patients were followed for an average of 18 months. Results: The VAS, SF-36, and AOFAS scores as well as the ankle range of motion all improved significantly at the last follow-up after the surgery ( P < .01). No deep surgical site infection, donor site complication, nonunion, osteochondral block loosening, or resorption was noted. No secondary arthrodesis was needed at the end of follow-up. Conclusion: Autologous osteochondral graft transplantation in combination with ankle distraction and SMOT was a promising joint-preserving technique for early posttraumatic arthritis of tibiotalar joint after severe pilon fractures in young patients. Level of Evidence: Level IV, case series.

Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis

“…Additionally, because of extensive soft tissue damage in high-energy trauma, there are high risks of wound infection, nonunion, and delayed union. Posttraumatic arthritis is also a common complication of pilon fractures [ 5 , 6 ].…”

Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures: a pilot study

“…For treating Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures, a consensus has not been reached in the literature regarding the optimal fixation method. The primary cause is unsatisfactory reduction of tibial plafond fractures [21], which results in elevated contract stress at the tibiotalar joint [22]. In this study, we report one experimental technique for tibiotalar joint reconstruction using large autologous ilium with periosteum that can be applied for the treatment of Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures.…”

Large autologous ilium with periosteum for tibiotalar joint reconstruction in Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures. A pilot study

“…For treating Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures, a consensus has not been reached in the literature regarding the optimal xation method. The primary cause is unsatisfactory reduction of tibial plafond fractures [21], which results in elevated contract stress at the tibiotalar joint [22]. In this study, we report one experimental technique for tibiotalar joint reconstruction using large autologous ilium with periosteum that can be applied for the treatment of Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures.…”