Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study

Meena, Umesh Kumar; Bansal, Mahesh Chand; Behera, Prateek; Upadhyay, Rahul; Gothwal, Gyan Chand

doi:10.1016/j.jcot.2017.05.005

Cited by 16 publications

(18 citation statements)

References 16 publications

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“…First, the two therapies presented similar infection rates, indicating that the additional LIF did not lead to increased infection risks, even in Gustilo-Anderson grade II or IIIA fractures, as long as thorough debridement and adequate soft tissue coverage were performed. A similar conclusion can be obtained from the experience of treating other open injuries, especially intra-articular tibial fractures [25–27]. Along with external fixation, limited internal fixation can offer sufficient stability and may decrease the incidence of subsequent reduction loss.…”

Section: Discussionsupporting

confidence: 60%

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

Hao

Xia

et al. 2019

BMC Musculoskelet Disord

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Background The treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, meanwhile it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Nevertheless, its application is accompanied by a series of problems in alignment and bone healing. Therefore, limited internal fixation (LIF), such as cortical screws, has been used based on the external fixator for better therapeutic effect. The aim of this study is to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, evaluating the efficacy and safety of using the combined technique in treating such fractures. Methods From January 2012 to December 2016, patients with open tibial shaft fractures treated with EF with or without LIF augmentation were identified. A total of 152 patients were included in the analysis, and there were 85 patients in the simple external fixation group and 67 patients in the EF-LIF group. General assessment indicators included the direct cost of hospitalization and the times of first surgery, full weight bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who changed the fixation system for various reasons were analysed. Results Effective follow-up of all participants for statistical analysis was obtained. The follow-up time averaged 17.15 months (range: 12.00 to 24.00 months) in the EF group and 16.20 months (range: 12.00 to 19.00 months) in the EF-LIF group. Combined fixation provided shortened time to bear full weight and achieve complete bone union, while requiring additional first surgery time. No significant difference was found in infection rates or direct cost of hospitalization. Delayed union and non-union in the EF-LIF group were significantly decreased (20.9% versus 40.0, 1.5% versus 14.1%, p < 0.05). In limb alignment, patients with combined fixation exhibited reduced malreduction, loss of reduction, and malunion. In terms of secondary fixation, the EF-LIF group showed a markedly lower incidence (5.8% versus 34.1%, p < 0.001). Conclusion Compared with simple EF, combined fixation is an effective and safe alternative for management of open tibial diaphyseal fractures. It provides superior initial reduction, better stability and decreases the risk of inferior alignment and delayed union without increasing the risk of infection.

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Section: Discussionsupporting

confidence: 60%

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

Hao

Xia

et al. 2019

BMC Musculoskelet Disord

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“…Some surgeons believe that EFLIF can achieve similar functional outcomes in open distal tibia fractures and shorten the operation and fracture healing times [19][20][21]. Meena et al suggested that combined external and internal xations were a safe and effective management option for intra-articular distal tibial fractures [22]. Therefore, we concluded that using limited internal xation could provide enough stability, cannot be replaced by internal xation, and presents a lower infection risk than it.…”

Section: Discussionmentioning

confidence: 85%

External and limited internal fixation in the treatment of open Gustilo-Anderson Grade III ankle fractures: A single-center retrospective cohort study

Zheng

2022

Preprint

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Background The treatment of Gustilo-Anderson grade III open distal tibia fractures remains controversial, and often results in serious complications, including amputation. External fixation combined with limited internal fixation (EFLIF) can provide stability and exert beneficial effects on the fracture. This study evaluated the functional and clinical outcomes of EFLIF in patients with Gustilo-Anderson grade III open distal tibia fractures. Methods We retrospectively reviewed the clinical and follow-up data of 36 patients with open distal tibia fracture treated in our hospital between January 2017 and July 2021. We excluded cases lost to follow-up and those who underwent amputation. The data analysis included 26 patients with Gustilo-Anderson grade III fractures. The patients were followed up for traumatic surface recovery, ankle complications, and ankle function. The American Orthopedic Foot & Ankle score (AOFAS) was used to evaluate the functional outcomes. Results The 26 patients were followed up for 6–24 (mean, 14) months. Based on the AOFAS, the outcome in 17 patients was excellent, good in five, medium in three, and poor in one. No patient experienced incision breakdown, postoperative infection, or fracture nonunion. Conclusion The EFLIF can achieve positive outcomes when used to treat open distal tibia fractures. Sometimes, it can be considered the first line of treatment for open distal tibia fractures.

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“…Regarding infection, in our series, there were 11 cases of pin tract infections, which is a well-recognised complication associated with external fixation around the ankle. 12 In metaanalysis by Papadokostakis et al, minor and major infection was observed in 11.7% and 3.9% cases respectively, treated with ankle spanning fixator with or without minimally invasive techniques. 1 Complication rate, mainly infection and wound dehiscence, was found higher (17%) in patients with ORIF, as reported by Mcferran et al 20 The incidence of osteoarthritis following tibial pilon fractures varies in the literature.…”

Section: Discussionmentioning

confidence: 97%

“…Temporary stabilization with K-wires also allows an intra-operative check with a C-arm image intensifier, before a definitive stabilization by screws is performed. 12 Analysing existing literature on this topic must be delicate because most studies refer to a heterogeneous group of patients that include type A and B injuries. 10 Davidovitch et al retrospectively compared between external fixation and ORIF and concluded that the overall complication and union rates as well as functional outcomes were similar between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Outcome of complex tibial pilon fractures definitively treated with external fixator

Lemsanni¹,

Najeb²,

Chafik³

et al. 2020

Int J Res Orthop

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Background: Complex tibial pilon fractures are typically sustained with high-energy mechanisms and they are often associated with severe soft tissue compromise that can frequently results in severe complications. The purpose of this prospective case series was to evaluate the radiological and clinical outcomes after the use of external fixation combined with minimally invasive osteosynthesis, as primary and definitive treatment of complex tibial pilon fractures.Methods: A prospective study was undertaken during the period from March 2012 to June 2016. A total number of 109 patients with complex tibial pilon fractures were managed in our institution and included in the study. All the patients were treated with external fixation and minimally invasive osteosynthesis. The mean follow-up period was 47 months (31-60 months). Clinico-radiological progression of fracture union as well as the functional outcome were studied.Results: Eighty fractures resulted from traffic accidents and type 43-C3 fracture according to AO/OTA classification was the most common. Seventy-eight were open fractures and 94 patients had associated distal fibular fractures. All patients were treated with monolateral external fixators for definitive management. The average time to union was 14 weeks (range 9-19). Eleven patients (10%) suffered superficial pin tract infection. One patient developed septic arthritis and evidence of radiological osteoarthritis was present in ten cases (9%) at final follow-up. The American orthopaedic foot and ankle society (AOFAS) score was 84.4±8.1, translating to good clinical results.Conclusions: This review concludes that external fixation, combined with minimally invasive osteosynthesis, consistently produces good functional results without serious complications.

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Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study

Abstract: The technique of combined external fixation with internal fixation is safe and effective management option for intra-articular distal tibial fractures.

Cited by 16 publications

References 16 publications

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study

External and limited internal fixation in the treatment of open Gustilo-Anderson Grade III ankle fractures: A single-center retrospective cohort study

Outcome of complex tibial pilon fractures definitively treated with external fixator

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