Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia

Abstract

The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a nonunion which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.Résumé Les fractures du pilon tibial sont toujours des fractures avec traumatisme complexe. Le but de cette étude est d'évaluer le devenir du traitement de ces fractures après utilisation de techniques dites mini-invasives. Matériel et méthode: une étude prospective portant sur des fractures de ce type fermées C2 et C3 dans la classification AO et traitées précocement (moins de 36 heures après le traumatisme) ont été inclues dans cette étude avec abord miniinvasif et rééducation rapide. 30 patients présentaient 32 fractures intra-articulaires, les patients ayant été traités par un chirurgien senior (GK). Le suivi de cette étude est de rapporter les complications et le devenir avec un suivi minimum de deux ans. Résultats, il faut déplorer deux infections superficielles, un patient présentant une pseudarthrose nécessitant un nouveau traitement chirurgical, un patient présentait des douleurs symptomatiques au niveau de la partie inférieure de la plaque d'ostéosynthèse. Un résultat excellent selon les critères de l'AOFAS a été obtenu dans 83% des cas (20/24). Conclusion: une réduction précoce par technique mini-invasive avec fixation permet d'avoir des résultats satisfaisants après un suivi minimum de deux ans dans ces fractures graves du pilon tibial.

Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia

“…Bacon et al [33] found osteomyelitis rates of 20% and 23% in a series of 42 fractures treated with open reduction and internal fixation and Ilizarov external fixation, respectively. However, promising results have been shown by Leonard et al, who found that early intervention (before 36 hours) prior to the initiation of swelling with minimally invasive techniques can reduce rates of soft tissue complication [34].…”

The mid-term results of treatment for tibial pilon fractures

“…1-Reduction and fixation of the fibula, 2-Reconstruction and fixation of the tibia joint, 3-Filling of the metaphysical defect, which remains after the reconstruction of the joint, with autogenous spongious bone graft, and 4-Application of a support plate in order to prevent varus deformity, which might occur at a later stage. [2,[8][9][10][11][12][13][14] In this study, the mid-term results of the ORIF method, which we applied to 31 patients with pilon tibia fractures, were evaluated in light of the literature. For five of these accompanying additional pathologies (45%), a surgical operation was applied, and the rest (55%) received conservative treatment.…”

Distal tibia fractures: management and complications of 101 cases

“…At the time of this work, such techniques were not used in our departments. Minimally invasive plate osteosynthesis (MIPO) reduces soft tissue damage, and preserves bone vascularity and fracture haematoma [3,7,19]. However, there are some complications with this method.…”

“…Many osteosynthesis techniques can be used for these fractures such as; traditional open reduction and internal fixation (ORIF), external fixation with or without limited internal fixation, intramedullary nailing or, more recently, minimally invasive plate osteosynthesis (MIPO) [5][6][7][8][9]. All of these techniques have advantages and disadvantages and there is no consensus concerning the management of these fractures [2,10].…”