Novel anterior curved incision combined with MIPO for Pilon fracture treatment

Abstract

Backgrounds: Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Methods: Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient's ankle pain, and related complications were also recorded. Results: The mean time for fracture healing was 3.6 months (range: 3-6 months). According to Mazur's criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. Conclusions: This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

Large Autologous Ilium with Periosteum for Tibiotalar Joint Reconstruction in Rüedi-Allgöwer III Pilon Fractures

“…The restoration of ankle movement may introduce physiological loading that is bene cial to the healing and grinding of the articular surface, and reduce the risk of developing posttraumatic osteoarthritis. [21] Although we have demonstrated satisfactory outcomes in this study, the use of the described technique for tibiotalar joint reconstruction should be considered with caution. It has been reported that complete reduction in pilon fractures can lead to complete failure, such as non-union, avascular necrosis and osteomyelitis.…”

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

“…However, the characterization at 18 months in this study does not give definitive evidence of the repair tissue composition, and longer-term follow-up with noting of possible complications such as arthritic changes are necessary [24,25]. Nevertheless, the restoration of ankle movement may introduce physiological loading that is beneficial to the healing and grinding of the articular surface, and reduce the risk of developing post-traumatic osteoarthritis [26].…”

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

“…However, the characterization at 18 months in this study does not give de nitive evidence of the repair tissue composition, and longer-term follow-up with noting of possible complications such as arthritic changes are necessary [24,25]. Nevertheless, the restoration of ankle movement may introduce physiological loading that is bene cial to the healing and grinding of the articular surface, and reduce the risk of developing post-traumatic osteoarthritis [26].…”