Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

Abstract

Background: Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allg€ ower type II and III, treated by either ORIF or EFLIF. Materials and methods: Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followedup clinically and radiologically for over 2 years after the surgical treatment. Results: The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion: Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence: Level II.

A case report of circular external fixator with low-profile mini-fragment plate fixation: A combination of two methods for a tibial pilon fracture

“…As for treatment with CEF, only a few studies have reported the treatment of tibial pilon fractures (especially for AO/OTA 43C3 type). In a comparative prospective study, Ahmed [ 8 ] compared 22 patients with ORIF and 20 with CEF. They reported no differences in the AOFAS score, arthritis, or pseudoarthrosis at the 2-year postoperative follow-up at a single institution.…”

Post-Operative Outcomes of Circular External Fixation in the Definitive Treatment of Tibial Plafond Fractures: A Systematic Review

“…Interestingly, the mean score continued to decline from 86.6 to 82.1 to 79.7, respectively. Imren et al, Rayan et al, Patra et al, and Sahin et al all reported one-year mean AOFAS scores of 86.6, 86.7, 76.3, and 80.4, respectively [ 30 , 31 , 33 ]. Kapoor et al reported a mean MMAS score of 79.8 from 16 patients [ 27 ].…”