Surgical Options for the Treatment of Severe Tibial Pilon Fractures: A Study of Three Techniques

Abstract

On the basis of our results, we now prefer a two-step procedure for the treatment of severe tibial pilon fractures with extensive soft tissue damage. In the first stage, primary reduction and internal fixation of the articular surface is performed using stab incisions, screws, and K-wires. Temporary external fixation is applied across the ankle joint. After recovery of the soft tissues, the second stage entails internal fixation with a medial plate using a reduced invasive technique.

Distal tibia fractures: management and complications of 101 cases

“…Similar to many other authors, we found that definitive external fixation provided more malunion, stiffness or pain than ORIF [6,8,10]. Thus, we believe that external fixation should be preferentially used in two-staged protocols as a temporary device before ORIF or limited internal fixation [1,5]. Our ipsilateral fibular fracture rate was small in comparison to rates near 80% found in the literature [17,18].…”

“…For fractures with skin injury, important soft tissue oedema or delayed surgery, we recommend a two-staged protocol similar to that of many other authors [1,5,21]. The first stage consists of an approximate reduction and application of an external fixator spanning the ankle joint.…”

“…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].…”

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

“…Infection rates vary between 0 % and 50 % following the surgical treatment of distal tibial fractures [10,15,25,34]. The highest infection rate is seen in patients treated with open reduction and internal fixation.…”

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

“…The fixation options for a distal tibial fracture include hybrid external fixation, limited internal fixation with external fixation, traditional open reduction internal fixation (ORIF), minimally invasive plate osteosynthesis (MIPO), fine-wire fixation, or possibly intramedullary nailing [2,4,11,28,33]. Although new changes in intramedullary nail design have extended distal metaphyseal fractures amenable to this type of fixation, difficulties with reduction, distal propagation of the fracture, inadequate distal fixation, and potentially complex articular involvement can limit its applicability in some distal metaphyseal fractures [28].…”