Our experience in the surgical treatment of the tibial pilon fractures

Abstract

Aim of study: to analyse the result of the surgical treatment of tibial pilon fractures. Materials and methods: We analyze the results of the surgical treatment of 51 tibial pilon fractures treated in the last four years, according on the severity of bone fracture and soft tissue lesions. We performed fixation in each case in one (35 patients) or two stages (16 patients), using the classifications Ruedi-Allgower and Tscherne. At the first stage we manage with the use of external fixation following the AO-ASIF principles: ligamentotaxis in the Ilizarov external fixation or Deltaframed external fixator across the ankle joint. At second stage was performed reduction and reconstruction of the articular surface with medial stabilization with a MIPO using a technique requiring only limited skin incisions (a reduced invasive technique). Rezults: Twenty-three fractures type Ruedi-Allgower I-II healed within an average of four months. 38 patients has developed posttraumatic arthrosis, 21 articular stifness, 4 superficial skin necrosis, 3 osteomyelitis, 7 mechanical complication. Conclusions: On the basis of our results, we now prefer a two-step procedure for the treatment of tibial pilon fractures. In the first stage, primary reduction and external fixation 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.