Surgical treatment of tibial pilon fractures

Abstract

Objective: The research of statistical and curative particularities of surgical treatment of tibial pilon fractures. Material and methods: The scientific work is based on a retrospective and prospective study on a group of total 172 patients with tibial pilon fructures treated during the years 2013-2015 in Traumatological Departments of The Emergency Medicine Institute from Chsinau. The diagnosis was confirmed by clinical, radiological in all cases and MRI in 59 cases. The ethiology of trauma in 103 cases were fall from height and in 44 cases - car collision. Open fractures was in 42 cases, GA type I – 21, GA type II – 18 and GA type III – 3 cases. Extra-articular fractures was 48 cases, intra-articular – 124 cases, RA type I – 29, RA type II – 54 and RA type III – 41 cases. Results: The surgical treatment was the most indicated, in 125 cases, extrafocar osteosyntesis (Ilizarov) - 33, plate osteosyntesis – 38, screws/pins osteosyntesis – 24 cases, external fixation was used in 29 cases associated with high damage of soft tissue, which later were converted in stabile osteosyntesis. After surgery a part of the patients were evaluated at an interval of 12 to 24 months using. We obtained good results in 18 patients, satisfactory - 20, unsatisfactory - 4 patients. Conclusions: The tibial pilon fractures prognosis in most cases is unpredictable because of intra-articular character with involve articular surface elevation, difficulty reducing and maintaining fragments and frequency of occurrence of various complications. Surgical treatment requires advanced experience of orthopaedic surgeon, and a very good preoperative planing with establish an appropriate time, surgical approach and method of fixation.