A Prospective Study on Functional Outcome of Internal Fixation of Tibial Pilon Fractures with Locking Plate using Minimally Invasive Plate Osteosynthesis Technique

Abstract

Introduction: Managing pilon fractures is still a great challenge for surgeons in terms of reduction and fixation. The soft tissue anatomy and the bony configuration, results in angular and rotational instability and other bony and soft tissue complications.

Aim: To evaluate the results of minimally invasive plate osteosynthesis using locking plates in management of fractures of tibial pilon in terms of radiological fracture union, restoration of ankle function and complications.

Materials and methods: A total of 18 patients with Ruedi Allgower class I, II & III fresh pilon fractures were taken into this study. All the patients underwent ankle spanning external fixator application on the day of presentation as a first stage. Wound debridement was done in patients with open fractures. Associated distal fibula fractures were fixed in the first stage. The second stage comprised of a definitive plate fixation using the minimally invasive plate osteosynthesis technique. This employed minimal periosteal and soft tissue dissection through a medial approach to the ankle. Postoperatively, all patients were reviewed at week six and 12 when partial weight bearing and full weight bearing mobilization was started respectively. The final review was done at 24 weeks when the final assessment of function was done as per the Mazur's scoring criteria. Analyses were done using frequency and proportions. Chi-square tests were used to assess the test of association.

Results: Three patients had excellent inference, nine patients had good inference, five patients had fair and one patient had poor inference as per the Mazur's scoring criteria. Two patients had scar dehiscence as a complication and one patient had a fixed equines deformity of the ankle who was under RuediAllgower class III.

Conclusion: Minimally invasive plate osteosynthesis is an excellent method of treating pilon fractures with very good functional results and minimal complication rate.

Keywords: Biological fixation; External fixator; Intra-articular; Mazur’s criteria; Ruedi Allgower.

[Table/Fig-1a,b]:

Preoperative anteroposterior and lateral radiographs of the right ankle showing RuediAllgower type II pilon fracture

[Table/Fig-2a]:

After ankle spanning external fixator application;

[Table/Fig-2b]:

1/3^rd tubular plating of distal fibula

[Table/Fig-3]:

Minimally invasive percutaneous plate insertion

[Table/Fig-4a,b]:

Anteroposterior and lateral radiographs of the right ankle after locking plate fixation

[Table/Fig-5]:

Bar graphs showing the distribution of patients as per the inference noted after modified Mazur’s scoring of ankle function

[Table/Fig-6]:

Bar graphs showing Ruedi Allgower class 1,2,3 with respective patients under each class and modified Mazur scores a) Of the two patients under Ruedi Allgower class I, One patient had excellent inference and one patient had good inference. b) Of the 13 patients under class II Ruedi Allgower, Two patients had excellent inference Eight patients had good inference and three patients had fair inference. c) Of the three patients who presented as RuediAllgower class III, none had excellent or good inference. Two patients had fair inference and one patient had poor inference.

[Table/Fig-7]:

Wound slough formation over surgical site with non-healing ulcer formation