Medium-Long-Term Radiographic and Clinical Outcomes after Surgical Treatment of Intra-Articular Tibial Pilon Fractures by Three Different Techniques

Abstract

Introduction: The goal of this retrospective, observational, case series study was to evaluate the medium-long-term clinical and radiographic results of the three most common surgical osteosynthesis techniques used for the treatment of articular tibial pilon fractures: ORIF, MIPO, and EF.

Materials and methods: A consecutive series of patients with articular pilon fractures who underwent surgery at our institution were enrolled in this study. Fractures were classified according to the Müller AO classification system. Overall outcomes took the following into account: radiographic quality of reduction, evaluated using Ovadia and Beals' criteria; clinical assessment, evaluated using the AOFAS questionnaire; and general health, evaluated with the SF36-v2 Health Survey.

Results: A total of 94 articular pilon fractures (34 type 43-B and 60 43-C) were evaluated with a mean follow-up of 56.34 months (range 33-101). The techniques used were ORIF, MIPO, and EF in 63 (67%), 17 (18.9%), and 14 cases (14.1%), respectively. According to Ovadia and Beals' criteria, good, fair, and poor results were reported in 61 (64.89%), 26 (27.66%), and 7 (7.45%) cases, respectively. The mean AOFAS score was 82.41 for MIPO, 79.83 for ORIF, and 50.57 for EF, respectively. Thirty-nine patients (41.49%) presented early and/or late complications.

Conclusion: Satisfactory outcomes using the three different techniques were reported. In particular, the radiographic outcomes were inversely proportional to the fracture comminutions and statistically different between internal and external osteosynthesis, but comparable between ORIF and MIPO techniques. On the other hand, the clinical outcomes were closely related to the soft tissue conditions and the anatomical reconstruction of the joint.

Figure 1

Case N° (42) of Table 2: a 41-year-old woman with a 43-B1 closed fracture treated with MIPO technique: (a) preoperative radiographic image; (b) postoperative radiographic image at 1-month follow-up; (c) radiographic aspect at 39-month follow-up after implant removal.

Figure 2

Case N° (47) of Table 2: a 68-year-old man with a 43-B3 closed fracture treated with two-stage ORIF technique: (a) preoperative radiographic image; (b) after prefix implant, radiographic image; (c) definitive implant after 16 days, 1-month follow-up; (d) radiographic aspect at 37-month follow-up after implant removal.

Figure 3

Case N° (34) of Table 2: a 43-year-old man with a 43-C1 open fracture (Gustilo II) treated with hybrid external fixator: (a) preoperative radiographic image; (b) after prefix implant, radiographic image; (c) definitive EF implant after 1 week, radiographic image; (d) radiographic aspect at 57-month follow-up after implant removal.