Retrograde Intramedullary Kirschner Wire Fixation as an Alternative for Treating Distal Fibular Shaft Fractures Combined with Distal Tibial Pilon Fractures

Abstract

Treatment or management techniques for pilon fractures are associated with high complication rates and poor outcomes. No consensus exists regarding the optimal surgical option for pilon fractures, especially for pilon fractures combined with distal fibular fractures. Accordingly, we explored the use of fibular fixation for treating pilon fractures involving distal fibular shaft fractures. We hypothesized that retrograde intramedullary Kirschner wire (K-wire) fixation is a suitable alternative technique for distal fibular fixation. We retrospectively reviewed the data of 156 patients who underwent surgery for pilon fractures at our hospital from May 2013 to May 2021. The radiographic and functional outcomes were comparable between the fibular intramedullary nailing (Group A; n = 80) and the fibular plating (Group B; n = 76) groups. Groups A and B differed significantly in total hospitalization time (11.4 vs. 18.2 days, p = 0.024), length of postoperative admission (6.8 vs. 11.4 days, p = 0.012), and total admission cost (USD 3624 vs. USD 6145, p = 0.004). We also noted that poor Olerud and Molander ankle scores were significantly associated with age (p = 0.008), smoking (p = 0.012), and preoperative admission length (p = 0.018). Retrograde intramedullary K-wire fixation produced a comparable 12-month functional outcome to plate fixation for distal fibular shaft fractures, rendering it a viable alternative method based on soft tissue condition.

Keywords: anterior distal tibial angle (ADTA); distal fibular fracture; lateral distal tibial angle (LDTA); pilon fracture; retrograde intramedullary pinning.

Figure 1

Patients were classified into two groups: (a) Group A—pilon fracture was fixed with the locking plate, and the distal fibula fracture was fixed with retrograde 2.0 mm K-pins; (b) Group B—pilon fractures and distal fibula fractures were both fixed with the locking plates.

Figure 2

The postoperative angle measurement: LDTA, the distal tibial articular surface and the anatomical axis of the tibia in the coronal plane (normal values 89° ± 3°); ADTA, the mechanical axis of the tibia and the joint orientation line of the ankle in the sagittal plane (normal values 80° ± 3°).