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Observational Study
. 2024 Dec;45(12):1330-1340.
doi: 10.1177/10711007241283778. Epub 2024 Oct 24.

Corrective Intra-articular Osteotomy for Malreductions of Tibial Pilon Fractures in Patients Less Than 55 Years Old

Ya-Xing Li  1 , Ting-Jiang Gan  1 , Xi-Kun Ma  1 , Yu Chen  1 , Xi Liu  1 , Hui Zhang  1
Affiliations
Observational Study

Corrective Intra-articular Osteotomy for Malreductions of Tibial Pilon Fractures in Patients Less Than 55 Years Old

Ya-Xing Li et al. Foot Ankle Int. 2024 Dec.

Abstract

Background: Tibial pilon malreductions are challenging to correctively reconstruct, and the relevant literature is limited. This study aims to assess whether corrective intra-articular osteotomy is worthwhile to treat relatively younger (<55-year-old) patients with intra-articular malreductions of pilon fractures.

Methods: This is a retrospective observational study with a minimum follow-up of 2 years. From 2013 to 2021, 21 patients (mean age: 39.2 ± 11.2 years) with intra-articular pilon malreductions ≥6 weeks treated with intra-articular osteotomies were analyzed. The median interval time until intra-articular osteotomy was 76 (interquartile range [IQR], 49-149) days. Plain radiographs and computed tomography were used for radiographic assessments. Clinical outcomes were evaluated with visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short-Form Health Survey (SF-36) score, and ankle range of motion (ROM).

Results: The median follow-up duration was 34.6 (IQR, 26.1-74.3) months. The median articular displacement was reduced from 12.7 mm preoperatively to 2.7 mm postoperatively (P < .05). According to the Kellgren-Lawrence grading, 16 patients were assigned to stage II, 4 to stage III, and 1 to stage IV. In the 10 patients with available preoperative assessments, substantial improvement was found in the VAS score, from 5.90 to 2.0 at the final follow-up (P < .05). Similarly, the AOFAS ankle-hindfoot score and SF-36 scores improved (P < .05). Ankle ROM did not change a clinically meaningful amount. Progressive degenerative changes were noted in 2 of 10 patients who had adequate preoperative imaging. Four patients had VAS scores ≥4 including 1 patient who is scheduled for an arthrodesis.

Conclusion: In this small series, we found that the corrective osteotomies generally provided reasonable improvement at 3 years in patients <55 years old with intra-articular malreduction of pilon fractures. Prospective cohort studies are needed to determine if it is worthwhile in long-term outcome.

Keywords: corrective reconstruction; intra-articular osteotomy; malreduction; pilon fractures.

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Conflict of interest statement

Ethical ApprovalThis study was performed in accordance with the Helsinki declaration of 1964, and it was approved by the relevant Institutional Review Board at the West China Hospital of Sichuan University. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

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