Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jan-Apr;20(1):6-10.
doi: 10.5005/jp-journals-10080-1636. Epub 2025 Aug 18.

Outcomes of Acute Ankle Distraction for Intra-articular Distal Tibial and Pilon Fractures

Ara Faraj  1 , Felix Hammett  1 , Beth Lineham  1 , Elizabeth Barron  1 , Yvonne Hadland  1 , Elizabeth Moulder  1 , Ross Muir  1 , Hemant Sharma  1
Affiliations
Review

Outcomes of Acute Ankle Distraction for Intra-articular Distal Tibial and Pilon Fractures

Ara Faraj et al. Strategies Trauma Limb Reconstr. 2025 Jan-Apr.

Abstract

Aims and background: Intra-articular distal tibia fractures can lead to post-traumatic osteoarthritis (PTOA). Joint distraction has shown promise in elective cases of osteoarthritis (OA) by temporarily offloading joint forces and potentially facilitating cartilage regeneration. However, its application in acute fractures remains unexplored. This pilot study aims to investigate the benefits of joint distraction in acute fractures.

Material and methods: A retrospective cohort study comprising consecutive patients with intra-articular distal tibia and pilon fractures, treated with a circular ring fixator (CRF) and ankle distraction as part of their fracture management, was undertaken at a single centre.Prospective data collection included radiological assessments, patient-reported outcome measures (PROM), complications, necessity for additional procedures, and the Kellgren and Lawrence grade (KL) for OA.

Results: There were 137 patients included in the study, among them 30 in the distraction group and 107 in the non-distraction group. There were no significant differences in age, gender, distribution of open or closed fractures, diabetic status, and smoking status between the groups. Mean follow-up was 3.73 years.There was no significant difference between the distraction and non-distraction groups in overall complications or need for further procedures. The mean radiological follow-up was 1.90 years, there was no significant difference in progression of KL between the groups (1.81 vs 2.0, p = 0.38). There were 32 patients who had radiological follow-up exceeding 2 years (average 3.52 years); here there was no significant difference between these groups (mean change 2.18 vs 2.4, p = 0.87).Patient-reported outcome measures data was available for 44 patients (6 in the distraction group, 38 in the non-distraction group) with a mean follow-up of 1.71 years. There were no significant differences in EQ5D and C Olerud-H Molander scores between the two groups.

Conclusion: Ankle joint distraction in the management of acute ankle fractures did not influence outcomes for patients in short and medium term follow-up. Future work should investigate for long-term effects of this auxiliary technique when using circular external fixators, in particular on the development of PTOA.

How to cite this article: Faraj A, Hammett F, Lineham B, et al. Outcomes of Acute Ankle Distraction for Intra-articular Distal Tibial and Pilon Fractures. Strategies Trauma Limb Reconstr 2025;20(1):6-10.

Keywords: Ankle fractures; Circular external fixation; Circular frame; Complications; Distraction; Patient-reported outcome measures; Pilon fracture; Tibial pilon.

PubMed Disclaimer

Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig 1
Fig 1
Kellgren and Lawrence grade for OA for each group, pre-op and post-op
See this image and copyright information in PMC

References

    1. Bister V, Lenkkeri T, Parkkinen M, et al. Intra-articular distal tibial fractures cause a major burden to individual patients and also stresses the public health care system. Injury. 2022;53(8):2888–2892. doi: 10.1016/j.injury.2022.05.049. - DOI - PubMed
    1. Sitnik A, Beletsky A, Schelkun S. Intra-articular fractures of the distal tibia. EFORT Open Rev. 2017;2(8):352–361. doi: 10.1302/2058-5241.2.150047. - DOI - PMC - PubMed
    1. British Orthopaedic Association . 2016. The management of ankle fractures. [online] British Orthopaedic Association.https://www.boa.ac.uk/resources/boast-12-pdf.html Available from: [Last accessed, July 2025]
    1. Rammelt S, Endres T, Grass R, et al. The role of external fixation in acute ankle trauma. Foot Ankle Clin. 2004;9(3):455–474, vii-viii. doi: 10.1016/j.fcl.2004.05.001. - DOI - PubMed
    1. Kapoor SK, Kataria H, Patra SR, et al. Capsuloligamentotaxis and definitive fixation by an ankle-spanning Ilizarov fixator in high-energy pilon fractures. J Bone Joint Surg Br. 2010;92(8):1100–1106. doi: 10.1302/0301-620X.92B8.23602. - DOI - PubMed

LinkOut - more resources