Long-term results of various therapy concepts in severe pilon fractures.
BACKGROUND
Intra-articular fractures of the tibia plafond are among the most challenging of orthopaedic problems. This is a retrospective case-control study of surgically treated pilon fractures which was undertaken to compare the internal fixation with the two external fixation methods.


METHODS
This is a case-control study of 55 patients with 55 pilon fractures. There were 36 type C and 19 type B. Of these fractures, 24 were open and 31 closed. Three surgical protocols were used. In 20 patients, Group A, a half pin external fixator with ankle spanning was performed. The mean age of patients was 42.0 years (22.0-74.0), SD 14.1 and the mean follow-up was 77.7 months (38.0-132.0), SD 25.4. In 22 patients, Group B, a single ankle sparring ring hybrid external fixator under a small arthrotomy was performed. The mean age of patients was 48.4 years (28.0-76.0), SD 12.4 and mean follow-up was 67.9 months (36.0-132.0), SD 27.8. In 13 patients, Group C, a two-staged internal fixation was performed. The mean age was 45.6 years (30.0-66.0), SD 9.7 and the mean follow-up was 78.6 months (55.0-132.0), SD 25.4. We addressed the dissimilarity of the type of fracture in each group performing supplementary stratified analyses within each fracture type group.


RESULTS
Group A had union in 6.9 months, group B in 5.6 months and group C in 5.1 months; P = 0.009. Six patients (Group A), two (Group B), and one (Group C) had limitation of ankle motion; P = 0.47. One patient from group C developed infection and the plate was removed. Four patients (Group A), one (Group B), and one (Group C) have developed posttraumatic arthritis (loss of joint space and pain); P = 0.25. Seven patients from Group A have reduced their activities; P = 0.004. In stratified statistical analysis by type of fracture, the associations noted for both fracture groups combined were also noted separately within each fracture group.


CONCLUSIONS
In this long term follow-up study, the two-staged internal fixation and the hybrid fixation with small arthrotomy were equally efficacious in achieving bone union. Patients in external fixation with the ankle spanning had a significantly higher rate of delayed union. Also more patients in this group have reduced their activities.
Koulouvaris
Panagiotis
P
Hospital for Special Surgery-Reconstruction of Joints, Weill Medical School of Cornell University, 542E-79st-Apt 4O, New York, NY 10021, USA. koulouvarisp@hss.edu
Stafylas
Kosmas
K
Mitsionis
Gregory
G
Vekris
Marios
M
Mavrodontidis
Alexandros
A
Xenakis
Theodore
T
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D001168:Arthritis / Q000503:physiopathology; D016025:Bone Transplantation; D016022:Case-Control Studies; D016267:External Fixators; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology; D005596:Fractures, Closed / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D005597:Fractures, Open / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000145:classification / Q000503:physiopathology / Q000601:surgery*