Radiological parameters determining outcome in pilon fractures treated by minimally invasive plate osteosynthesis

Vishnu Sankar Appusamy, Karthik Ramachandran, Arvind Manoj Kumbakrishnakumar


Background: Tibial pilon fractures are one of the challenging fractures to manage in the field of orthopaedics due to its complex fracture patterns as well as associated soft tissue injury. Minimally invasive plate osteosynthesis (MIPO) technique aims to reduce the surgical trauma to the surrounding soft tissues and hence maintain a more biologically favourable environment for fracture healing. The purpose of the study is to analyse the various factors especially radiological parameters determining functional outcome in pilon fractures treated by MIPO technique.

Methods: This is a prospective study conducted from June 2015 to May 2018. The study included 46 patients (33 males, 13 females) with pilon fractures treated by minimally invasive plate osteosynthesis. All patients were followed for average period of 2 years. Functional outcome was assessed using American Orthopedic Foot and Ankle Score (AOFAS).

Results: Among 46 patients, 21 patients (45.65%) had excellent, 16 patients (34.78%) had good and 6 patients (13.04%) had fair functional outcome. The quality of reduction was the most important parameter determining the functional outcome. We found that patients with higher lateral distal tibial angle (LDTA), anterior distal tibial angle (ADTA) and length of lateral malleolus (LLM) had better functional outcome than patients with lower values. The timing of surgery had no significant influence on the functional outcome of the patients.

Conclusions: We like to conclude that apart from the quality of fracture reduction, radiological parameters like ADTA, LDTA, and LLM also play a crucial role in determining the functional outcome in pilon fractures.



Pilon fractures, Minimally invasive plate osteosynthesis, Lateral distal tibial angle, Anterior distal tibial angle, Length of lateral malleolus

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