DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20191790

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

Vishnu Sankar Appusamy, Karthik Ramachandran, Arvind Manoj Kumbakrishnakumar

Abstract


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.

 


Keywords


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

Full Text:

PDF

References


Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am. 2003;85(10):1893-900.

Barei DP, Nork SE. Fractures of the tibial plafond. Foot Ankle Clin 2008;13:571–91.

Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases. Arch Orthop Trauma Surg. 2009;129(5):649-59.

Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M. Treatment of distal tibia fractures without articular involvement: a systemic review of 1125 fractures. J Orthop Trauma. 2006;20(1):76–9.

Othman M, Strzelczyk P. Results of conservative treatment of “pilon” fractures. Ortop Traumatol Rehabil. 2003;5:787–94.

Digby JM, Holloway GM, Webb JK. A study of function after tibial cast bracing. Injury. 1983;14:432–9.

Redfern DJ, Syed SU, Davies SJM. Fractures of the distal tibia: minimally invasive plate osteosynthesis.

Apivatthakakul T, Phornphutkul C, Patumasutra S. Idea and innovation: Simple minimally invasive plate osteosynthesis (MIPO) instruments. Injury Extra. 2009,40:39–44.

Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. 2008;22(5):307-11.

Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing. Injury. 2006;37:531–5.

Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92:984-8.

Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury 2007;38:365–70.

Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaveric injection study. Injury. 1999;28:7-12.

Lee YS, Chen SW, Chen SH, Chen WC, Lau MJ, Hsu TL. Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods. Int Orthop. 2008;33(3):695–9.

Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg Am. 1986;68:543–51.

Sommer C, Nork SE, Graves M, Blauth M, Rudin M, Stoffel K. Quality of fracture reduction assessed by radiological parameters and its influence on functional results in patients with pilon fractures—a prospective multicentre study. Injury. 2017;48(12):2853–63.

McCann PA, Jackson M, Mitchell ST, Atkins RM. Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia. Int Orthop. 2011;35(3):413-8.

Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ. Management of high-energy tibial pilon fractures. Strategies Trauma Limb Reconstr. 2015;10(3):137–47.

Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999;13(2):78-84.

Helfet DL, Shonnard PY, Levine D, Borrelli J Jr. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 1997;28:42-8.

Carbonell-Escobar R, Rubio-Suarez JC, Ibarzabal-Gil A, Rodriguez-Merchan EC. Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation. J Clin Orthop Trauma. 2017;8(4):332-8.

Korkmaz A, Ciftdemir M, Ozcan M, Copuroğlu C, Sarıdoğan K. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury. 2013;44(10):1270–4.

White TO, Guy P, Cooke CJ, Kennedy SA, Droll KP, Blachut PA, et al. The results of early primary open reduction and internal fixation for treatment of OTA 43. C-type tibial pilon fractures: a cohort study. J Orthop Trauma. 2010;24:757–63.

Tang X, Liu L, Tu CQ, Li J, Li Q, Pei FX. Comparison of early and delayed open reduction and internal fixation for treating closed tibial pilon fractures. Foot Ankle Int. 2014;35:657–64.

Lomax A, Singh AN, Jane MC, Senthil KC. Complications and early results after operative fixation of 68 pilon fractures of the distal tibia. Scott Med J. 2015;60:79–84.