Published: 2020-10-22

Outcome of complex tibial pilon fractures definitively treated with external fixator

Meryem Lemsanni, Youssef Najeb, Rachid Chafik, Mohamed Madhar, Hanane Elhaoury


Background: Complex tibial pilon fractures are typically sustained with high-energy mechanisms and they are often associated with severe soft tissue compromise that can frequently results in severe complications. The purpose of this prospective case series was to evaluate the radiological and clinical outcomes after the use of external fixation combined with minimally invasive osteosynthesis, as primary and definitive treatment of complex tibial pilon fractures.

Methods: A prospective study was undertaken during the period from March 2012 to June 2016. A total number of 109 patients with complex tibial pilon fractures were managed in our institution and included in the study. All the patients were treated with external fixation and minimally invasive osteosynthesis. The mean follow-up period was 47 months (31-60 months). Clinico-radiological progression of fracture union as well as the functional outcome were studied.

Results: Eighty fractures resulted from traffic accidents and type 43-C3 fracture according to AO/OTA classification was the most common. Seventy-eight were open fractures and 94 patients had associated distal fibular fractures. All patients were treated with monolateral external fixators for definitive management. The average time to union was 14 weeks (range 9-19). Eleven patients (10%) suffered superficial pin tract infection. One patient developed septic arthritis and evidence of radiological osteoarthritis was present in ten cases (9%) at final follow-up. The American orthopaedic foot and ankle society (AOFAS) score was 84.4±8.1, translating to good clinical results.

Conclusions: This review concludes that external fixation, combined with minimally invasive osteosynthesis, consistently produces good functional results without serious complications.


Pilon fracture, External fixation, Minimally invasive osteosynthesis, High energy mechanism

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Papadokostakis G, Kontakis G, Giannoudis P, Hadjipavlou A. External fixation devices in the treatment of fractures of the tibial plafond. A systematic review of the literature. J Bone Joint Surg [Br]. 2008;(90-B):1-6.

Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg. 2007;127(1):55-60.

Osman W, Alaya Z, Kaziz H, Hassini L, Braiki M, Naouar N et al. Treatment of high-energy pilon fractures using the ILIZAROV treatment. Pan Afr Med J. 2017;27:199.

Dunbar RP, Barej DP, Kubiak EN, Nork SE, Henley MB. Early limited internal fixation of diaphyseal extensions in select pilon fractures: upgrading AO/OTA type C fractures to AO/OTA type B. J Orthop Trauma. 2008;22:426-9.

Gardner MJ, Mehta S, Barei DP, Nork SE. Treatment protocol for open AO/OTA type C3 pilon fractures with segmental bone loss. J Orthop Trauma. 2008;22:451-7.

Villaseñor Villaseñor LE, Olea Leyva MA, Rodríguez Flores R, Hernández López JL. Clinical outcome of a bilateral tibial pylon fracture treated with a minimally invasive technique. Acta Ortop Mex. 2009;23(3):163-6.

Galante VN, Vicenti G, Corina G, Mori C, Abate A, Picca G et al. Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures. Injury. 2016;47(4):S131-7.

Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg. 2011;77(4):432-40.

Kapoor SK, Kataria H, Patra SR, Boruah T. Capsuloligamentotaxis and definitive fixation by an ankle-spanning Ilizarov fixator in high-energy pilon fractures. J Bone Joint Surg [Br]. 2010;92(8):1100-6.

1Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ.Management of high-energy tibial pilon fractures. Strat Traum Limb Recon. 2015;10:137-47.

Bear J, Rollick N, and Helfet D. Evolution in Management of Tibial Pilon Fractures. Curr Rev Musculoskelet Med. 2018;11(4): 537-45.

Meena UK, Bansal MC, Behera P, Upadhyay R, and Gothwal GC. Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study. J Clin Orthop Trauma. 2017;8(2):S16-20.

Davidovitch RI, Elkhechen RJ, Romo S, Walsh M, Egol KA. Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA type 43C). Foot Ankle Int. 2011;32(10):955-61.

Wyrsch B, McFerran MA, Mc Andrew M. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am. 1996;78-A:1646-7.

Bacon S, Smith WR, Morgan SJ, Hasenboehler E, Philips G, Williams A et al. A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: Open reduction and internal fixation versus external Ilizarov fixation. Injury. 2008;39(2):196-202.

Malik-Tabassum K, Pillai K, Hussain Y, Bleibleh S, Babu S, Giannoudis PV et al. Post-operative outcomes of open reduction and internal fixation versus circular external fixation in treatment of tibial plafond fractures: A systematic review and meta-analysis. Injur. 2020;51(7):1448-56.

McDonald MG, Burgess RC, Bolano LE, Nicholls PJ. Ilizarov treatment of pilon fractures. Clin Orthop Relat Res. 1996;325:232-8.

Wang D, Xiang JP, Chen XH, Zhu QT. A meta-analysis for postoperative complications in tibial plafond fracture: open reduction and internal fixation versus limited internal fixation combined with external fixator. J Foot Ankle Surg. 2015;54(4):646-51.

Mitkovic MB, Bumbasirevic MZ, Lesic A, Golubovic Z .Dynamic external fixation of comminuted intra-articular fractures of the distal tibia (type C pilon fractures). Acta Orthop Belg. 2002;68(5):508-14.

McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6:195-200.

Thordarson DB. Complications after treatment of tibial pilon fractures: prevention and management strategies. J Am Acad Orthop Surg. 2000;8(4):253-65.

Harris AM, Patterson BM, Sontich JK. Results and outcomes after operative treatment of high-energy tibial plafond fractures. Foot Ankle Int. 2006;27:256-5.