Published: 2021-04-26

Functional results of compound extra articular tibial pilon fractures managed with hybrid external fixator

Gagandeep Singh Raina, Sanjeev Gupta, Mohammad Azharuddin, Zubair A. Lone, Manoj Kumar


Background: Distal tibia fractures are difficult to treat. It is often difficult to assess the potential risk of surgical complications because of the variations in the clinical findings. Less subcutaneous tissue, limited blood supply and no muscle insertions are the factors that tend to make the healing of the soft tissue more complex. Compounding presents a great challenge for the treating surgeon regarding the treatment options.

Methods: A total of 23 patients were included in the study based on the inclusion and exclusion criteria and were managed by hybrid external fixator as definitive treatment. They were kept in follow up for at least 6 months and were assessed using Ovadia and Beal’s objective and subjective scoring.

Results: All patients achieved fracture union with 82% patients reporting excellent to good functional outcome. Pin site infections and ankle stiffness were most common complications.

Conclusions: A very good outcome is achieved in compound extra articular tibial pilon fractures with the hybrid fixator technique. Adequate stability is provided and hence early motion and ambulation can be started.


Distal tibia, Tibial pilon, Extra articular fracture, Compounding, Hybrid external fixator

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Martin JS, Marsh JL, Bonar SK, De Coster TA. Found EM. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma. 1997;11:477- 83.

Tull F, Borrelli. Soft-tissue injury associated with closed fractures: evaluation and management. J Am Acad Orthop Surg. 2003;11:431-8.

Zelle B, Bhandari M, Espiritu M, Koval K, Zlowodzki M. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006;20(1):76-9.

Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle: classification and treatment by locked intramedullary nailing. J Bone Joint Surg Br. 1995;77-B:781-7.

Crist BD, Khazzam M, Murtha YM, Della Rocca GJ. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg. 2011;19(10):612-22.

Hoenig M, Gao F, Kinder J, Zhang LQ, Collinge C, Merk BR. Extra-articular distal tibia fractures: a mechanical evaluation of 4 different treatment methods. J Orthop Trauma. 2010;24(1):30-5.

Rathod J, Tailor H. Functional outcome of hybrid external fixator for fractures of metaphyseal distal tibia. Int J Orthop Sci. 2019;5(1):205-11.

Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. New York: Springer; 1990.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-8.

Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24:742-6.

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

Barbieri R, Schenk R, Koval K, Aurori K, Aurori B. Hybrid external fixation in the treatment of tibial plafond fractures. Clin Orthop. 1996;332:16-22.

Aggarwal AK, Nagi ON. Hybrid external fixation in periarticular tibial fractures. Good final outcome in 56 patients. Acta Orthop Belg. 2006;72(4):434-40.

Gaudinez RF, Mallikar, Szporn M. Hybrid external fixation in tibial plafond fractures. Clin Orthop. 1996;329:223-32.

Bone LB, Stegemann P, McNamara K. External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop. 1993;292:101-7.

French B, Tornetta P. Hybrid external fixation of tibial pilon fractures. Foot Ankle Clin. 2000;5:853-71.

Zeman J, Matejka J. Use of a hybrid external fixator for treatment of tibial fractures. Acta Chir Orthop Traumatol Cech. 2005;72(6):337-43.