Functional and radiographic outcomes following limited open reduction with ankle-spanning Ilizarov fixation in high-energy tibial pilon fractures

Tapos Kumar Roy; M. Rabiul Islam; A. B. M. Rashedul Amir; Sujan Tripura; Sanaulla Khandaker; M. Raihanul Hoque; Mohammad Sultanul Arefin; S. M. Ziaul Alam

doi:10.18203/issn.2455-4510.IntJResOrthop20263896

Authors

Tapos Kumar Roy Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
M. Rabiul Islam Bangladesh Spine and Orthopedic Hospital, Dhaka, Bangladesh
A. B. M. Rashedul Amir Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Sujan Tripura Bangladesh Medical University, Dhaka, Bangladesh
Sanaulla Khandaker Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
M. Raihanul Hoque Department of Orthopaedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Mohammad Sultanul Arefin Department of of Musculoskeletal Tumor & Orthopaedic Oncology, Rangpur Medical College, Rangpur, Bangladesh
S. M. Ziaul Alam Department of Orthopaedic Surgery, Brahmanbaria Medical College, Brahmanbaria, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263896

Keywords:

External fixation, Ilizarov fixation, Limited open reduction, Tibial pilon fracture

Abstract

Background: High-energy tibial pilon fractures are complex peri-articular fractures that have significant soft-tissue involvement and are at high risk of complications with immediate internal fixation. This study aimed to assess the functional and radiographic results of limited open reduction with ankle-spanning Ilizarov fixation in high-energy tibial pilon fractures.

Methods: This descriptive observational study was conducted at National Institute of Traumatology & Orthopaedic Rehabilitation, Dhaka, Bangladesh, from May 2017 to August 2019, including 45 patients with high-energy tibial pilon fractures who underwent limited open reduction and ankle-spanning Ilizarov fixation. All enrolled patients had their sociodemographic, injury-related, operative, radiographic, functional and postoperative complication data systematically recorded and analyzed.

Results: The majority of patients were young men, road traffic accidents were the most common mechanism of injury, AO/OTA type 43-C2 (42.2%) and Rüedi-Allgöwer type III (60%) fractures were the most common and 75.6% had an associated fibular fracture. The radiological union was obtained in 93.3% of patients, anatomical or near-anatomical reduction was obtained in 64.4% and an articular step-off less than 2 mm was obtained in 71.1%. The overall functional outcome was satisfactory in 68.9% of patients and the AOFAS ankle-hindfoot score was excellent or good in 68.9% of patients. Superficial pin-tract infection was seen in 33.3% of patients; deep infection, nonunion and secondary procedures were relatively uncommon.

Conclusions: Limited open reduction with ankle-spanning Ilizarov fixation was associated with high rates of union and satisfactory functional outcomes in patients with high-energy tibial pilon fractures and is therefore a reproducible treatment option in this difficult fracture group.

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