Functional outcome of JESS fixation and bone grafting in distal tibial plafond-pilon fracture: a prospective study

Reji Varghese, Shajimon Samuel


Background: The Pilon fractures are one of the most difficult to treat. Fracture known as “orthopedicians nightmare”. The incidence of complications following ORIF of pilon ranges from 10-55% and other complication are infection, loss of reduction, secondary arthrosis. In these circumstances JESS and Bone grafting is cost effective and less hospitalization. Our aim was to evaluate in the functional outcome of JESS fixation and bone grafting in distal tibial plafond- pilon fracture using Olerud and Molander score.

Methods: The JESS fixation and bone grafting was used for pilon fracture in 30 patients, 24 male and 6 female. Mean age 44 years range (18-60 years). Fractures caused by fall and RTA. All were treated with JESS fixation and bone grafting. the patients were assessed clinically and radiographically at regular interval of 1 month and later 2 months interval. Outcome was assessed using Olerud and Molander score. Complications were recorded.

Results: 12 patients had Ruedi and Allgower type II fracture and 18 patients had type III fracture. After 9 month of follow up midterm OMAS score- 11.766 was achieved. Outcomes were good in 71.25% and fair results in 50.83% respectively. The complication seen was residual ankle pain in 6.66% patients and implant failure in 13.33%.

Conclusions: Fixation of pilon fracture with JESS and bone grafting is associated with good functional outcome in type II and fair in type III pilon fracture. The incidence of complications high in type III pilon fracture. 


JESS fixation, Olerud and Molandar score, Reudi allgower

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Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fracture. Variables contributing to poor results and complication. Clin Ortho Relate Res. 1993;292:108-17.

Bourne RB, Rerabeck CH, Mac Nab J. Intraarticular fracture of distal tibia: the pilon fracture. J Trauma. 1983;23(7):591-6.

Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999;13(2):85-91.

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

Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73(5):635-40.

Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21(6):355-61.

Collinge CA, Sanders RW. Percutaneous plating in the lower extremity. J Am Acad Orthop Surg. 2000;8(4):211-6.

Assal M, Ray A, Stern R. The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing. J Orthop Trauma. 2007;21(3):198-206.

Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15:153.

Bonar SK, Marsh JL. Unilateral external fixation for severe pilon fractures. Foot Ankle. 1993;14:57.

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.

Cole PA, Benirschke SK. Minimally invasive surgery for the pilon fracture: the percutaneous-submuscular plating technique. Tech Orthop. 1999;14:201.

Court-Brown CM, Walker C, Garg A, McQueen MM. Half-ring external fixation in the management of tibial plafond fractures. J Orthop Trauma. 1999;13:200.

Dickson KF, Montgomery S, Field J. High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface—preliminary report. Injury. 2001;32:92.

Egol KA, Wolinsky P, Koval KJ. Open reduction and internal fixation of tibial pilon fractures. Foot Ankle Clin. 2000;5:873.

Grose A, Gardner MJ, Hettrich C, Fishman F, Lorich DG, Asprinio DE, et al. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J Orthop Trauma. 2007;21(8):530-7.

Heim U, Naser M. Operative treatment of distal tibial fractures. Technique of osteosynthesis and results in 128 patients (author's transl). Arch Orthop Unfallchir. 1976;86(3):341-56.

Giordano CP, Koval KJ, Zuckerman JD, Desai P. Fracture blisters. Clin Orthop Relat Res. 1994(307):214-21.

Giordano CP, Scott D, Koval KJ. Fracture blister formation: a laboratory study. J Trauma. 1995;38(6):907-9.

McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6(2):195-200.

Strauss EJ, Petrucelli G, Bong M, Koval KJ, Egol KA. Blisters associated with lower-extremity fracture: results of a prospective treatment protocol. J Orthop Trauma. 2006;20(9):618-22.

Dillin L, Slabaugh P. Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma. 1986;26(12):1116-9.

Rüedi TP, Allgöwer M. The operative treatment of intraarticular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979;138:105.

Ovadia DN, Beals RK. Fracture of the tibial plafond. J Bone Joint Surg Am. 1986;(4):543-51.

Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993(292):108-17.

Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, et al. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am. 1996;78(11):1646-57.

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.