Abstract
This study of surgically treated distal tibia fractures was undertaken to compare the internal fixation with the two external fixation methods.
There were 40 patients with 41 pilon fractures. The mean age was 51.2 years (18–76). 17 of the 40 patients-14 from vehicular accident, 3 from fall – were treated with an ankle-spanning half-pin external fixator (11C, 6B, 11 Weber B- 5 C, 1IIIa, 5I, 6II). 11 patients-10 from vehicular accident, 1 from fall- were treated with a single-ring hybrid ankle-spanning external fixator (9C, 2 B, 6 Weber B-4 C, 5I, 2II). 13 patients-10 from vehicular accident and 1 from fall- were treated with an epiunion plate (1A, 8B, 4C, 5I, 3II, 10 Weber B- 1C). The mean follow-up was 4.2years (1–8). Fracture union was defined as having three cortices bridging on the plain radiographs for a patient who was able to bear full weight. Non union was defined as a fracture that did not heal within a year.
Fracture union was achieved for 36 of the 41 fractures. Three patients with external fixator, one with hybrid and one with plate had septic pseudarthrosis. Fractures in the external fixator and hybrid groups had a tendency to lose the reduction. Four patients with external fixator had delayed union and have lost range of motion in the ankle. Five patients in the external fixator group are candidates for ankle arthrodesis due to arthritis.
The ORIF and hybrid fixator were equally efficacious in achieving bony union and not to lose range of motion in the ankle. Fractures in the external fixator with the ankle – spanning had higher rate of delayed union and loss of motion in ankle. The choice of the external fixator is dependent on the surgeon and the type of the fracture. However the patient must be followed up for the stability of the system.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
