CUSTOM-CONTOURED INTERLOCKED BLADE PLATE FOR DISTAL TIBIA FIXATION

Abstract

Non-unions of pilon fractures are difficult Orthopaedic problems. Significant bone loss and infection can lead to amputation. Joint stiffness in conjunction with disuse osteopenia make stabilization in this area challenging. We present the use of a custom blade plate design that offers sufficient stability for successful treatment in six successive cases. With a mean follow-up of thirty-three months, all fractures treated with this method healed. The five infected cases healed without recurrence of infection. With average scores of 70.7 on the Maryland Foot Score, and sixty-eight on the Foot and Ankle Society Ankle-Hindfoot Scale, the patients overall had satisfactory results.

The purpose of this study was to describe a new technique of treating non-unions of distal tibia pilon fractures using a custom blade plate design. A report of successful outcomes in six consecutive cases.

A retrospective analysis of fifty-six pilon fractures treated over a three- year period revealed six patients with significant complications related to their fractures. Of these, all had significant bone loss and five were infected. All six failures were revised using a custom blade plated design with oblique locking screws for triangular fixation of the distal pilon. The average follow-up period was thirty-three months. These patients were evaluated with the Maryland Foot Score (MFS) and the Foot and Ankle Society Ankle-Hindfoot Scale (AHS).

All of the six patients treated with the proposed method went on to heal without recurrence of infection. Three patients required additional surgical interventions including bone grafting, debridement and hardware removal to achieve the final result. Their average MFS and AHS were 70.7 and sixty-eight respectively.

Stable fixation is an absolute necessity for a successful outcome in the failed pilon fracture. A custom blade plate design with oblique interlocked screws offers sufficient long-term stability, despite infection and disuse osteopenia, for healing of the non-united fracture to occur. As shown by our series, satisfactory clinical results can be expected and amputation can be avoided in complicated cases using this surgical technique.