Abstract
Introduction: Pilon fractures are severe injuries of the distal tibia usually characterised by severe soft tissue “hit” in addition to the underlying fracture. Historically, plating techniques have led to a significant rate of serious complications. This study describes our early experience treating such injuries by the Ilizarov Method.
Methods: 30 patients were prospectively identified and followed up beyond frame removal clinically and by case note review. Fractures classified according to AO. Bony union evaluated radiologically and clinically – remodelling of bone trabeculae on two radiographs and ability to weight bear without discomfort/walking aids on a dynamised frame.
Results:
Mean age 45.3 years, male: female = 26:4.
Seven fractures were Grade 3 open.
Patients were grouped as follows:
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43-A .1/.2/.3 = 1/2/2
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43-B .1/.2/.3 = 1/0/4
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43-C .1/.2/.3 = 3/4/13.
Two patients with 43-C.3 fracture had additional corticotomy for bone loss.
Twenty-nine pilons united.
Overall mean time to union was 20 weeks.
Times to union (weeks):
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Group 43-A: - median = 20, mean = 21.
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Group 43-B: - median = 11, mean = 12.
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Group 43-C: -median = 20, mean = 21.
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Group 43-C.3: -median = 20, mean = 21
24 patients had no major complications. One Grade 3B open 43-C.3 fracture had deep sepsis prior to transfer to our unit which could not be eradicated – this led to transtibial amputation. Two patients had valgus mal-union and One had stiff nonunion requiring a second frame. Eleven patients experienced superficial pinsite infection that resolved with oral antibiotic therapy. Two deep pinsite infections were eradicated by overdrilling.
Conclusion: The Ilizarov method offers safe and reliable healing for distal tibial pilon fractures in mean 20 weeks, with low levels of serious complications despite the severity of the initial injuries.
Correspondence should be addressed to: S. Dhar, BLRS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
