OUTCOME OF DISTAL TIBIAL METAPHYSEAL/PILON FRACTURES TREATED WITH THE ALPS POLYAXIAL LOCKED PLATING SYSTEM

Abstract

Introduction: Locking plate technology for fixation of periarticular fractures has been adopted widely since its development. Distal tibial/pilon fractures represent one of the major indications of this method of fixation. The recent development of polyaxial locking systems has offered more versatility to the surgeon.

Patients and Methods: In this cohort prospective study we present our early experience of a new polyaxial locked plating system in the treatment of complex ankle and distal tibial fractures (anatomic locked plating systems– ALPS, DePuy). Demographic, mechanism of injury, AO-OTA classification, surgical procedure, postoperative course, complications, rehabilitation scheme, clinical and radiological healing as well as functional outcome (SF-36, Olerud & Molander Ankle Score, AOFAS Ankle-Hindfoot Scale, VAS pain score) were all recorded over a minimum follow-up period of 9 months.

Results: Between July 2008 and July 2009, there were 21 patients with complex ankle and distal tibial fractures who were treated with this method of fixation. There were 16 males and 5 females. The mean age was 42.9 years (16–90). All female patients were over 60 years. The majority of these injuries were related to falls or RTAs (11 and 8 cases respectively). The mean time from injury to operation was 5 days (range 1 to 14 days), and in the majority of these cases a temporary bridging external fixator was applied (in 17/21 cases). All injuries were closed fractures. There were 11 patients with 43-A, 5 with 43-B, 5 with 43-C. Fractures were treated with a choice of medial ALPS tibial plate (12 patients), anterolateral ALPS tibial plate (9 patients). There were 8 associated distal fibular fractures, which were also fixed with a plate. The mean length of stay was 8 days (range 4 to 27 days). One patient had to be converted to a circular external fixator due to local deep sepsis, while two other patients had local wound healing problems managed without implant removal. The overall healing rate was over 95%, with one case of non-union at 9 months. Fifteen of them have returned to their work, while the recorded functional scores at the last follow-up visit were good in the majority.

Conclusions: The overall clinical and functional outcome of this cohort of patients over the short-term follow-up was recorded to be comparable to existing similar case series of open reduction internal fixation of pilon fractures. The surgical advantages of the new system lie in its versatility, and short learning curve.