THE MANAGEMENT OF THE METAPHYSEAL BONE LOSS IN THE HIGH ENERGY TIBIAL PILON FRACTURES TREATED WITH HYBRID FIXATION

Abstract

Introduction: High energy tibial pilon fractures are usually associated with a significant bone loss in the metaphyseal area of the tibia. This study evaluates three different treatment options for the management of the metaphyseal bone loss.

Materials and Methods: Betwwen 1996 and 2007, 85 high energy pilon fractures- Ovadia Beals type IV: 39 and V: 46- were treated and reviewed in our institution. Twenty four fractures were open, and fifty one closed fractures had soft tissue lesion grade1 or 2 according to Tscherne classification. To restore the bone continuity in tibia metaphyseal area bone graft substitutes were used in 53 fractures, acute shortening and proximal lengthening in 18 fractures and bone transport in 14 fractures. Evaluation was carried out according to the Ovadia-Beals evaluation system.

Results: The mean average follow up was 6 years. Thirty seven fractures (70%) treated with bone graft substitutes achieved an excellent or good result. Eleven fractures (61%) treated with proximal tibia lengthening achieved an excellent or good result, whereas only eight fractures (57%) treated with bone transport achieved an excellent or good. Bone infection was recorded in 6 fractures, all in the group of the patients treated with bone graft substitutes.

Conclusion: The management of the metaphyseal bone loss in the high energy tibial pilon fractures is a basic priority to achieve a satisfactory result. Hybrid external fixation with the use of bone graft substitutes seems to be a more suitable technique to these devastating injuries. However bone infection remains a major concern for these devastating injuries.