Abstract
Background:
Pilon fractures are complex intra-articular fractures of the tibial plafond associated with significant short and long morbidity. Minimising surgical complications is essential.
Methods:
Clinical and radiological outcomes in 49 patients with AO type 43B and 43C fractures were evaluated retrospectively. Definitive management depended on patient factors, soft tissue injury and fracture pattern.
Results:
The majority of fractures (n=26, 53%) were C3 type. 9 fractures were open (18%), grade 3A or 3B. 34 patients (69%) were definitively managed with open reduction and internal fixation (ORIF) predominantly through an anterior approach. 15 (31%) had mini-open or percutaneous plafond reduction and external fixation. No medial plates were used. There were no deep infections. Complications occurred in 5 (10%) patients, all relating to metaphyseal delayed or non-union. At last review, 18 patients (36%) had radiographic evidence of post-traumatic arthritis.
Discussion:
Surgeons treating pilon fractures should be familiar with external and internal fixation techniques in order to minimise surgical complications. An algorithm for treatment planning is suggested.
Conclusion:
It is possible to achieve low surgical complication rates through careful management according to the nature of the fracture and patient characteristics. For plating, the antero-lateral distal tibial Peri-Loc plate is an effective and safe implant.
