Surgical treatment of pilon fracture based on ankle position at the time of injury/initial direction of fracture displacement: A prospective cohort study

Abstract Objective The purpose of this study is to evaluate a surgical strategy for pilon fractures based on ankle position/initial direction of fracture displacement at the time of injury. Methods Sixty-nine patients were categorized into groups based on ankle position at the time of the injury: Gr...

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Published inInternational journal of surgery (London, England) Vol. 12; no. 5; pp. 418 - 425
Main Authors Wei, Shi-jun, Han, Fang, Lan, Sheng-hui, Cai, Xian-hua
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 01.01.2014
Subjects
Adult
Ankle
Distal tibial fracture
Female
Humans
Intra-articular ankle fracture
Male
Middle Aged
Orthopedic Procedures - adverse effects
Orthopedic Procedures - methods
Pilon fracture
Plafond fracture
Postoperative Complications - etiology
Prospective Studies
Surgery
Tibial Fractures - surgery
Treatment protocol
Pilon fracture
Distal tibial fracture
Plafond fracture
Intra-articular ankle fracture
Treatment protocol
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Summary:Abstract Objective The purpose of this study is to evaluate a surgical strategy for pilon fractures based on ankle position/initial direction of fracture displacement at the time of injury. Methods Sixty-nine patients were categorized into groups based on ankle position at the time of the injury: Group I (varus), Group II (valgus), Group III (dorsiflexion), Group IV (plantarflexion), and Group V (neutral). The American Orthopedic Foot and Ankle Society (AOFAS) score was determined at 12 months. Results More than 90% of participants in Groups I–IV as well as 57.2% of participants in Group V had anatomic/good fracture reduction, respectively. Fracture healing/union was significantly slower in Group V vs Groups I, III, and IV, and in Group II vs Group IV ( P  < 0.005). AOFAS scores were significantly higher ( P  < 0.005) in Groups III (96.0, IQR: 90.0–96.0) and IV (95.0, IQR: 90.0–100.0) vs Groups II (86.9, IQR: 75.0–90.0) and V (83.0, IQR: 73.0–86.0). Wound breakdown was the most common complication ( n  = 11). Conclusions Determining the surgical strategy for managing pilon fractures based on ankle position at the time of the injury/initial direction of fracture displacement may be effective.
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ISSN:1743-9191
1743-9159
DOI:10.1016/j.ijsu.2014.03.008