1. Late results after a two-stage protocol for soft tissue management in the treatment of tibial pilon fractures
Obadă B., Șerban Al. O., Costea D., Grasa C., Zekra M., Alecu Silvana-Crina
Emergency Clinical Hospital of Constanta, Romania
P141
Objective
Although a variety of options are available to treat these fractures, timing of the definitive surgery is crucial with respect to the condition of the soft tissues. The prospective study targets the tibial pilon fractures admitted in our clinic, to which a new treatment protocol was applied, consisting of two surgical steps, assesing in the end the results achieved at the discharge of the patient and later follow up.
The protocol consisted of immediate (within 12 hours) open reduction and internal fixation of the fibula when fractured, using a tubular plate and application of an external delta frame fixator spanning the ankle joint. After, on average, 14 days, patients underwent removal of external fixator and fixation by locking plate via MIPO technique (antero-medial approach).
Material. Methods.
Demographic profile – 196 patients/198 fractures (2012 – 2015)
Criteria
Number
Average age (years)
46.5 (19-83)
Evaluation period (months)
16 (12-24)
Sex (men/women)
156/40
Simple trauma/high energy trauma
57/139
Type 43 B (AO)
119
Type 43 C (AO) 79
Open fractures
Type I 17
Type II 14
Type III
Results. Discussions.
A minimal follow-up of 1 year was obtained. All wounds healed. All the fractures healed within an average of 3.6 months. In one case the patient come at 6 weeks after operation with refracture and broken plate secondary to inappropriate full weight-bearing. One ankle had joint fusion after 24 months due to severe arthritis.
Case 1 – aspect at 18 months
Case 2 – aspects in emergency, at 12 days, at 18 months
Case 3 – bilateral distal tibia fractures in emergency, at 14 days and at 12 months
Case 4 – aspects in emergency, at 10 days and at 12 months
Case 5 – broken implant after 6 weeks
Conclusions
A two staged surgical approach offers acceptable results for the treatment of distal tibia fractures. When a staged procedure is performed with initial restoration of fibula length and tibial external fixation, soft tissue stabilization is possible. Once soft tissue swelling has significantly diminished, reduction and internal fixation using MIPO can be performed with no soft tissue problems. This procedure seems to play a key-role in reducing complication rates associated with ORIF . The arthrosis risk increase with the fracture severity and the type C fractures had the poorest arthosis risk.