A Comparison of Functional Outcome of Intra Articular Distal Tib-ial Pilon Fracture Treated by One Stage vs Two Stage Surgically

Punit  Talwar; Rahul  Kothari; Hemin  Singh

doi:10.55489/njmr.1222022896

Authors

Punit Talwar S. S. Institute of Medical Sciences & Research Centre, Davanagere, Karnataka
Rahul Kothari Smt. B. K. Shah Medical Institute & Research Centre & Dhiraj Hospital, Wagodia, Gujarat
Hemin Singh S. S. Institute of Medical Sciences & Research Centre, Davanagere, Karnataka

DOI:

https://doi.org/10.55489/njmr.1222022896

Keywords:

Tibial Pilon Fracture, Ovadia Beals Evaluation Score, AO/OTA, AOFAS

Abstract

Introduction: The study was conducted to evaluate clinical and functional outcomes of comminuted pilon of distal tibial fractures after surgical management and fixation by modalities available ranging from temporary external fixation, simple distal tibial plates to moderate plating system and intra medullary nails for fibula.

Methodology: Total 24 cases with intraarticular distal tibial pilon fracture were randomly divided in to two group. One group was managed by one stage procedure and second group was operated by two stage procedure.

Results: From this study we infer that patient who had undergone one stage procedure had shorter hospital stay. In present study we observed that arthrosis, superficial infection and arthritis was higher in two stage procedure. Assessed by Ovadia Beals Evaluation Score - Objective Evaluation as well as subjective evaluation. Furthermore, the rate of complications was also identical. However, functional outcome assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score revealed that the patients underwent one stage procedure had better functional outcome.

Conclusion: Considering the better functional outcome and the shorter hospital stay, we preferred using one stage operative procedure in better skin condition, less soft tissue damage, closed fracture of type b and C AO/OTA Pilon fractures.

References

1. Heim U. In: Duparc J, editor. Fractures du pilon tibial. Confé-rencesd'enseignement. Paris: Expansion Scientique Franc¸ aise; 1997. p. 35-51.

2. Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia.J Bone Joint Surg Br 2005;87:692-7. Doi: https://doi.org/10.1302/0301-620X.87B5.15982 PMid:15855374

3. Aubry P, Fiévé G. Vascularisation osseuse et cutanée du quart inferieur de jambe. Rev Chir Orthop 1984;70:589- 97.

4. Dujardin F., Abdulmutalib H., Tobenas A.C. Total fractures of the tibial pilon. Orthop Traumatol Surg Res. 2014;100(Suppl. 1 February):S65-74. Doi: https://doi.org/10.1016/j.otsr.2013.06.016 PMid:24412046

5. Liangjun J, Qiang Z, Hang L, Zhijun P. Injury mechanism, fracture characteristics and clinical treatment of pilon fracture with intact fibula-A retrospective study of 23 pilon fractures. J Clin Orthop Trauma. 2017 Nov;8(Suppl 2):S9-S15. Doi: https://doi.org/10.1016/j.jcot.2017.05.002 PMid:29158644 PMCid:PMC5681230

6. Sajjadi MM, Ebrahimpour A; Okhovatpour MA; Karimi A, Zandi R, Sharifzadeh A.The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two-stage Approach. Arch Bone Jt Surg. 2018; 6(5): 412-419.

7. Ovadia D. N., Beals R. K. Fractures of the tibial plafond. The Journal of Bone & Joint Surgery. 1986;68(4):543-551. Doi: https://doi.org/10.2106/00004623-198668040-00010

8. Van Lieshout EMM, De Boer AS, Meuffels DE, et al American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version BMJ Open 2017;7:e012884. Doi: https://doi.org/10.1136/bmjopen-2016-012884 PMid:28242768 PMCid:PMC5337732

9. Scolaro J, Ahn J. Pilon fractures. Clin Orthop Relat Res. 2011; 469(2):621-3. Doi: https://doi.org/10.1007/s11999-010-1509-z PMid:20694535 PMCid:PMC3018216

10. Dickson KF, Montgomery S, Field J. High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface-preliminary report. Injury. 2001;32(Suppl 4):SD92-8. Doi: https://doi.org/10.1016/S0020-1383(01)00163-2 PMid:11812482

11. Minator Sajjadi M, Ebrahimpour A, Okhovatpour MA, Karimi A, Zandi R, Sharifzadeh A. The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two-stage Approach. Arch Bone Jt Surg. 2018 Sep;6(5):412-419. PMID: 30320182; PMCID: PMC6168224.

12. Lavini F, Dall'Oca C, Mezzari S, Maluta T, Luminari E, Perusi F, et al. Temporary bridging external fixation in distal tibial fracture. Injury. 2014;45(6):S58-63. Doi: https://doi.org/10.1016/j.injury.2014.10.025 PMid:25457321

13. Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trau-ma. 1999; 13(2):85- 91. Doi: https://doi.org/10.1097/00005131-199902000-00003 PMid:10052781

14. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of com-plex pilon fractures. J Orthop Trauma. 2004;18(8 Suppl):S32-8. Doi: https://doi.org/10.1097/00005131-200409001-00005 PMid:15472563

15. Richards JE, Magill M, Tressler MA, Shuler FD, Kregor PJ, Obremskey WT, et al. External fixation versus ORIF for distal intra-articular tibia fractures. Orthopedics. 2012;35(6):e862-7. Doi: https://doi.org/10.3928/01477447-20120525-25 PMid:22691658

16. Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical op-tions for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15(3):153-60. Doi: https://doi.org/10.1097/00005131-200103000-00002 PMid:11265004

17. Bacon S, Smith WR, Morgan SJ, Hasenboehler E, Philips G, Williams A, et al. A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and in-ternal fixation versus external Ilizarov fixation. Injury. 2008; 39(2):196-202. Doi: https://doi.org/10.1016/j.injury.2007.09.003 PMid:18241864

18. Tang X, Tang PF, Wang MY, Lü DC, Liu MZ, Liu CJ. Pilon fractures: a new classification and therapeutic strategies. Chin Med J (Engl) 2012;125(14):2487-92. [PubMed] [Google Scholar]

19. White TO, Guy P, Cooke CJ, Kennedy SA, Droll KP, Blachut PA, et al. The results of early primary open reduction and in-ternal fixation for treatment of OTA 43.C-type tibial pilon fractures. J Orthop Trauma 2010;24:757-63. Doi: https://doi.org/10.1097/BOT.0b013e3181d04bc0 PMid:21076248

20. Paluvadi SV, Lal H, Mittal D, Vidyarthi K. Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients. J Clin Orthop Trauma. 2014;5(3):129-36. Doi: https://doi.org/10.1016/j.jcot.2014.07.010 PMid:25983486 PMCid:PMC4223765

21. Li Q, Zhao WB, Tu CQ, Yang TF, Fang Y, Zhang H, et al. Locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of pilon fracture. Zhongguo Gu Shang. 2014;27(12):1029-32. [PubMed] [Google Scholar]

22. De-Las-Heras-Romero J, Lledo-Alvarez AM, Lizaur-Utrilla A, Lopez-Prats FA. Quality of life and prognostic factors after in-tra-articular tibial pilon fracture. Injury. 2017 Jun;48(6):1258-1263. Doi: https://doi.org/10.1016/j.injury.2017.03.023 PMid:28365069