scholarly journals Open distal tibial pilon fractures treated with "one-stage" external fixation method

2015 ◽  
Vol 62 (1) ◽  
pp. 13-18
Author(s):  
Sasa Milenkovic ◽  
Milan Mitkovic ◽  
Milorad Mitkovic ◽  
Ivan Micic ◽  
Sonja Stamenic ◽  
...  
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Major Complication ◽  
Functional Results ◽  
High Energy ◽  
Fixation Method ◽  
Wound Irrigation ◽  
One Stage ◽  
Tibial Pilon ◽  
Pilon Fractures

Introdiction: Open distal tibial pilon fractures are considered as hard injuries, caused by high-energy axial load. Different treatment methods of these injuries are described in the literature. Authors of this paper are presenting own experience and results in the method of ?one-stage? external fixation with or without limited internal fixation of the fracture. Material and methods: All the patients had emergent surgical treatment in 4 to 8 hours after the hospitalisation. Surgical protocol included wound irrigation, debridement, fracture reduction and external fixation in type A fractures. Type B and type C fractures were treated by ?bridging? external fixation with limited internal fixation. In the cases where wound had not been possible to close primarily additional surgical procedures (soft tissue defects coverage) were performed. Results: Final functional outcome was excelent in 5(31,25%) patients, good in 6 (37,5%) patients, moderate in 3(18,75%) patients and bad in 2 (12,5%) patients (according Karlsson Score). Final anatomical and functional results were in correlation with the type of primary injury. One case of septic pseudoarthrosis and three cases of late ankle arthrosis were found as a major complication. Conclusion High-energy open distal tibial pilon fractures are still considered as a challange and significant surgical problem. The method of external fixation with or without limited internal fixation, as ?one-stage? method, was approved in clinical practice to give excelent and good final functional and anatomical results. Though final functional results were in correlation with degree of the injury, described method gives good outcome results and further clinical application will surely approve its clinical significance.

scholarly journals Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

2018 ◽  
Vol 24 (1) ◽  
pp. 84-89
Author(s):  
Rayan Ahmed ◽  
Kotb Ahmed ◽  
M. Elmoatasem Elhussein ◽  
Samir Shady ◽  
Tamer A. El-Sobky ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Articular Surface ◽  
High Energy ◽  
Complication Rates ◽  
Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

scholarly journals Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method

2013 ◽  
Vol 70 (9) ◽  
pp. 836-841 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Ivan Micic ◽  
Desimir Mladenovic ◽  
Stevo Najman ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ankle Joint ◽  
Fixation Method ◽  
Universal Method ◽  
Type B ◽  
Tibial Pilon ◽  
Post Surgery ◽  
Articular Fractures ◽  
Type C ◽  
Pilon Fractures

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint.

scholarly journals Outcome of complex tibial pilon fractures definitively treated with external fixator

2020 ◽  
Vol 6 (6) ◽  
pp. 1145
Author(s):  
Meryem Lemsanni ◽  
Youssef Najeb ◽  
Rachid Chafik ◽  
Mohamed Madhar ◽  
Hanane Elhaoury
Keyword(s):  
Minimally Invasive ◽  
External Fixation ◽  
Case Series ◽  
High Energy ◽  
Definitive Treatment ◽  
External Fixators ◽  
Minimally Invasive Osteosynthesis ◽  
Tibial Pilon ◽  
Pilon Fractures

<p class="abstract"><strong>Background:</strong> Complex tibial pilon fractures are typically sustained with high-energy mechanisms and they are often associated with severe soft tissue compromise that can frequently results in severe complications. The purpose of this prospective case series was to evaluate the radiological and clinical outcomes after the use of external fixation combined with minimally invasive osteosynthesis, as primary and definitive treatment of complex tibial pilon fractures.</p><p class="abstract"><strong>Methods:</strong> A prospective study was undertaken during the period from March 2012 to June 2016. A total number of 109 patients with complex tibial pilon fractures were managed in our institution and included in the study. All the patients were treated with external fixation and minimally invasive osteosynthesis. The mean follow-up period was 47 months (31-60 months). Clinico-radiological progression of fracture union as well as the functional outcome were studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Eighty fractures resulted from traffic accidents and type 43-C3 fracture according to AO/OTA classification was the most common. Seventy-eight were open fractures and 94 patients had associated distal fibular fractures. All patients were treated with monolateral external fixators for definitive management. The average time to union was 14 weeks (range 9-19). Eleven patients (10%) suffered superficial pin tract infection. One patient developed septic arthritis and evidence of radiological osteoarthritis was present in ten cases (9%) at final follow-up. The American orthopaedic foot and ankle society (AOFAS) score was 84.4±8.1, translating to good clinical results.</p><p class="abstract"><strong>Conclusions:</strong> This review concludes that external fixation, combined with minimally invasive osteosynthesis, consistently produces good functional results without serious complications.</p>

scholarly journals Surgical treatment of pertrochanteric fractures by dynamic methods of external and internal fixation

2003 ◽  
Vol 60 (6) ◽  
pp. 663-667 ◽  
Author(s):  
Sasa Milenkovic ◽  
Milorad Mitkovic ◽  
Mile Radenkovic ◽  
Desimir Mladenovic ◽  
Gordana Soldatovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Results ◽  
Surgical Trauma ◽  
Pertrochanteric Fractures ◽  
Skeletal Mass ◽  
Dynamic Methods ◽  
Life Threat ◽  
Methods Of Treatment

Pertrochanteric fractures usually occur in patients over 65 years of age, with greater loss of skeletal mass (osteoporosis). Nonsurgical methods of treatment are accompanied by relatively high lethality rate. Moreover, they do not produce satisfactory anatomical and functional results. Surgical treatment by using dynamic implants represents a method of choice in the fixation of pertrochanteric fractures. This paper presents the treatment results of 110 patients, 61 with pertrochanteric fractures, who were surgically treated by the dynamic method of internal fixation, and 49 patients who were treated by the method of external fixation. Dynamical implants enabled both dynamization and compression of the fracture in the axis of the neck, as well as the diaphysis of the femur, which lowered the risk of mechanical complications, and, at the same time, provided effective healing of the fracture, early activation, and mobilization of the patients on whom the surgery was performed. In patients infected by various diseases, for whom surgical trauma represents a life threat, the external fixation is recommended as a method of choice.

scholarly journals Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

2018 ◽  
Vol 46 (7) ◽  
pp. 2525-2536 ◽  
Author(s):  
Xueliang Cui ◽  
Hui Chen ◽  
Yunfeng Rui ◽  
Yang Niu ◽  
He Li
Keyword(s):  
Postoperative Complications ◽  
Internal Fixation ◽  
Bone Healing ◽  
Open Reduction ◽  
Lower Risk ◽  
Meta Analysis ◽  
Two Stage ◽  
Superficial Infection ◽  
Tibial Pilon ◽  
Pilon Fractures

Objectives Two-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures. Methods We conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis. Results The two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups. Conclusion Two-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures. Level of evidence 2.

External Fixation of Severely Comminuted and Open Tibial Pilon Fractures

1993 ◽  
Vol 292 ◽  
pp. 101-107 ◽  
Author(s):  
LAWRENCE BONE ◽  
PHILIP STEGEMANN ◽  
KEVIN MCNAMARA ◽  
ROGER SEIBEL
Keyword(s):  
External Fixation ◽  
Tibial Pilon ◽  
Pilon Fractures
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