Treatment of Tibial Pilon Fractures with Minimal Open Reduction and Circular Ring External Fixation

Abstract

The purpose of this thesis was to evaluate effectiveness of minimal open reduction and circular ring external fixation for treating of tibial pilon fractures with serious soft-tissue injuries or open wounds. The retrospective outcome study was performed as one of the methodology to conduct this research. The study was conducted on fifteen patients with tibial pilon fractures associated with serious soft-tissue injuries or open wounds. Patients were treated with minimal open reduction and circular ring external fixation and all of them were monitored for more than one year. Out of fifteen patients, thirteen of them were males and two were females, and their mean age was 45.3 years old (ranging from 29 to 62). Reduction status was evaluated with radiology based on the Burwell and Charnley’s criteria. Ankle function was graded using the criteria suggested by Mast and Teipner. The length of time that the circular ring external fixation device remained in place varied for each patient according to time until bony union. Any other complications were recorded throughout the study. Bony union was achieved within average 17.2 weeks in 13 out 15 fracture (86.6%). For 2 fractures complicated by infection, bony union was achieved at an average of 37 weeks after eradication of the infection. During the final follow-up examination, radiographs revealed that 7 patients had anatomic reduction, 6 had fair reduction, and 2 had poor reduction. Clinically, 7 patients had good function, 4 had fair function, and 4 had poor function. Range of motion of ankle joint at last follow up. Showed average 17 degree of dorsiflexion and 13 degree of plantarflexion. There were 3 types of complications found during the study: pin-tract infection (1 patient), osteomyelitis (1 patient), and posttraumatic arthritis (1 patient). In conclusion, the combination of minimal open reduction and circular ring external fixation could be considered as an alternative treatment for tibial pilon fracture associated with serious soft-tissue injuries or open wounds.