PRELIMINARY REPORT - DISTAL TIBIAL PILON FRACTURES TREATED BY ILIZAROV METHOD

Abstract

Introduction: Pilon fractures are severe injuries of the distal tibia usually characterised by severe soft tissue “hit” in addition to the underlying fracture. Historically, plating techniques have led to a significant rate of serious complications. This study describes our early experience treating such injuries by the Ilizarov Method. Methods: 30 patients were prospectively identified and followed up beyond frame removal clinically and by case note review. Fractures classified according to AO. Bony union evaluated radiologically and clinically – remodelling of bone trabeculae on two radiographs and ability to weight bear without discomfort/walking aids on a dynamised frame. Results: Mean age 45.3 years, male: female = 26:4. Seven fractures were Grade 3 open. Patients were grouped as follows: 43-A .1/.2/.3 = 1/2/2 43-B .1/.2/.3 = 1/0/4 43-C .1/.2/.3 = 3/4/13. Two patients with 43-C.3 fracture had additional corticotomy for bone loss. Twenty-nine pilons united. Overall mean time to union was 20 weeks. Times to union (weeks): Group 43-A: - median = 20, mean = 21. Group 43-B: - median = 11, mean = 12. Group 43-C: -median = 20, mean = 21. Group 43-C.3: -median = 20, mean = 21 24 patients had no major complications. One Grade 3B open 43-C.3 fracture had deep sepsis prior to transfer to our unit which could not be eradicated – this led to transtibial amputation. Two patients had valgus mal-union and One had stiff nonunion requiring a second frame. Eleven patients experienced superficial pinsite infection that resolved with oral antibiotic therapy. Two deep pinsite infections were eradicated by overdrilling. Conclusion: The Ilizarov method offers safe and reliable healing for distal tibial pilon fractures in mean 20 weeks, with low levels of serious complications despite the severity of the initial injuries.

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