Surgical Treatment of the Pilon Fractures

Kim, Jung Jae; Park, Jong Hi; Cho, Woo Shin; Kim, Key Yong

Abstract

The intraarticular fractures of the distal tibia. so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B1 5 cases, type B2 7 cases, type B3 5 cases, type C1 3 cases, type C2 4 cases, type C3 10 cases. The authors analyaed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow : 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of flbula fracture. 2. Good results in fracture reduction was obtained at 26 cases(76.5%) and good functional reults was obtained at 26 cases(76.5%). 3. The most commom postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.