J Korean Fract Soc.  2017 Apr;30(2):75-82. 10.12671/jkfs.2017.30.2.75.

The Result of Using an Additional Mini-Locking Plate for Tibial Pilon Fractures

• Jo S
• Lee JY
• Kim B
• Ryu KH

• KMID: 2376613
• DOI: http://doi.org/10.12671/jkfs.2017.30.2.75

Abstract

PURPOSE
We evaluated the usefulness of an additional, 2.7 mm mini-locking plate for tibial pilon fractures.
MATERIALS AND METHODS
We studied 21 patients (14 males and 7 females), who were treated with a 2.7 mm mini-locking plate via the anterolateral approach for tibial pilon fractures between September 2012 and April 2014. The mean age was 43.85 years, and the mean follow-up period was 16.6 months. The radiologic outcomes were graded by the Burwell and Charnley modified system and clinical outcomes were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score.
RESULTS
The mean union period was 14.3 weeks. At the final follow-up, radiologic results showed 16 excellent results, 4 fair results, and 1 poor result. The average VAS was 3.4 points; the average AOFAS score was 81.8 points. During the follow-up period, there were three cases of posttraumatic osteoarthritis and one case of superficial skin infection.
CONCLUSION
Additional anterolateral, 2.7 mm mini-locking plate may be a good treatment method to manage tibial pilon fractures.

Keyword

Distal tibia fracture; Tibia plafond fracture; Pilon fracture; Locking plate

MeSH Terms

Ankle
Follow-Up Studies
Foot
Humans
Male
Methods
Osteoarthritis
Skin

Figure

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  Fig. 1 Fluroscopic image, 3.5 mm locking compression plate distal anterolateral plate is not contoured to the anatomy of tibia.

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  Fig. 2 (A) A 47-year-old man suffered a traffic accident and sustained Rüedi-Allgower type III Pilon fracture. (B) The photographs show poor soft tissue condition and a bullous hemorrhagic lesions around the fracture site. (C) As the 1st stage treatment, the Pilon fracture was realigned and stabilized by an external fixator, using ligament taxis. The postoperative radiograph shows restoration of the tibial length, joint spanning, and articular surface reduction. (D) Intraoperative fluoroscopic image for articular surface reduction through the anterolateral approach using a 2.7 mm minilocking compression plate. Thereafter, the medial distal locking plate under Carm guidance (Synthes®) through limited medial approach was applied. (E) Intraoperative photographs. (F) Immediate postoperative radiographsdemonstrate a satisfactory articular reduction and restoration of distal tibial alignment.

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  Fig. 3 (A) A 17-year-old female experienced a fall-down injury and sustained a Rüedi-Allgower type II Pilon fracture. (B) The computed tomography scan shows comminution of tibia plafond with displaced articular fragments, especially anterolateral aspect of the tibia. (C) The patient underwent closed reduction and external fixation. (D) The surgical incision of the anterolateral and limited medial approach to metaphysis and ankle joint have been marked on the right ankle. (E) Immediate postoperative radiographs demonstrate a satisfactory articular reduction and restoration of the distal tibial alignment by locking compression plates (Synthes®) in the 2nd-staged operation. (F) At postoperative 13 months, the implant was removed. (G) The patient showed a mild stiff ankle with no pain, with a final American Orthopaedic Foot and Ankle Society score of 75 points.

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