Abstract: Objective: Pilon fractures are intra articular distal tibia fractures involving articular surface or tibial plafond. Various options of treatments are open reduction and internal fixation (ORIF), external fixation, arthroscopic assisted fixation, minimally invasive plate osteosynthes (MIPO). MIPO is an option for extra articular and few undisplaced type B fractures. It may not be suitable in complete articular fractures (43 C) type injuries unless severe soft tissue injury is involved. Type C fractures need accurate articular reduction which may need open reduction and internal fixation. This is a prospective study comparing functional outcome and complications of internal fixation of different types of low energy pilon fractures treated in our hospital with MIPO and ORIF technique.
Methods: This prospective study was conducted in our trauma centre from 2012 to 2015 on pilon fractures. We included all low energy pilon fractures (OTA A, B, and C) both open and closed fractures treated by internal fixation with MIPO or ORIF. Group 1 subjects were treated by distal tibia locking plates by MIPO technique. Group 2 by open reduction and internal fixation by different approaches as required depending on fracture fragments. AOFAS ankle hind foot scale was used to assess outcome and was done at the end of follow-up.
Results: Pilon fractures type A and B were mainly treated by MIPO while type C was mainly treated by ORIF. Delayed union more frequently seen in MIPO and flap necrosis and delayed wound healing in ORIF group. There was no significant difference in functional outcome by the end of two year as shown by AOFAS scoring (p value 0.851).
Conclusion: Internal fixation is an effective method of treatment for pilon fractures. MIPO and ORIF are equally effective provided articular congruity is maintained.
