Pilon fractures are distal tibial intra-articular fractures with proximal extensions and often associated with extensive soft tissue damages. There is no level 1 treatment for tibial pilon fractures. Some experts advice bridging external fixators combined with limited fixation to minimize the soft tissue injuries and some authors advocate ORIF technique to prevent articular incongruence. Attaining anatomical reconstruction of the joint, restoring the tibial alignment, and fracture stabilization are the methods to achieve an optimal outcome. Fracture morphology and soft tissue injuries must taken into serious consideration for the pre-operative planning as they are the frequent cause for complications. External fixation combined with limited fixation or open reduction and internal fixation are different modes of management. LFWEF have the advantage of preserving the vascularity of the fracture and minimizes the soft tissue compromise but pin tract infection is the common complication.
Aim: The aim of the study was to compare the outcome of external fixation combined with limited fixation vs open reduction and internal fixation in restoring and fixing the articular surface for either open or closed tibial pilon fractures.
Patients and Methods: This study includes 15 patients with pilon fractures of Reudi Allgower type I, II, III, treated by either LFWEF or ORIF. Their clinical and functional outcome and radiological outcome were compared. They were evaluated for the degree of involvement of articular surface and the condition of the soft tissue envelop around the fracture for surgeries. Before surgery, all patients were evaluated clinically and radiologically. All patients were followed up till the achievement of fracture union and soft tissue healing. Evaluation was done based on anatomical articular reduction, achievement of union in time and function of the ankle joint using AOFAS ankle scoring system.
Results: The mean average time of union was 17 weeks (range 12–21 weeks) for all the fractures after fixation. 12/15 of cases had near anatomical restoration of the articular surface, representing 80% of cases. Acceptable alignment seen in 14/15 cases cases, representing 93.6% of cases in this study. In my study two cases showed limitation of range of movements (2/15 cases), representing13.3% of cases. Only one case showed deep soft tissue infection (1/15) representing 6.6 %. The results of external fixation combined with limited fixation is more effective in terms of soft tissue management, early union and superficial or deep infections than ORIF.
Conclusion: LFWEF have the advantages of minimizing soft tissue insult and preserving the vascularity and hematoma thereby reducing fracture union time but the disadvantages are pin tract infection. ORIF was associated with higher risk of post operative complication with respect to superficial or deep infection, delayed union and non union than external fixation with limited fixation.