The Ilizarov method in the treatment of pilon fractures

Background. Comminuted fractures of the distal epiphysis and metaphysis of the tibia with penetration to the ankle joint, which occur rarely, are known as "pilon fractures". Material and methods. From 1996 to 2001, eight cases of distal tibia epiphysis fractures (pilon fractures), including four cases of open fractures, were treated by the Ilizarow technique. According to the Rüedi-Allgöwer classification, there were two patients with type I fractures, four patients with type II fractures, and two patients with type III fractures. Four patients were treated on an emergency basis, while two other patients underwent planned surgery 2 weeks after injury. In two patients previously treated by internal fixation the Ilizarow method was applied after 4 months due to pseudoarthrosis. Repositioning of the fractures was performed under x-ray control. The construction of the apparatus allows for weight bearing and early movement of the foot.The average period of treatment by this method was 5 months. Follow up examinations were performed from 2 months to 5 years after conclusion of treatment. Results. Bone consolidation was achieved in all cases. There were no deviations of bone axis, apart from one case of 10-degree varus deformity. A good range of motion was obtained in seven cases. Only in one case was the range of motion of the crurotalar joint reduced to 0 degrees dorsiflexion and 20 degrees plantar flexion. There were no cases of osteomyelitis or deep infections. Pin-tract infections occured in three patients. Conclusions. The Ilizarov technique is a safe and very effective method for the treatment of pilon fractures.