Results of conservative treatment of "pilon" fractures

Material and methods. From 1996 to 2002 30 cases of distal tibia epiphysis fractures (pilon fractures), including 4 cases of open fractures, were treated by conservative technique. According to the Rüedi-Allgöwer AO classification, there were 13 patients with type I fractures, 9 type II and 8 type III fractures. Follow up examinations were performed from 4 moths to 4 years.
Results. Long-term results (mean 3 years) have been assessed in 8 cases as good, 12 as fair and 10 as bad. In 23 cases osteoarthritis of talotibiae joint has been found. In 16 cases there were deviations of bone axis (15 degree of varus). The range of movement of the joint was limited in all patients. In 18 cases there was no dorsiflexion. In one case shortening of the treated leg 2 cm has occured.
Conclusions. The conservative treatment is effective for pilon fractures type I and II. The majority of bad results was found in type III due to the severe destruction of the articular surfaces. In that cases we recommend treatment by external fixation with corrections of deformation.