The role of external fixation in displaced pilon fractures of distal tibia

Results of treatment in patients with high-energy displaced pilon fractures are presented. During five years, 15 patients with displaced pilon fractures (AO type C2 and C3) were treated. All other types of fracture were excluded from the study. Fractures were identified using standard radiographs and computed topography scanning. The method and timing of the operation were dictated by the status of soft tissues. In all fractures, external fixation was placed immediately and was left until the initial callus bridged the fracture fragments. In case of moderate contusion of soft tissues, limited incision and minimal internal osteosynthesis was done in the same act. In patients with more severe soft tissue damage, limited open reduction and restoration of articular surface was undertaken in second procedure after 7 days on average. All fractures united and the average time of healing was 4 months. Two patients had superficial infections that resulted in prolonged wound healing, and another four patients had pin site infection. There were no cases of deep infection, nonunion or malunion, but we had five cases of secondary osteoarthritis. Results were evaluated by Teeny and Wiss rating system. The results were as follows: 5 excellent results, 10 good and fair results, and no poor results. This study showed that external fixation with open reduction and limited internal osteosynthesis, with or without bone grafting, could be an option in the management of displaced multifragmentary pilon fractures with soft tissue injury. It was followed by significantly less complications with better functional results compared to open reduction and internal plate fixation.