Hybrid external fixation via a minimally invasive method for tibial pilon fractures ​- Technical note

We aimed to present the clinical and radiological outcomes of patients with tibial pilon fractures who were treated with hybrid external fixators. Shanz screws were applied synchronously and used as joysticks for fracture reduction. Radiological evaluations were conducted on roentgenograms at the second week, sixth week, third month and first year.

The study group included 42 patients with tibial pilon fractures that were classified as 43C according to the AO/OTA classification system. We used 2-hydroxyapatite-coated Schanz screws for the tibial pilon reduction. Schanz screws fixated to two separate motors were synchronously passed through the fracture fragments. An external fixator was applied after the fracture was stabilized with Schanz screws.

The mean operation duration was 45 min Fracture healing was observed in all patients, and the mean fracture healing time was 17 (range, 12-32 weeks) weeks. The mean lateral distal tibial angle was 89°. Joint surface irregularity was not observed in any patient. All of the patients had 0-15° of ankle dorsiflexion. None of the patients had restricted ankle plantar flexion. No wound complications were observed. According to the AOFAS scoring system, the clinical evaluation was excellent in 26 patients, good in 14 patients and fair in 2 patients. Malunion and nonunion may necessitate additional surgical procedures, delay the return to activities of daily living, and increase treatment costs. Good alignment was achieved, with a mean lateral distal tibial angle of 89 (range, 84-92) degrees.

Permanent hybrid external fixator applied using Schanz screws via a mini open technique is a fast, easily applied alternative with low morbidity and satisfying results.