Treatment Algorithm for Pilon Fracture - Clinical and Radiological Results

Area of Science:

• Orthopedic Surgery
• Trauma Surgery

Background:

• Pilon tibial fractures are severe injuries requiring careful management.
• Treatment algorithms have evolved towards staged protocols.
• Fracture severity and soft-tissue injury significantly impact outcomes.

Purpose of the Study:

• To evaluate the postoperative outcomes of pilon tibial fractures treated with a staged algorithm.
• To assess functional recovery and radiographic results at a minimum 24-month follow-up.

Main Methods:

• Retrospective analysis of 27 patients with pilon tibial fractures and ≥24 months follow-up.
• Inclusion of clinical (ROM, AOFAS hindfoot score) and radiological (Kellgren score) assessments.
• Evaluation of a two-stage operative strategy (closed reduction, external fixation, then osteosynthesis).

Main Results:

• Overall good clinical outcome with a mean AOFAS hindfoot score of 82.1.
• B-type fractures and closed fractures showed significantly better outcomes than C-type and open fractures, respectively.
• Age and gender did not influence functional outcomes; osteoarthritis was observed in a minority of patients.

Conclusions:

• A staged treatment protocol, emphasizing meticulous planning and soft-tissue preservation, optimizes outcomes for pilon tibial fractures.
• Adherence to standardized surgical principles is crucial for managing these severe injuries.
• Early fracture severity and soft-tissue damage remain key determinants of functional recovery.