Does surgical approach affect sagittal plane alignment and pilon fracture outcomes?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Radiology

Background:

• Sagittal plane alignment is crucial for pilon fracture outcomes but often overlooked.
• Surgical approach may influence the ability to achieve optimal sagittal plane correction.
• Anterolateral (AL) approach was hypothesized to improve sagittal parameters due to plate placement.

Purpose of the Study:

• To evaluate the impact of surgical approach on sagittal plane alignment in pilon fractures.
• Specifically assess anterior distal tibial angle (ADTA) and lateral talar station (LTS).
• Compare anteromedial (AM) versus AL approaches regarding sagittal parameters.

Main Methods:

• Retrospective review of 580 pilon fracture cases from Level 1 trauma centers.
• Data collected: demographics, comorbidities, AO/OTA classification, surgical approach, complications.
• Radiographic assessment of ADTA, LDTA, and LTS for reduction quality.

Main Results:

• No significant difference in ADTA, LDTA, or LTS between AM and AL approaches.
• AM approach showed decreased local wound care and reoperations compared to AL.
• AM approach had increased rates of infection, non-union, and amputations.

Conclusions:

• Surgical approach does not appear to affect sagittal plane alignment in pilon fractures.
• Choice of approach should be guided by fracture pattern and soft tissue envelope.
• The AM approach is a safe and effective option for complex pilon fractures when indicated.