RANDOMIZED COMPARATIVE STUDY OF DEFINITIVE EXTERNAL FIXATION VERSUS ORIF IN PILON FRACTURES: AN EARLY CLINICAL...

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomechanics

Background:

• Pilon fractures present a surgical challenge, with Open Reduction Internal Fixation (ORIF) offering direct reduction but significant soft tissue disruption.
• External fixation provides indirect reduction with less soft tissue damage but carries a risk of malunion.
• Optimal management for pilon fractures remains under investigation due to the trade-offs between surgical approaches.

Purpose of the Study:

• To compare the functional outcomes and complication rates of external fixation versus ORIF for pilon fractures.
• To evaluate secondary outcomes including quality of reduction, bone union, arthritic changes, and time to union/weight-bearing.

Main Methods:

• A prospective randomized comparative study included 40 patients with comminuted closed pilon fractures.
• Patients were randomized into two groups: external fixation with limited internal fixation (n=20) or ORIF (n=20).
• Exclusion criteria included skeletally immature patients, open fractures, compartment syndrome, and pathological fractures.

Main Results:

• No significant difference was found in ankle-hindfoot function (AOFAS score at 9 months) between external fixation and ORIF (P=0.547).
• Complication rates were also similar between the two groups (P=0.227).
• External fixation demonstrated a statistically significant faster time to union (P=0.042) and earlier weight-bearing (P<0.001) compared to ORIF.

Conclusions:

• Both external fixation and ORIF are viable options for managing pilon fractures, yielding comparable functional results at nine months.
• External fixation offers advantages in terms of accelerated bone healing and earlier mobilization.
• The choice of surgical modality for pilon fractures requires careful consideration of potential malunion risks associated with external fixation.