Evaluation of Functional Outcome in Surgically Managed Tibial Pilon Fractures

Background Pilon fractures are infrequent and among the most challenging to manage. One reason is the extensive soft tissue injury surrounding the distal tibia. Second, the articular surface of the distal tibia with a complex fracture pattern needs anatomic reduction. These fractures occur due to high energy impaction of the talus into the distal tibia. The fracture patterns and extent of soft tissue involvement vary based on the intensity of the impact's energy. The management needs to be patient-specific to prevent complications. Proper pre-operative planning with the help of computer tomography scans aids in choosing the approach and proper reduction. Either single-stage early definitive fixation or two-staged protocols involving the application of spanning external fixation to maintain length and allow soft tissue healing followed by definitive open reduction and internal fixation is done. However, complications still remain inevitable in a significant subset of patients. Objective To evaluate the functional outcome in surgically managed tibial pilon fractures using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. Methods This prospective observational study included 20 patients who underwent surgery for pilon fractures of the tibia at Nizam's Institute of Medical Sciences between November 2020 and September 2022. The patients were between 18 and 65 years old and consented to participate in the study group. After undergoing patient-specific surgical management, all patients are followed for a minimum of six months. Their functional outcome is evaluated after fracture union and scheduled physiotherapy sessions every four weeks using the AOFAS scoring system. Ankle range of motion (ROM) is also evaluated. Results The average age of the patients was 40 years, and male predominance was present. Most of the patients (60%) underwent internal fixation. According to the AOFAS scoring system, six patients had an excellent outcome, 11 had a good outcome, and three had a fair outcome. Most of the patients (11 patients) had excellent to good ankle ROM. Complications were encountered in two patients with ankle stiffness and one with wound dehiscence. Conclusion Pilon fractures are more common in young adults due to road traffic accidents. The most common type of pilon fracture is a closed fracture, which can be treated with definitive internal fixation after the soft tissue has healed. Definitive internal fixation has shown excellent and good functional outcomes (according to the AOFAS score) with improved ankle ROM and no complications when compared to external fixation, which can result in ankle stiffness and delayed union.