Outcomes of Acute Ankle Distraction for Intra-articular Distal Tibial and Pilon Fractures

Intra-articular distal tibia fractures can lead to post-traumatic osteoarthritis (PTOA). Joint distraction has shown promise in elective cases of osteoarthritis (OA) by temporarily offloading joint forces and potentially facilitating cartilage regeneration. However, its application in acute fractures remains unexplored. This pilot study aims to investigate the benefits of joint distraction in acute fractures.

A retrospective cohort study comprising consecutive patients with intra-articular distal tibia and pilon fractures, treated with a circular ring fixator (CRF) and ankle distraction as part of their fracture management, was undertaken at a single centre.Prospective data collection included radiological assessments, patient-reported outcome measures (PROM), complications, necessity for additional procedures, and the Kellgren and Lawrence grade (KL) for OA.

There were 137 patients included in the study, among them 30 in the distraction group and 107 in the non-distraction group. There were no significant differences in age, gender, distribution of open or closed fractures, diabetic status, and smoking status between the groups. Mean follow-up was 3.73 years.There was no significant difference between the distraction and non-distraction groups in overall complications or need for further procedures. The mean radiological follow-up was 1.90 years, there was no significant difference in progression of KL between the groups (1.81 vs 2.0, p = 0.38). There were 32 patients who had radiological follow-up exceeding 2 years (average 3.52 years); here there was no significant difference between these groups (mean change 2.18 vs 2.4, p = 0.87).Patient-reported outcome measures data was available for 44 patients (6 in the distraction group, 38 in the non-distraction group) with a mean follow-up of 1.71 years. There were no significant differences in EQ5D and C Olerud-H Molander scores between the two groups.

Ankle joint distraction in the management of acute ankle fractures did not influence outcomes for patients in short and medium term follow-up. Future work should investigate for long-term effects of this auxiliary technique when using circular external fixators, in particular on the development of PTOA.

Faraj A, Hammett F, Lineham B, et al. Outcomes of Acute Ankle Distraction for Intra-articular Distal Tibial and Pilon Fractures. Strategies Trauma Limb Reconstr 2025;20(1):6-10.