Joint-preserving corrective reconstruction strategy for malunions of tibial pilon fractures in young patients

Malunions of tibial pilon fractures pose significant challenges for corrective reconstruction due to the solidly healed displaced fracture fragments and frequently defective articular cartilage. This study aims to introduce a joint-preserving reconstruction strategy for managing tibial pilon fracture malunions in young patients and to evaluate the clinical outcomes.

We retrospectively analyzed 39 patients (mean age: 32.7 ± 10.4 years) with malunions of tibial pilon fractures who were treated with corrective reconstruction surgeries from 2013 to 2021. This cohort included 11 patients who underwent corrective intra-articular osteotomy, 17 who received combined osteoperiosteal iliac autograft transplantation, and 11 who underwent combined osteochondral autograft transplantation. The median duration from the initial injury to joint-preserving treatment was 7.4 months (interquartile range [IQR], 4.4-11.1). Radiographic assessments included plain radiographs and computed tomography (CT) scans. Clinical outcomes were evaluated using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and ankle range of motion (ROM).

After a median follow-up of 41.5 months, patients showed significant improvements in pain and function. The median VAS score improved from 5 (IQR, 6-7) to 2 (IQR, 1-3), and the median AOFAS score increased from 42 (IQR, 33-58) to 79 (IQR, 73-87) (P < 0.001). The mean SF-36 scores increased from 37.2 ± 12.2 to 71.2 ± 9.6 (P < 0.001), and the median ankle ROM improved from 20 degrees (IQR, 16-30) to 25 degrees (IQR, 20-34) (P = 0.004). Major complications included two patients requiring reoperation, and two patients progressing to radiographic end-stage arthritis; however, the pain remained tolerable, and no secondary arthrodesis or arthroplasty was performed by the final follow-up.

Joint-preserving corrective reconstruction surgeries can offer reasonable improvement over a four-year follow-up period, making them a viable alternative for the reconstruction of tibial pilon fractures malunions in young patients.