[Minimal osteosynthesis of tibial pilon fracture]

Fifty-eight patients with a total of 60 pillion fractures of the tibia were treated, mainly operatively, in the Department of Surgery (Klinikum Innenstadt, University of Munich) from 1984 to 1989. After 1-4 years, it was possible to question 90% of the patients, and 75% were also examined clinically and radiologically. The most frequent cause of fracture was a heavy impact, whereas sporting injuries accounted for only 13%. Thus, there was a high incidence (39%) of severe fractures (type C, AO classification) with tissue damage. The initial operative procedure was minimal osteosynthesis in 77% of the patients and tibial plate fixation in 20%. Delayed wound healing was observed in 17% with a rate of osteitis of 5%. The follow-up examination showed good to excellent results in 74%, and in two-thirds of the patients only minor arthrotic changes or none of all were found. Despite less severe fracture types in the group with tibial plate stabilization they more frequently had impaired wound healing (27% vs 14%) and severe posttraumatic arthrosis (43% vs 18%) than patients with minimal osteosynthesis. The results are discussed.