Surgical treatment of pilon fracture based on ankle position at the time of injury/initial direction of fracture displacement: a prospective cohort study

Abstract

Objective: The purpose of this study is to evaluate a surgical strategy for pilon fractures based on ankle position/initial direction of fracture displacement at the time of injury.

Methods: Sixty-nine patients were categorized into groups based on ankle position at the time of the injury: Group I (varus), Group II (valgus), Group III (dorsiflexion), Group IV (plantarflexion), and Group V (neutral). The American Orthopedic Foot and Ankle Society (AOFAS) score was determined at 12 months.

Results: More than 90% of participants in Groups I-IV as well as 57.2% of participants in Group V had anatomic/good fracture reduction, respectively. Fracture healing/union was significantly slower in Group V vs Groups I, III, and IV, and in Group II vs Group IV (P < 0.005). AOFAS scores were significantly higher (P < 0.005) in Groups III (96.0, IQR: 90.0-96.0) and IV (95.0, IQR: 90.0-100.0) vs Groups II (86.9, IQR: 75.0-90.0) and V (83.0, IQR: 73.0-86.0). Wound breakdown was the most common complication (n = 11).

Conclusions: Determining the surgical strategy for managing pilon fractures based on ankle position at the time of the injury/initial direction of fracture displacement may be effective.

Keywords: Distal tibial fracture; Intra-articular ankle fracture; Pilon fracture; Plafond fracture; Treatment protocol.