Evaluation of Complex Tibial Pilon Fractures Treated with Ilizarov External Fixator

Abstract

BACKGROUND: Ilizarov external fixator is now considered a suitable alternate treatment modalityfor treatment of complex tibial pilon fractures with questionable soft tissue integrity; it allows early weight bearing without jeopardizing the fracture stability and bone healing. OBJECTIVE: The purpose of study was to evaluate clinico-radiological outcome and morbidity of the Ilizarov external fixator used for fixation of complex tibial pilon fractures. METHODS: This retrospective analytic cross-sectional study was conducted at Orthopaedic Surgery department, Dow Medical College / Dr Ruth Pfau Civil Hospital Karachi, from June 2014 to May 2017. A total of 17 consecutive patients with complex tibial pilon fracture (AO type 43C) operated with Ilizarov external fixator technique were evaluated functionally by using the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and radio-logically for fracture union (delayed, nonunion) after a mean followup of 6 months. Post-surgical complications were noted. Polytrauma patients with additional fracture in pelvis and spine, pathological fracture, delayed presentation (> 2 weeks) and AO type 43A & B were excluded from the study. RESULTS: Total 17 patients (29.4% female and 70.6% male) with mean age 28 years (range, 17 - 48 years) were analyzed in this study. 11 (64.7%) fractures had left ankle while 6 (35.2%) fractures had right ankle involvement. The minimum follow-up was 3 months after complete frame removal. According to AO classification, C1 in 9 cases, C2 in 3 cases and C3 in 5 cases. All fractures were united in average 14.6 weeks (range 10-28 weeks). According to AOFAS scoring system, the final functional results were excellent in 5 (29.4%), good in 10 (58.8%) and fair in 2 (11.7%). There were 82.3% pin tract infections in this series. Ankle joint arthritis was noted in five patients. We had no instance of postoperative deep infection and neurovascular complications due to Ilizarov fixation. CONCLUSIONS: The Ilizarov ring fixator is a minimal invasive procedure that offers biological advantages and is a suitable alternate for treatment of complex tibial pilon fractures with questionable soft tissue integrity providing fracture healing, rapid functional recovery, and avoidance of major complications associated with extensive operative dissection needed with plate osteosynthesis.