MINIMAL INVASIVE OSTEOSYNTHESIS OF PILON TIBIAL-FRACTURE

Fifty-eight patients with a total of 60 pilon fractures of the tibia w ere treated, mainly operatively, in the Department of Surgery (Kliniku m 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 e xamined clinically and radiologically. The most frequent cause of frac ture 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 proced ure was minimal osteosynthesis in 77% of the patients and tibial plate fixation in 20%. Delayed wound healing was observed in 17% with a rat e of osteitis of 5%. The follow-up examination showed good to excellen t results in 74%, and in two-thirds of the patients only minor arthrot ic changes or none of all were found. Despite less severe fracture typ es in the group with tibial plate stabilization they more frequently h ad impaired wound healing (27% vs 14%) and severe posttraumatic arthro sis (43% vs 18%) than patients with minimal osteosynthesis. The result s are discussed.