THERAPEUTIC MANAGEMENT AND LONG-TIME RESU LTS IN PYLON TIBIAL FRACTURES IN RELATION TO THE PRIMARY SOFT-TISSUE DAMAGE

Between 1980 and 1990, 81 fractures of the pilon tibial of type B or C in the AO classification, presenting in 78 patients, were treated ope ratively in the Department of Traumatology and Emergency Surgery of th e University Hospitals of Leuven. One-fourth of the fractures were ope n, 36 had second- or third-degree soft tissue damage according to the Tscherne classification system. The relationship between the fracture type and soft tissue damage was significant: the more severe the soft tissue damage, the more complex the fracture type. Screw osteosynthesi s was performed mostly in fractures without soft tissue damage; plate osteosynthesis was used more frequently than external fixation in frac tures with severe soft tissue damage. The number of late complications was much higher when the fracture was combined with severe soft tissu e lesions. The number of secondary operative procedures on the soft ti ssue and bones was especially elevated in fractures primarily stabiliz ed with a plate osteosynthesis. Sixty-four patients were reviewed clin ically and radiologically after a mean time of 52.7 months. The subjec tive and objective end results were classified in accordance to the sc ales of Ovadia. Of the patients without soft tissue lesions, 86.4% sho wed excellent or good subjective and 74.6% excellent or good objective end results; 55.6% of the patients with severe soft tissue damage had excellent or good subjective and 48.1% excellent or good objective en d results. In pilon fractures with severe soft tissue damage, bony con solidation can only be reached after several operative steps. In the p rimary procedure, only minimal osteosynthesis, combined with medial ex ternal fixation should be performed. After healing of the soft tissues , the external fixator can be exchanged for a medial implant. The obje ctive and subjective end result is not only influenced by the primary soft tissue damage, but is also dependent on the anatomical reconstruc tion of the articular surface and on the extent of the cartilage damag e.