EXTERNAL FIXATION OF SEVERELY COMMINUTED AND OPEN TIBIAL PILON FRACTURES

Twenty patients with severely comminuted fractures about the ankle, ei ther severely comminuted pilon fractures or open pilon fractures (thre e Grade II, seven Grade III), were managed with the use of a Delta-fra med external fixator across the ankle joint. All fractures had open re duction and internal fixation (ORIF) with either screw fixation or sma ll plates to stabilize the articular surface with minimal soft-tissue dissection. Average external fixator time was 2.5 months, and the time to union averaged 4.5 months. All fractures healed. Three delayed uni ons required bone grafting and two had plate stabilization. No infecti on occurred in the 12 open fractures. There was no infection of the cl osed injuries, no skin sloughs, and only two minor pin tract infection s. Follow-up analysis averaged 12 months (range, six to 30 months). Ra nge of motion (ROM) at last follow-up observation was excellent in six patients, good in nine, fair in three, and poor in two. Two patients required ankle arthrodesis because of posttraumatic arthritis. The ROM and outcomes of the severely comminuted or open fractures of the dist al intraarticular tibia were very good.