Tibial pilon fractures: A comparison of treatment methods

Objective: This retrospective review of surgically treated distal tibia fra ctures was undertaken to determine whether treatment with open reduction an d internal fixation (ORIF) was more efficacious in achieving fracture union than one of two external fixation methods. Methods: Of the 60 study patients with pilon fractures, 21 patients were tr eated with an ankle-spanning half-pin external fixator, 15 patients with a single-ring hybrid external fixator, and 24 patients with ORIF, The severit y of injuries was similar across groups, Results: There was no significant difference in complication rates between groups, although two below-knee amputations were required in the ORIF group . A greater (p = 0.03) number of malunions occurred in the fractures treate d with external fixation when compared with those treated with ORIF, Fractu res in the external fixator groups showed this significant tendency to lose their initial adequate reduction, independent of bone grafting or fibula f ixation. There was no significant difference between groups in the need for bone grafting, There was a trend for patients treated with a single ring h ybrid frame to require late bone grafting for metaphyseal-diaphyseal nonuni on. Conclusion: External fixation offers advantages in the treatment of the sof t-tissue injury associated with pilon fractures, but malunion continues to be a problem with this method of fixation.