A prospective study to evaluate functional outcome of staged management of closed pilon fractures using medial locking compression plates

Abstract

Aim: This study aims to evaluate functional outcome of staged management of tibia pilon fractures using anatomic medial locking compression plate in adults. Patients and Methods:A hospital based prospective study was conducted at a tertiary centre between May 2017 to May 2019. All cases were managed in a two-staged protocol- early temporary joint spanning AO external fixator followed by delayed definitive fixation. Postoperatively functional outcome of the ankle was assessed using AOFAS score at 6months. Radiological outcome was assessed using the Teeny- Wiss scoring system and fracture union. Complications like infection and ankle stiffness were documented. Results: The study included 30 cases with an average follow up of 8.4 months (range 6-13 months). The mean age of the patients was 45.73years. Male predominance 23(76%) was noted. All fractures were caused by high energy trauma. 26 patients had AO type 43C fractures and 4 patients had 43B. Delay between primary external fixator application to definitive ORIF ranged from 7-13 days. Average Duration of surgery was 83±10.3 minutes. The mean AOFAS score was 72.33±4.4 .Majority of the patients 73.3% (22 patients) had AOFAS scores between 71-80. Radiological outcome was noted Anatomical in 17 cases (56.67%), Good in 10 cases (33.33%) and Fair in 3 cases (10%). Post-operatively, 5 patients (16.67%) developed superficial skin infection and 5 patients (16.67%) developed ankle stiffness. All fractures united at mean union time of 17.5 ± 1.5 weeks, with 1(4%) case of delayed union. Conclusions: This study supports staged management protocol accompanied with open reduction and internal fixation through minimally invasive techniques of application of medial locking compression plate has resulted in improved outcomes with reduced postoperative wound complications.