Journal of Musculoskeletal Trauma

Arthroscopically Assisted Limited Open Reduction and Ilizarov External Fixation of Tibial Pilon Fractures: Jin Young Lee, Gab Lae Kim, Hyung Seok Oh, Kun Ho Shin, Deok Yong Park; J Korean Fract Soc 2006;19(2):176-181. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.176

Abstract: PURPOSE
To evaluate the clinical results of the pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation.
MATERIALS AND METHODS
This is a retrospective study of the clinical result, bone union, complication and postoperative ankle function of 22 pilon fractures treated with arthroscopically assisted limited open reduction and Ilizarov external fixation between January 1999 to March 2004.
RESULTS
Clinical follow up averaged 16 months, with an average age of 39.2. All patients with type 1 and 2 fracture had excellent or good score by Ovadia and Beals criteria. Closed fractures healed within 13 weeks and open fractures within 16 weeks after surgery in average. Average range of motion of the ankle was 12o dorsiflexion (0~20 degree) and 25o plantar flexion (15~35 degree).
CONCLUSION
Minimal soft tissue dissection and anatomical reduction are very important factor for minimizing complication and satisfactory ankle function. So, arthroscopically assisted limited open reduction and Ilizarov external fixation is an effective treatment option for tibial pilon fractures.

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Complications after treatment of tibial Non fracture: Ki Do Hong, Sung Sik Ha, Hyun Jong Cha; J Korean Soc Fract 2001;14(4):668-676. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.668

Abstract PDF: PURPOSE
Aim of this study was to find the treatment and preventive method of the complication occurred after treatment of tibial pilon fracture. MATERIAL AND METHODS: 10 cases of complication, which has required the unplanned operative treatment among 25 cases of tibial pilon fracture from 1994 to 1999 were analyzed rertrospectively according to the Ruedi-Allgower classification, open or closed fracture, isolated or polytrauma , type of complication, type of procedure, primary or delayed wound closure.
RESULTS
There were 1 type I, 3 type II, and 6 type III Ruedi-Allgower fracture type, 3 open fracture, 7 isolated and 3 polytrauma. 6 required plastic surgery procedure such as pedicle flap or full thickness skin graft and 7 required orthpaedic procedure such as osteotomy, cancellous bone graft, metal removal and currettage, debridement of ankle.
CONCLUSION
The complications after treatment of tibial pilon fracture are classified to intraoperative, early and late postoperative complication. Intraoperative complication include penetration of the joint by screw and inadequate reconstitution of the articular surface which can be avoided by taking intraoperative roetgenograms, early complication include wound necrosis which can be minimized by good soft tissue technique, late complication include nonunion, joint stiffness and posttraumatic arthritis can be treated by osteotomy, cancellous bone graft and anatomic reduction with early motion.

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Surgical Treatment of the Pilon Fractures: Jung Jae Kim, Jong Hi Park, Woo Shin Cho, Key Yong Kim; J Korean Soc Fract 1997;10(3):492-500. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.492

Abstract PDF: The intraarticular fractures of the distal tibia. so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B1 5 cases, type B2 7 cases, type B3 5 cases, type C1 3 cases, type C2 4 cases, type C3 10 cases. The authors analyaed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow : 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of flbula fracture. 2. Good results in fracture reduction was obtained at 26 cases(76.5%) and good functional reults was obtained at 26 cases(76.5%). 3. The most commom postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.

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A Clinical Study of the Tibial Pilon Fractures: Chil Soo Kwon, Jong Kuk Ahn, Jin Hyok Kim, Yerl Bo Sung, Hyung Jin Chung; J Korean Soc Fract 1997;10(2):338-345. Published online April 30, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.2.338

Abstract PDF: The pilon fracture result from axial compression and rotational forces causing variable degrees of metaphyseal disruption, articular damage, and malleolar displacement. It is managements are closed reduction and plaster immobilization, skeletal traction, fibular stabilization alone, limited open reduction and extemal fixation, primary arthrodesis, and even immediate amputation. Recently limited open reduction and external fixation has been proved to provide good clinical results for the severely comminuted or open pilon fractures. Authors reviewed 20 cases of the pilon fractures. Among them 10 cases were treated with limited open reduction and external fixation from October 1989 to January 1994. The results were as follows : 1. Age distribution was from 14 years to 77 years(mean ; 47 years). 2. Of the 20 cases, male were 14, and female were 6. 3. The cause of injury were tracffic accident in 10 cases, slip down in 6 and fall from a height in 4. 4. The most frequent type of fractures was type III(12 cases : 60%) according to Ruedi and Allgower classification. 5. Limited open reduction and external fixation(10 cases) has shown better results than classic open recduction and internal fixation for severely comminuted or open pilon fractures.

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Operative Treatment of Tibial Pilon Fractures : Appication of Int. Fixation and Ext. Fixation: Jeong Gook Seo, Seung Hun Jeong; J Korean Soc Fract 1997;10(1):59-66. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.59

Abstract PDF: We have reviewed 15 cases of tibial pilon fractures who have been treated operatively from May, 1990 to May, 1995 at our hospital. 1. The fractures were classifed into Type I, I and III according to the system of Mast, Spiegel and Pappas and Type III were subdivided into Type A, B and C according to the system of Ruedi-Allgewer, Type I was 1 case(6.7%), Type II were 8(53.3%), Type IIIA were 2(13.3%), Type IIIB were 3(20%) and Type IIIC was 1 case(6.7%). 2. Type I, II and IIIA were treated with open reduction and internal fixation using screw or plate. 2 cases of Type IIIB were treated with open reduction and external fixation and 1 case was treated with plate. Type IIIC was treated with open reduction and external fixation. 3. Conclusively. we had good results with open reduction and internal fixation in Type I, II and IIIA. In Type IIIB, IIIC, if it was difficult to maintain of reduction with internal fixation due to severe bone loss, comminution and soft tissue injury, we could have good results with open reduction, bone graft and external fixation including ankle joint.

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Operative treatment of the tibial pilon fractures following AO/ASIFprinciple: Key Yong Kim, Sung Il Bin, Won Hyeok Oh; J Korean Soc Fract 1992;5(1):129-137. Published online May 31, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.1.129

Abstract PDF: No abstract available.

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A Clinical Study of tibial Pilon Fractures: Key Yong Kim, Duck Yun Cho, Jai Gon Seo, Sung Bum Yang, Kyu Jung Cho; J Korean Soc Fract 1989;2(2):211-218. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.211

Abstract PDF: The tibial pilon fracture is one of the most difficult fracuture to treat because of severe metaphyseal bone defect, comminution of the articular surface, disruption of ankle mortise and accompanying soft tissues injury resulting from axial compression and rotational forces. The recent concept of management of tibial pilon fracture is to open and provide anatomical reduction with stable internal fixation, early joint motion and considerably delayed weight bearing. We reviewed 16 cases of tibial pilon fracture experienced from June 1985 to December 1 988 and the result were as follows; Tibial pilon fracture comprises 8.7% of all ankle fractures(183 cases) during the period and prevalent in male. According to the classification by Ruedi and Allgoewer, 2 cases of typeI, 9 cases of type II and 5 cases of type III. 3 cses treated conservatively and 13 cases operatively. Better results were obtaiined in latter group, and in typeI and type II than III. The important factors influencing the clinical result were the type of fracture and accuracy of reduction including maintainace of fibular length.

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