Functional and radiographic outcomes following limited open reduction with ankle-spanning Ilizarov fixation in high-energy tibial pilon fractures

Abstract

Background: High-energy tibial pilon fractures are complex peri-articular fractures that have significant soft-tissue involvement and are at high risk of complications with immediate internal fixation. This study aimed to assess the functional and radiographic results of limited open reduction with ankle-spanning Ilizarov fixation in high-energy tibial pilon fractures. Methods: This descriptive observational study was conducted at National Institute of Traumatology & Orthopaedic Rehabilitation, Dhaka, Bangladesh, from May 2017 to August 2019, including 45 patients with high-energy tibial pilon fractures who underwent limited open reduction and ankle-spanning Ilizarov fixation. All enrolled patients had their sociodemographic, injury-related, operative, radiographic, functional and postoperative complication data systematically recorded and analyzed. Results: The majority of patients were young men, road traffic accidents were the most common mechanism of injury, AO/OTA type 43-C2 (42.2%) and Rüedi-Allgöwer type III (60%) fractures were the most common and 75.6% had an associated fibular fracture. The radiological union was obtained in 93.3% of patients, anatomical or near-anatomical reduction was obtained in 64.4% and an articular step-off less than 2 mm was obtained in 71.1%. The overall functional outcome was satisfactory in 68.9% of patients and the AOFAS ankle-hindfoot score was excellent or good in 68.9% of patients. Superficial pin-tract infection was seen in 33.3% of patients; deep infection, nonunion and secondary procedures were relatively uncommon. Conclusions: Limited open reduction with ankle-spanning Ilizarov fixation was associated with high rates of union and satisfactory functional outcomes in patients with high-energy tibial pilon fractures and is therefore a reproducible treatment option in this difficult fracture group.