The mid-term results of treatment for tibial pilon fractures

BACKGROUND
In this report, the surgical treatment results of distal tibia (pilon) fractures are analyzed radiologically and clinically.
METHODS
Between 2002 and 2009, 32 feet of 31 patients (25 males, 6 females; mean age 46 years; range 17 to 72 years) who were treated surgically for tibial pilon fractures were evaluated. Open reduction and internal fixation were applied to 24 and external fixation to 8 fractures. The patients were evaluated according to the Teeny-Wiss functional ankle score, and overall assessment of reduction was calculated radiographically according to the criteria of Ovadia and Beals.
RESULTS
While excellent results were achieved in 9 (47.4%) type 2, 5 type 1 (26.3%), and 5 (26.3%) type 3 fractures, fair/poor outcomes were obtained in 9 (69.2%) type 3 and in 2 (15.4%) types 1 and 2 fractures each (p<0.015). Compared to the external fixation application, a statistically significantly higher number of excellent and good outcomes were obtained with open reduction internal fixation application (n=3, 15.8% vs n=16, 84.2%, respectively; p<0.05).
CONCLUSION
If the principles of atraumatic soft tissue dissection, anatomic reduction of the joint face, stable fixation, and early mobilization of the patient are complied with in the surgical treatment of pilon fractures, successful results can be achieved. However, in type 3 fractures, even if these principles are complied with, post-traumatic arthritis is inevitable.

Tibia pilon kýrýklarýnda orta dönem cerrahi sonuçlarýmýz

AMAÇ
Bu yazýda, distal tibia (pilon) kýrýklarýnýn cerrahi tedavi sonuçlarý, radyolojik ve klinik olarak araþtýrýldý.
GEREÇ VE YÖNTEM
2002-2009 tarihleri arasýnda cerrahi olarak tedavi edilen 31 hastanýn (25 erkek, 6 kadýn; ortalama yaþ 46; daðýlým 17-72 yaþ) 32 ayaðý deðerlendirildi. Bu kýrýklarýn 24’üne açýk redüksiyon ve internal fiksasyon, 8’ine eksternal fiksasyon yapýldý. Hastalar ortalama 46 ay takip edildi. Hastalar Teeny-Wiss fonksiyonel ayakbileði skorlamasýna göre deðerlendirildi. Radyolojik olarak kýrýk redüksiyon skorlamasý Ovadia ve Beals kriterlerine göre yapýldý.
BULGULAR
Tip 2 kýrýklarýn 9’unda (%47,4), tip 1 kýrýklarýn 5’inde (%26,3) ve tip 3 kýrýklarýn 5’inde (%26,3) mükemmel sonuç elde edildi. Tip 3 kýrýklarýn 9’unda (%69,2) kötü sonuç elde edilmiþken, tip 1 ve tip 2 kýrýklarýn 2’sinde (%15,4) kötü sonuç elde edildi. Eksternal fiksatör uygulamasý ile karþýlaþtýrýldýðýnda, çok iyi ve iyi sonuçlar anlamlý derecede yüksek sayýda açýk redüksiyon internal fiksasyon uygulamasý ile elde edildi (sýrasýyla, n=3, %15,8 ve n=16, %84,2; p<0.05).
SONUÇ
Pilon kýrýklarýnýn cerrahi tedavisinde, atravmatik yumuþak doku diseksiyonu, eklem yüzünün anatomik redüksiyonu, stabil bir tespit, erken hareket ve hastanýn mobilizasyonu ilkelerine uyulduðunda baþarýlý sonuçlar alýnabilmektedir, ancak bu prensiplere uyulmasýna raðmen tip 3 kýrýklarda travma sonrasý artrit kaçýnýlmazdýr.