Authors : B. Kienast , A.P.S. Schulz , C. Queitsch , U. Schumann , S. Fuchs , Ch Jurgens and A. Paech
Abstract: Special care must been taken to the treatment of soft tissues of patients with fractures of the distal lower-limb, particularly in the treatment of high-energy trauma with participation of the tibial pilon. We used a two-staged treatment plan for 38 patients suffering from closed fractures of the distal lower limb between January 1998 and October 2003. All patients received a joint immobilizing external fixator at the day of trauma. After consolidation of soft tissues at an average of 8,3 days after trauma and after planning surgery on the basis of native X-ray and CT-scan we performed open reduction and internal fixation with a multi directional locked-screw plate fixator. Nine cases without joint participation could be operated in a minimal invasive pattern. We could follow up all Patients after an average of 28 months. In 17 cases no reduction of Range Of Motion (ROM) of the ankle joint compared to the opposite side was recorded. Twenty one patients showed a moderate reduction of less than a third of range of motion compared to the not injured side. Four patients showed a reduction of ROM of up to two thirds. Bony consolidation was achieved in all cases. As complications we noted one deep vein thrombosis and three superficial wound necrosis which could be treated conservatively. We performed early autologous bone graft due to delayed bony consolidation in two cases. We observed a direct correlation between type of fracture and restriction of ROM and post traumatic arthritis. Eleven Patients with extra-articular fractures showed no restriction of ROM. Ninteen patients with a fracture involving the tibial pilon showed no or only mild post-traumatic arthritis of the ankle (according to the Bargon classification system). Because results of surgical treatment of the tibial pilon depend on soft tissue condition at the time of trauma we recommend a two-staged surgical treatment plan with external fixation and secondary internal locked-plate osteosynthesis to reduce soft tissue complications and to achieve good functional results.
B. Kienast , A.P.S. Schulz , C. Queitsch , U. Schumann , S. Fuchs , Ch Jurgens and A. Paech , 2008. The Importance of Soft Tissue Conditions for Fractures of the Tibial Plafond: Advantages of a 2-Stage Treatment with External Fixation and Locked Plate. Surgery Journal, 3: 43-48.