Study of Functional Outcome of Various Surgical Method of Tibial Pilon Fractures

INTRODUCTION: Pilon fractures involve the dome of the distal tibial articular surface and extend into the adjacent metaphysis. They are relatively rare fractures ranging from low to high energy injuries. The low energy rotational injuries have shown to have excellent functional results with open reduction and internal fixation. The high energy axial loading have had uniformly moderate results and higher complication rates. These can be challenging to manage because of the usual high energy involved and the limited soft tissue envelope that surrounds the distal tibia. The condition of the soft tissues is crucial with respect to timing of definitive surgery and method of surgical fixation. poor timing is associated with poor outcomes. Soft tissue must be ready for the second insult dealt by surgery. Additional treatment outcomes vary depending on multiple factors such as degree of bony comminution, quality of reduction, the surgeon’s experience and associated injuries. Therefore, the optimal treatment for high energy tibial fractures remains controversial. Some authors advocate the use if ORIF to avoid articular incongruence and consequent post traumatic arthritis and to maximise long term results. others advocate the use of bridging external fixation with limted internal fixation (EFLIF) in high energy tibial fractures to reduce sift tissue related complications and blood loss. Proponents of the EFLIF may argue that the necessity for an anatomical restoration of the articular surface is controversial and does not always correlate with the clinical outcome. AIMS AND OBJECTIVES: 1. Prospectively analyse of the functional outcome of tibial pilon fracture fixation. 2. To assess the range of motion of ankle joint and functional outcome after surgical management. MATERIALS AND METHODS: SOURCE OF DATA: The proposed study is a hospital based prospective study centered in Govt. Stanley Medical College & Hospital, Chennai, during the term June 2017 – March 2020. METHODS OF COLLECTING DATA: Sample size: Minimum of 18 cases meeting criteria for the present study. 11 cases of hybrid external fixator and 7 cases of internal fixator done. Sampling Method: All cases presenting to the outpatient and fulfilling the below mentioned criteria will be taken up for the study. INCLUSION CRITERIA: Patients above 20 years of either sex. ➢ Closed tibial pilon fractures. ➢ Radiological diagnosis of fractures with classification based on three column concept classification. Exclusion Criteria: ➢ Patients age below 15 years. ➢ Open tibial pilon fracture. ➢ Patients medically unfit for surgery. ➢ Pathological fractures other than osteoporosis. ➢ Multiple fracture and periphery vascular disorder. METHODOLOGY: � Patients subjected to surgery will be followed up at regular intervals with clinical and radiological data. Assessment will be done based on a proforma containing all necessary information regarding. � Personal details: age, sex, address and occupation. CONCLUSION: Treatment of tibial pilon fractures are still unsolved. There is no significant difference In the functional outcome between hybrid external fixator and Open reduction and internal fixation. Choice of approach and implant strictly based on good clinical judgement of fracture pattern and bone quality and intra operative fracture reduction. The main aim of open reduction and internal fixation include accurate reconstruction of the articular surface and stable fixation allowing early range of movement and containment of softtissue injuries. The main aim of hybrid external fixator is to restore the fibula length and stability of severly comminuted fragment of tibial pilon. The complications noted in our series are ankle stiffness, wound dehiscence and pinsite infection. Surgeon must be prepared enough to choose specific approach based on fracture pattern and soft tissue damage to prevent peri operative complication and long term outcome of the patient. The functional outcome of our study is superior to the study based on ruedi and allgower based study.