Prospective Randomized Comparison of Locked Plates Versus Nonlocked Plates for the Treatment of High-Energy Pilon Fractures.

Abstract To compare the radiographic and functional outcome of patients with high-energy pilon fractures treated with locked versus nonlocked plates. Randomized prospective trial. Academic level 1 trauma center. Between December 2006 and December 2008, 60 consecutive patients with 62 AO/OTA type A, B, and C tibial pilon fractures were enrolled in the study. Thirty-two of the fractures were treated using locked plates and 29 were treated with nonlocked plates. Follow-up data were available for 33 of the 60 patients. Treatment with locked versus nonlocked plates. Short Musculoskeletal Function Assessment (SMFA) questionnaire and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHS). Radiographic measurements on anteroposterior and lateral views for the quality of reduction and maintenance of alignment immediately postoperatively compared with the latest follow-up. There were no significant differences in the mechanism or injury pattern, average age of the patients, ratio of males to females, tourniquet time, operative time, interval to surgery, AHS, or SMFA scores. One of 15 fractures in the locked plate group lost reduction at the latest follow-up compared with 3 of 19 fractures in the nonlocked group. In this study, there seems to be no difference between the 2 constructs. Thus, one must question the routine use of locked plates in the treatment of high-energy pilon fractures. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.