Complications in pilon-fractures of the tibia - do they influence the outcome of treatment?
Abstract
Background: The pilon fracture of the tibia carries a high risk of complications. In retrospective study the author asked, whether and which complications have influenced the outcome after operative treatment of pilon fractures.
Methods: From 1990 to 1996 thirty pilon fractures of the distal tibia were operated in General Hospital Jesenice, Slovenia. Nineteen fractures (63%) were displaced intraarticular (AO/ASIF: 43-B2, C1 and C2; Type II according to Ruedi and Allgower), eleven fractures (37%) had intraarticular comminution (AO/ASIF: 43-B3 in C3; Type III). Eight fractures were open (27%). Eleven fractures were treated with minimal osteosynthesis (in five external fixator was added) and nineteen with plate fixation. Thirteen fractures were operated urgently (in first eight hours after injury). Among seventeen delayed treated fractures only two operations were delayed for seven days or more. Fourteen cases had at least one complication (secondary dislocation 2×, deep vein thrombosis 1×, toe contracture 1×, wound edge necrosis 2×, superficial infection 5×, osteitis/osteoarthritis 3×). Pain, range of motion and arthritic changes were evaluated at follow up. The worst of the factors determined the result of treatment.
Results: Twenty-eight patients were evaluated on average five years after injury (25–102 months). Four patients have excellent, fourteen good, three fair and seven poor result. Stratified statistical analysis showed that type of fracture was the risk factor of unsuccessful outcome. Fractures with intraarticular comminution (Type III) have significantly worse results. Analysis of patients with complications showed that osteitis/osteoarthritis was another risk factor of unsatisfactory outcome. All patients with osteo-arthritis have bad results.
Conclusions: This retrospective study of operatively treated pilon fractures of the tibia suggests that some complications do not preclude successful outcome. Type of the fracture and osteitis/osteoarthritis are believed to be critical factors for unsatisfactory outcome as both end in arthrosis.
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References
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