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Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

To determine the results of “biologic fixation” with a minimally invasive plating technique using a newly designed low profile “Scallop” plate in the treatment of pilon fractures.

Design

Retrospective case series.

Setting

A tertiary referral center.

Patients/participants

Seventeen patients were treated between 1999 and 2001 for a tibial plafond fracture at the Hospital for Special Surgery with a newly designed low-profile plate. Eleven of the fractures (65%) were high-energy injuries. Two fractures were open.

Intervention

Staged surgical treatment with open reduction and fixation of the fibular fracture and application of an external fixator was performed in 12 cases. As soon as the soft tissues and swelling allowed, i.e. skin wrinkling, the articular surface was reconstructed and simply reduced, if necessary through an small incision, and the articular block was fixed to the diaphysis using a medially placed, percutaneously introduced flat scallop plate. In the remaining five cases the operation was performed in one session.

Main outcome measurements

Time to healing and complications including delayed union, non-union, instrument failure, loss of fixation, infection, quality of reduction and number of reoperations were evaluated. Quality of results and outcome were graded using the ankle–hindfoot–scale and a modified rating system.

Results

All patients went on to bony union at an average time of 14 weeks. There were no plate failures or loss of fixation/reduction. Two superficial wound-healing problems resolved with local wound care. At an average follow up of 17 months (range 6–29 months) eight patients (47%) had an excellent result; seven (41%) had a fair result whereas two (12%) had a poor result. The average ankle–hindfoot–score was 86.1 (range 61–100). Four patients have had the hardware removed and one of them is awaiting an ankle arthrodesis.

Conclusions

Based on these initial results, it appears that a minimally invasive surgical technique including new low profile plate can decrease soft tissue problems while leading to fracture healing and obtaining results comparable with other more recent series. We believe that this new “Scallop Plate” is effective for the treatment of pilon fractures and should be used in conjunction with a staged procedure in the acute trauma setting.

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References

  1. Anglen JO (1999) Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma 2:92–97

    Article  Google Scholar 

  2. Ayeni JP (1988) Pilon fractures of the tibia: a study based on 19 cases. Injury 19:109–114

    Article  PubMed  CAS  Google Scholar 

  3. Babis GC, Vayanos ED, Papaioannou N, Pantazopoulos T (1997) Results of surgical treatment of tibial plafond fractures. Clin Orthop 341:99–105

    PubMed  Google Scholar 

  4. Blauth M, Bastian L, Krettek C, Knop C, Evans S (2001) Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 3:153–160

    Article  Google Scholar 

  5. Blotter RH, Connnolly E, Wasan A, Chapman MW (1999) Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus. Foot Ankle Int 20:687–694

    PubMed  CAS  Google Scholar 

  6. Bone L, Stegemann P, McNamara K, Seibel R (1993) External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop 292:101–107

    PubMed  Google Scholar 

  7. Borrelli J Jr, Catalano L (1999) Open reduction and internal fixation of pilon fractures. J Orthop Trauma 8:573–582

    Article  Google Scholar 

  8. Borrelli J Jr, Torzilli PA, Grigiene R, Helfet DL (1997) Effect of impact load on articular cartilage: development of an intra-articular fracture model. J Orthop Trauma 11:319–326

    Article  PubMed  Google Scholar 

  9. Claes L, Heitemeyer U, Krischak G, Braun H, Hierholzer G (1999) Fixation technique influences osteogenesis of comminuted fractures. Clin Orthop 365:221–229

    Article  PubMed  Google Scholar 

  10. Cole PA, Benirschke SK (1999) Minimally invasive surgery for the pilon fracture: the percutaneous-submuscular plating technique. Tech Orthop 14:201–208

    Article  Google Scholar 

  11. Collinge CA, Sanders RW (2000) Percutaneous plating in the lower extremity. J Am Acad Orthop Surg 8:211–216

    PubMed  CAS  Google Scholar 

  12. Flynn JM, Rodriguez-del-Rio F, Piza PA (2000) Closed ankle fractures in the diabetic patient. Foot Ankle Int 21:311–319

    PubMed  CAS  Google Scholar 

  13. Gaudinez RF, Mallik AR, Szporn M (1996) Hybrid external fixation in tibial plafond fractures. Clin Orthop 329:223–232

    Article  PubMed  Google Scholar 

  14. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five fractures of long bones. Retrospective and prospective analyses. J Bone Joint Surg 58-A:453–458

    Google Scholar 

  15. Heim U, Näser M (1976) Die operative Behandlung der Pilon-tibiale-Fraktur. Technik der Osteosynthese und Resultate bei 128 Patienten. Arch Orthop Unfallchir 86:341–356

    Article  PubMed  CAS  Google Scholar 

  16. Helfet DL, Koval K, Pappas J, Sanders RW, DiPasquale T (1994) Intraarticular pilon fracture of the tibia. Clin Orthop 298:221–228

    PubMed  Google Scholar 

  17. Helfet DL, Shonnard PY, Levine D, Borrelli J Jr (1997) Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 28(Suppl):42–47

    Article  Google Scholar 

  18. Helfet DL, Sorkin AT, Levine DS, Borrelli J Jr (1999) Minimally invasive plate osteosynthesis of distal tibial fractures. Tech Orthop 14:191–200

    Article  Google Scholar 

  19. Hutson JJ Jr, Zych GA (2000) Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma 3:214–218

    Google Scholar 

  20. Kim HS, Jahng JS, Kim SS, Chun CH, Han HJ (1997) Treatment of tibial pilon fractures using ring fixators and arthroscopy. Clin Orthop 334:244–250

    PubMed  Google Scholar 

  21. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle–hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353

    PubMed  CAS  Google Scholar 

  22. Marsh JL (1999) External fixation is the treatment of choice for fractures of the tibial plafond. J Orthop Trauma 8:583–585

    Article  Google Scholar 

  23. Mast JW, Spiegel PG, Pappas JN (1988) Fractures of the tibial pilon. Clin Orthop 230:68–82

    PubMed  Google Scholar 

  24. McCormack RG, Leith JM (1998) Ankle fractures in diabetics complications of surgical management. J Bone Joint Surg 80-B:689–692

    Article  Google Scholar 

  25. McDonald MG, Burgess RC, Bolano LE, Nicholls PJ (1996) Ilizarov treatment of pilon fractures. Clin Orthop 325:232–238

    Article  PubMed  Google Scholar 

  26. Müller M, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification for fractures of long bones. Springer, Berlin Heidelberg New York

    Google Scholar 

  27. Oestern HJ, Tscherne H (1984) Pathophysiology and classification of soft tissue injuries associated with fractures. In: Tscherne H, Gotzen L (eds) Fractures with soft tissue injuries. Springer, Berlin Heidelberg New York

    Google Scholar 

  28. Ovadia DN, Beals RK (1986) Fractures of the tibial plafond. J Bone Joint Surg 68-A:543–551

    Google Scholar 

  29. Patterson MJ, Cole JD (1999) Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 2:85–91

    Article  Google Scholar 

  30. Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD (1999) Tibial pilon fractures: a comparison of treatment methods. J Trauma 5:937–941

    Article  Google Scholar 

  31. Rüedi TP (1973) Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury 5:30–34

    Article  Google Scholar 

  32. Rüedi TP, Allgöwer M (1979) The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop 138:105–110

    PubMed  Google Scholar 

  33. Sirkin M, Sanders R (2001) The treatment of pilon fractures. Orthop Clin North Am 332:91–102

    Article  Google Scholar 

  34. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr (1999) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 2:78–84

    Article  Google Scholar 

  35. Teeny SM, Wiss DA (1993) Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop 292:108–117

    PubMed  Google Scholar 

  36. Thordarson DB (2000) Complications after treatment of tibial pilon fracture: prevention and management strategies. J Am Acad Orthop Surg 8:253–265

    PubMed  CAS  Google Scholar 

  37. Tornetta P III, Gorup J (1996) Axial computed tomography of pilon fractures. Clin Orthop 323:73–276

    Google Scholar 

  38. Tornetta P III, Weiner L, Bergman M, Watnik N, Steuer J, Kelley M, Yang E (1993) Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma 6:489–496

    Article  Google Scholar 

  39. Watson JT, Moed BR, Karges DE, Cramer KE (2000) Pilon fractures—treatment protocol based on severity of soft tissue injury. Clin Orthop 375:78–90

    Article  PubMed  Google Scholar 

  40. Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, Schwartz HS (1996) Operative treatment of fractures of the tibial plafond. J Bone Joint Surg 78-A:1646–1657

    Google Scholar 

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Acknowledgments

Craig Klinger for the help with the manuscript.

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Authors and Affiliations

  1. The Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Olivier Borens, Jeffrey Richmond, Goetz Roederer, David S. Levine & David L. Helfet

  2. Department of Orthopedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands

    Peter Kloen

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  1. Olivier Borens
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  2. Peter Kloen
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  3. Jeffrey Richmond
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  4. Goetz Roederer
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  5. David S. Levine
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  6. David L. Helfet
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Correspondence to David L. Helfet.

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Borens, O., Kloen, P., Richmond, J. et al. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases. Arch Orthop Trauma Surg 129, 649–659 (2009). https://doi.org/10.1007/s00402-006-0219-1

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  • DOI: https://doi.org/10.1007/s00402-006-0219-1

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