Objective: To explore the operative method of open distal tibial pilon fractures, and to evaluate the outcome of ankle joint function postoperatively.
Methods: From March 2003 to March 2007, 24 patients with open Pilon fractures were treated with one-stage open reduction and internal fixation (18 males and 6 females). The average age was 37.6 years (14-53 years). All 24 patients had open fracture, 12 of whom combined fibular fracture. According to AO comprehensive classification system, the fractures was classified as C1 in 4, C2 in 9, and C3 in 11. According to Gustilo-Anderson classification method, the fracture was classified as Type I in 3, Type II in 5, Type III A in 4, Type III B in 10, and Type III C in 2. All tibial pilon fractures were treated by radical debridement, one-stage open reduction and internal fixation. Soft tissue defection was covered by a vascularized flap and continually washed by pipes under the flap.
Results: All patients were followed-up at an average of 2.3 years (1-3.8 years) after the surgery. All the fractures healed at an average of 22.3 weeks (16-54 wk) postoperatively. According to the scoring system of Conroy, 17 were excellent (62.5%), 4 good (25%), and 3 poor (12.5%), the excellence rate was 87.5%. According to the ankle score of Teeny and Wiss, there were 11 excellent (37.5%), 7 good (37.5%), 3 fair (16.7%), and 3 poor (8.3%) and the excellence rate was 75%.
Conclusion: One-stage management for open Pilon fracture has the advantages of fewer complications, lower infectious rate, and better ankle joint function.