Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Trauma - Tibia/Fibula
Abstract number: 26471
TWO-STAGE OPERATIVE TREATMENT OF HIGH-ENERGY COMPLEX PILON
FRACTURES
Alexander FROLOV 1 , Alexey SEMENISTIY 2 , Andrey KOROLEV 1 , Eugeniy
LOMTATIDZE 3
1 European Clinic of Sports Traumatology and Orthopaedics, Moscow (RUSSIA),
2 City Clinical Hospital # 13, Moscow (RUSSIA), 3 Peoples Friendship University of
Russia, Moscow (RUSSIA)
INTRODUCTION: The basic treatment concepts include anatomical reduction and
stabilization of the fibula and distal tibia and early mobilization of the ankle.
Application of these techniques to high-energy injuries resulted in a high rate of
complications, most commonly soft-tissue problems and infection. Primary external
fixation instead of plate fixation decreases the risk of early
complications.MATERIALS AND METHODS: We treated 24 patients with complex
high-energy pilon fractures using two-stage method from 2007 to 2009. We used
AO/ASIF classification: 43A 4, 43B 6, 43C 14. At first step external AO tubular
fixator fixed all fractures. After 5-7 days the ex-fix was removed and plate
osteosynthesis was done. The mean hospitalization time was for an average of 15
days. RESULTS: The long-term results were observed in 20 patients. The patients
were allowed to bear partial weight at an average of nine weeks and full weight at an
average of thirteen weeks after the injury. Two complications were registered: 1
secondary wound closure, 1 superficial wound infection. DISCUSSION: Open
reduction and internal fixation of severe pilon fractures directly after have been
associated with a high rate of complications. Extensive operative dissection through
the poorly vascularized and traumatized soft-tissues of the distal tibia, combined with
the implantation of subcutaneous plates, leads to these complications.
CONCLUSIONS: The goal of the treatment of complex pilon fractures is to obtain
union of the fracture and to restore normal function of ankle joint. Two-stage surgical
treatment results using AO techniques provides excellent and good outcomes.
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