Comparison of External Circular Fixation and Plate and Screw Fixation Methods in Tibial Pilon Fractures

Abstract

Objective To compare the fixation methods for tibial pilon fractures among patients treated in a hospital.

Methods We analyzed the medical records of 28 patients who underwent a surgical procedure for tibial pilon fracture, among whom 15 subjects received a circular external fixator, and 13 underwent internal fixation using a plate and screws. We assessed age, sex, aggravating factors, trauma energy (high or low), presence of soft tissue injuries, associated fractures, and clinical outcomes.

Results Most patients were male, aging between 40 and 60 years. The most common trauma mechanism was car accident, and the associated injury was a fracture of the distal third of the fibula. The fracture patterns in patients treated with a circular external fixator were AO 43C3 and 43C2. As for the prevalent fracture patterns in the internal fixation group, we identified AO 43C1, 43C2, and 43C3.

Conclusion An individualized therapeutic choice is critical for a better functional outcome. Additionally, it is essential to highlight that the profile of fractures and patients in the circular external fixator and internal fixation groups tends to be quite heterogeneous, because the treatment of fractures with the worst classification and most frequently associated with soft tissue injuries often uses circular external fixation; meanwhile, those with less severe fractures and a lower incidence of soft tissue injuries are usually managed with open reduction and internal fixation. We noted that the clinical and radiographic outcomes tended to be similar between both groups despite the particularities of each method.

Keywords

external fixators - Ilizarov technique - tibial fractures

Financial Support

This authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.

Work carried out at the Orthopedics and Traumatology Service, Hospital e Maternidade Marieta Konder Bornhausen, Itajaí, SC, Brazil.

Publikationsverlauf

Eingereicht: 06. November 2023

Angenommen: 23. Juni 2024

Artikel online veröffentlicht:
07. Dezember 2024

• Referências

• 1 Netter FH. Atlas de Anatomia Humana. 7ª. ed.. Rio de Janeiro: Elsevier; 2019
• 2 Moura Júnior AF, Machado Filho AA, Campos ET, Martins JS. Tibial pilon fractures: functional results and evaluation of quality of life. Sci J Foot Ankle 2018; 12 (01) 42-48
• 3 Koval KJ, Zucherman JD. Fraturas: Manual para consulta rápida. 3ª. ed.. Rio de Janeiro: Di Livros Editora Ltda; 2008
• 4 Pozzi I, Reginaldo S, de Almeida MV, Cristante AF. Manual de Trauma Ortopédico. São Paulo: Sociedade Brasileira de Ortopedia e Traumatologia; 2011
• 5 Marsh JL, Saltzaman CL. Fraturas do Tornozelo. In: Bucholz RW, Heckman JD. editors. Fraturas em adultos de Rockwood e Green. 5° ed.. Barueri: Manole; 2006: 2051-2078
• 6 Catagni MA, Carvalho Filho G. Tratamento da fratura tibial em pilão com fixador externo circular de Ilizarov. Rev Bras Ortop 1996; 31 (08) 643-648
• 7 Matias VEG, Brito GV, Spósito AL, Zamboni C, Mercadante M, Christian RW. “Preliminary evaluation of a prospective randomized case series comparing plate and screws versus Ilizarov circular external fixator for distal tibial fractures” [Internet]. SciELO Preprints. 2023 [cited 2023 Nov. 9]. Available from: https://preprints.scielo.org/index.php/scielo/preprint/view/6785
• 8 Pimenta LSM, Costa ARF, Baptista MV, Daher SS. Fraturas do pilão tibial: avaliação do tratamento em 25 pacientes. Rev Bras Ortop 1997; 32 (07) 497-502
• 9 Borges VQ, Moraes LVM, Ferraz GF, Stéfani KC. Fraturas de pilão tibial tipo AO 43C – o que influencia o resultado funcional?. Sci J Foot Ankle 2018; 12 (03) 233-239
• 10 Gobezie R, Ponce B, Vrahas M. Pilon fractures: Use of the posterolateral approach for ORIF. Oper Tech Orthop 2003; 13 (02) 113-119