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Biaxial Distraction with Limited Internal Fixation in Pilon Fractures of the Ankle

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Author(s): Dr Anwar Marthya

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 1;
Issue: 1;
Date: 2004;
Original page

Keywords: Biaxial distraction | Pilons Fracture

ABSTRACT
Background A short term follow up study of pilon fractures of the ankle treated over a period of 5 years in a teaching institution. Pilon fractures are becoming more and more common because of increased incidence of high velocity injuries. Many are compound fractures, since Tibia is a subcutaneous bone. Outcome of such fractures are generally not satisfactory because of secondary osteoarthritis, which occur as a sequele of inadequate reconstruction of the joint. 1 mm tilt of Talus changes the weight transmission by 25%. Primary reconstruction with achievement of joint congruence is the only method by which secondary osteoarthritis can be prevented. Methods 21 patients during the period of 1997-2002 were assessed. Majority were males. 8 of these fractures were compound. Initial management consisted of heamodynamic stabilization and wound debridement in compound fractures. Primary stabilization is done whenever the general conditions were satisfactory. Mode of treatment consisted of biaxial distraction and stabilization by external fixation and limited internal fixation. Primary internal fixation without external fixation was also done in some cases, where internal fixation alone has given good stability to the fracture and joint congruence. Results Of the 21 patients studied during the period with an average follow up of 2 ½ years. 13 fractures united with congruent ankle joint, 3 developed Osteoarthritis, 3 patients had 1-3ºof tilt of the talus, which have painful ankle joint and needs a second surgery. Other patients are still on follow up. 61% of the patients in this series had best outcome. Discussion Pilon fractures always cause difficulty in management because of its inherent instability and intraarticular extension. To attain the best outcome needs a perfect reconstruction of articular congruence with best possible alignment. Open reduction is not usually advisable because of severity of communition and loose fragment. Biaxial distraction with limited internal fixation helps a better alignment and articular reconstruction without much trauma to the patient. But in cases where a primary fixation is possible, external fixation can be avoided. Biaxial distraction with limited internal fixation is a good feasible technique in pilon fracture to attain fracture alignment
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