Background and Objective: Various surgical techniques, including Open Reduction and Internal Fixation (ORIF), Minimally Invasive Plate Osteosynthesis (MIPO), and External Fixation (EF), have been proposed for the tibial pilon fractures treatment. However, limited comparative data exist regarding the outcomes of these three methods. Despite advancements in surgical procedures, the outcomes have not consistently been excellent, and patients often experience numerous complications. This study aimed to evaluate the outcomes and complications of the tibial pilon fractures treatment in a six-month follow-up.
Methods: This descriptive-analytical prospective cohort study was conducted on 22 patients (18 men and 4 women; mean age=39.4±10.8 years) who presented with tibial pilon fractures at the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, from April 2020 to March 2022. All 22 eligible patients agreed to participate. Following the necessary treatment determined by the attending physician, patients were examined after six months, and their outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle score.
Results: The majority of fractures (54.5%) were of closed type. The surgical procedures performed included two-stage EF (40.9%), ORIF (31.8%), expert nailing (13.6%), and MIPO (13.6%), respectively. A total of 72.7% of patients experienced early or late postoperative complications. The most common postoperative complications were osteoarthritis and wound dehiscence, occurring at a rate of 18.2% each. The mean AOFAS score for patients was 82.3±11.2. AOFAS scores were classified as excellent in 4 patients (18.18%), good in 12 patients (54.55%), moderate in 4 patients (18.18%), and poor in 2 patients (9.09%). A statistically significant inverse correlation was observed between the mean surgical time and the AOFAS score (r=−0.661, P=0.001). Furthermore, a statistically significant direct correlation was found between the mean surgical time and the mean length of hospital stay (r=0.571, P=0.006). Surgical time for patients undergoing MIPO (68.3±7.6 minutes) was significantly shorter than that of the other three methods (P<0.05). For open fractures, the frequency of ORIF was significantly higher than that of other procedures (P<0.05). Osteoarthritis was observed as a treatment complication in both expert nailing and two-stage EF interventions. In contrast, non-union and wound dehiscence complications were exclusively observed following ORIF. Superficial infection and mal-union were only observed after two-stage EF, and all instances of deep infection occurred with MIPO.
Conclusion: Two-stage EF and ORIF were the most common surgical techniques employed for patients with tibial pilon fractures. Worse postoperative complications, including non-union and wound dehiscence, commonly occurred in ORIF procedures. However, there was no statistically significant difference in patient-reported outcomes based on the AOFAS self-report questionnaire among the various surgical techniques.