Management and outcomes of high-energy pilon fractures: A case of King Saud Medical City, KSA

Abstract

Background: Despite being uncommon, pilon fractures are of interest to orthopedic surgeons because of the awkwardness of their treatment. Although various surgical techniques were used, poor outcomes are frequently encountered, and complications are highly prevalent. Objective: The objective of this study was to evaluate the clinical and radiographic outcomes of pilon fractures treated with a two-stage technique. Materials and Methods: The study included patients with tibial pilon fractures who had undergone two-stage procedures in King Saud Medical City (April 2017–March 2022). Fractures were categorized based on the Arbeitsgemeinschaftfur Osteosynthesefragen (AO) classification method. Outcomes were measured by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Results: Twenty-one patients had tibial pilon fracture. Open fractures were seen in 23.8%, the majority was Gustilo type II in 60%. The mean follow-up was 24.7 months. The majority (47.6%) was AO type 43-B. Osteoarthritis was developed in 61.9%, and none mandates arthrodesis. Mean AOFAS was 86.91 points, it was excellent in 38.1%. Type 43 C fracture significantly had a poorer AOFAS score (P = 0.021). AOFAS score was significantly affected by fracture grade and association with fibular fracture, P = 0.025, and P = 0.019, respectively. Conclusion: Treatment for severe pilon fractures with a two-stage protocol yields favorable outcomes. Fewer soft-tissue complications and better articular reconstruction were the main benefits.