Posterior plating as an alternative to external fixators in the first stage of treatment of pilon fracture with anteromedial soft tissue injury

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Abstract
Introduction: Pilon fractures management is a challenge. Orthopedic surgeons should manage fracture and soft tissue injury simultaneously in optimum condition. This study evaluates the outcomes of the management of Pilon fracture in two different approaches. Materials and methods: 40 patients were included with Pilon fractures Between March 2016 and March 2018. Patients were divided into A and B groups. Group A was operated with the external fixator of the pilon and open reduction and internal fixation (ORIF) of distal fibular in the first stage, and medial plating of the pilon in the second stage. Group B was operated with posterior plating of the pilon and fibular by posterolateral approach at the first stage and medial distal tibia plating in the second stage. The AOFAS score, postoperative satisfaction questionnaire score (MODEMS) score, surgical wound complication, union rate, and operation time were evaluated in 12-month follow-up. Results: 40 Pilon fractures were evaluated finally. 28 were male and 12 were female. Average time for union was 200 ±10 days in group A, and 215±20 days in group B. The average operation duration in the first stage was 65±10 min in group A and 60± 15 min in group B. The MODEMS score at the end of the first stage in most patients of group A was somewhat dissatisfied(86%) and in group B was somewhat satisfied (84%). This score at the end of the 12-month follow-up in most patients of group A and group B was somewhat satisfied, 85% and 87% respectively. The mean AOFAS score in groups A and B were 87.5 and 89.4 respectively at the end of follow-up. There was no significant difference between the two groups in the union rate and time and duration of the operation. Patients in the posterior plating group were more satisfied during the first stage of surgery but in the long-term follow-up, there was no difference between the two groups. Conclusion: Most surgeons prefer the two-stage strategy and external fixator usage at the stage one to manage the soft tissue complications in the pilon fractures . Based on the result, Posterior plating may be a substitute for external fixation in the first stage of Pilon fractures management.

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