Pilon fractures are complex, high-energy, intra-articular fractures of the distal tibia. Achieving good outcomes is challenging due to fracture complexity and extensive soft tissue damage. The purpose of this study was to determine the long-term functional and clinical outcomes of definitive management with fine wire Ilizarov fixation for closed pilon fractures. 185 patients treated over a 14-year period (2004–2018) were included. All patients had Ilizarov frames applied to restore mechanical axis and fine wires to control periarticular fragments. CT scans were performed post operatively to confirm satisfactory restoration of the articular surface. All frames were dynamized prior to removal. Patients' functional outcome was assessed using the validated Chertsey Outcome Score for Trauma (“COST”). Review of clinical notes and imaging was used to determine complications and time to union.Introduction
Materials and Methods
Ashford and St Peter's Hospital (ASPH) is a district general hospital in Chertsey, Surrey. It is a tertiary referral unit offering a circular frame service to manage complex trauma patients in the South East of England. This study analyses the patient pathway in 66 consecutive tertiary referrals from 2015–2020. All patients were managed with an Ilizarov frame for either a tibial plateau fracture or pilon fracture. The patient journey of 66 consecutive tertiary referrals for tibial plateau and pilon fractures were analysed. The following data was captured: patient demographics; type of injury; referring centre; date of injury; date of referral; date of arrival at ASPH; date of surgery and date of discharge. Using this data we aimed to identify areas of the pathway that can be improved. In addition, the 66 patients were split into two groups of 33 patients. 33 patients were referred via an electronic referral platform and 33 patients were referred verbally prior to the implementation of the electronic referral platform. The groups were compared to see the impact of an electronic referral platform on the patient's journey.Introduction
Materials and Methods
The purpose of this study was to review the long term functional results of patients undergoing treatment for high energy tibial plateau fractures. Between January 1994 and June 2013 our unit managed 105 high energy tibial plateau fractures (Schatzker IV-VI) with an Ilizarov frame. All cases were treated via ligamentotaxis and percutaneous fine wire fixation or with a limited open reduction of the joint surface. A retrospective analysis of all patients that have undergone Ilizarov fixation of a tibial plateau fracture was performed with radiological and clinical functional outcome measurements. We analysed 105 patients with a mean follow up of 93.5 months (range 5–200). The patient group had an average age of 49 years (range 15–87) with 62 patients being male. Fracture pattern was analysed with Schatzker's classification showing 18 type IV, 10 type V and 77 type VI tibial plateau fractures. All fractures had an average time to union of 145 days. Patients had and average range of movement of 117 degrees. Patients undergoing Ilizarov treatment for high energy tibial plateau fractures achieve successful results long term. Definitive treatment should be decided with respect to fracture pattern and the soft tissue envelope. The management aim should be to achieve anatomical reduction and stable fixation to enable early mobilization. Our study confirms the good functional outcomes and low morbidity that can be achieved in high energy fractures treated with Ilizarov fixation.
Standard Ilizarov technique uses the tensioned olive wires to provide interfragmentary compression in the acute fracture setting and in non-union surgery. In osteopenic metaphyseal bone this can lead to the olive “cutting through” the thin attenuated cortex reducing compression and stability. We describe a technique placing a percutaneous 3 hole Synthes Mini-fragment plate against the outer cortex of the bone fragment. An olive wire is then placed through each of the outer two holes and through the bone fragment. The construct is then tensioned. This stops the olive cutting into the bone and allows increased compression which is particularly important in non-union surgery.
Currently the debate continues in definitive fixation method for complex tibial plateau fractures. The aim of surgical management remains prevention of further damage to the articular cartilage, whilst avoiding iatrogenic risks - Low Risk Surgery (LRS). The purpose of this study was to determine the functional impact, clinical radiological outcome following tibial plateau fractures treated with either external fixation or internal fixation. 124 Schatzker IV-VI tibial plateau fractures were reviewed following surgical fixation. Fractures analysed included 24 type IV, 20 type V and 80 type VI tibial plateau fractures. The majority of Schatzker IV fractures were treated with internal fixation, but 67 of 80 Schatzker VI fractures were treated with the Ilizarov method. The average IOWA knee score, was 86 (16 to 100) and the average range of motion was 133 degrees (60 to 150). There were no differences between the circular fixator group and the internal fixation group in terms of range of motion or IOWA scores. There were comparable functional outcomes and complication rates between both groups. In summary patients with high energy tibial plateau fracture treated with internal or external fixation, have a good chance of achieving satisfactory long term knee function.
