Management of Comminuted Tibial Pilon Fractures by Ilizarov External Fixation

Various types of external fixators have been used to treat Ruedi and Allgöwer Type III pilon fractures, as serious complications can occur using conventional treatment principles. However, insufficient reduction and loss of reduction are the two main disadvantages of external fixator treatments. This is a case series involving 15 patients with comminuted closed fractures of the distal tibia (Ruedi type III) treated using cross ankle external fixators. Five patients underwent closed reduction, while the others required open reduction using minimal incision techniques. The reduction score, reduction loss, early and late complications, and ankle symptoms and functions were evaluated. The mean duration of external fixation was 15.9 ±3.7 weeks. The patients were followed for an average of 20.1 ±4.1 months (range: 12-26 months). We achieved excellent to good articular reduction in 66.7% of the patients. Fracture union was achieved in all patients with only one case of malunion at 16o of varus encountered. Superficial wound infection developed in one case. Pin tract infection was the most commonly encountered complication (60%) but all cases responded well to antibiotic therapy. In conclusion, treatment of pilon fractures by external fixation, using Ilizarov fixators, is a reliable method for stabilization and healing of high-energy distal tibial intraarticular fractures with acceptable frequency of soft tissue complications.