Comparison of External Circular Fixation and Plate and Screw Fixation Methods in Tibial Pilon Fractures.

Abstract

Objective  To compare the fixation methods for tibial pilon fractures among patients treated in a hospital. Methods  We analyzed the medical records of 28 patients who underwent a surgical procedure for tibial pilon fracture, among whom 15 subjects received a circular external fixator, and 13 underwent internal fixation using a plate and screws. We assessed age, sex, aggravating factors, trauma energy (high or low), presence of soft tissue injuries, associated fractures, and clinical outcomes. Results  Most patients were male, aging between 40 and 60 years. The most common trauma mechanism was car accident, and the associated injury was a fracture of the distal third of the fibula. The fracture patterns in patients treated with a circular external fixator were AO 43C3 and 43C2. As for the prevalent fracture patterns in the internal fixation group, we identified AO 43C1, 43C2, and 43C3. Conclusion  An individualized therapeutic choice is critical for a better functional outcome. Additionally, it is essential to highlight that the profile of fractures and patients in the circular external fixator and internal fixation groups tends to be quite heterogeneous, because the treatment of fractures with the worst classification and most frequently associated with soft tissue injuries often uses circular external fixation; meanwhile, those with less severe fractures and a lower incidence of soft tissue injuries are usually managed with open reduction and internal fixation. We noted that the clinical and radiographic outcomes tended to be similar between both groups despite the particularities of each method.