Early Tibiotalar Arthrodesis via Posterior Approach Using an Inverted Humeral Plate in Tibial Pilon Fractures: Functional and Radiological Outcomes.

Abstract

Introduction: Communitive tibial pilon fractures are complex fractures in which management is controversial and technically challenging, often leading to a high rate of complications and unsatisfactory outcomes.

Objective: The primary objective of this study was to evaluate the union rate of early tibiotalar arthrodesis using an inverted PHILOS® plate via a posterior approach following a severe comminuted tibial pilon fracture.

Materials and methods: A retrospective study including 9 patients who underwent early tibiotalar arthrodesis between January 2015 and August 2020 following severe comminuted tibial pilon fractures. The procedure was performed via a posterior approach and stabilized using a reversed PHILOS® plate after initial temporary stabilization with an external fixator. The minimum follow-up period was 12 months. The study evaluated the union rate of the arthrodesis and associated fracture, as well as the rate of postoperative complications. Functional outcomes were also assessed using the AOFAS score and the Maryland Foot Score (MFS).

Results: At the latest follow-up, eight patients demonstrated consolidation of both the fracture and the tibiotalar arthrodesis. One patient developed an aseptic non-union, requiring revision surgery. No wound or infectious complications were reported. Two patients showed signs of subtalar arthritis. The mean AOFAS score was 66 points (range 51-82), and the MFS averaged 71 points (range 53-84).

Conclusion: Early tibio-talar arthrodesis via the posterior approach appears to be a reliable technique for achieving consolidation in complex comminuted pilon fractures. The alternative use of an inverted PHILOS® humeral plate also represents a mechanically reliable material option compared to other existing fixation systems LEVEL OF EVIDENCE: IV; case series study.