The management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy

• Ankle spanning using the Ilizarov technique is a useful tool in reducing pilon fractures without excessive soft tissue damage.
• Ankle distraction using Ilizaov allows for a good environment for healing of the articular surface by increasing the blood supply and by distraction that will relief the compression on the articular surface making sure it will heal without the risk of collapse and accordingly will decrease the incidence of osteoarthritis.
• Although the use of arthroscopy was helpful in assessing the articular surface, reducing any depressed fragments after closed reduction and washing all the debris inside the ankle, it did not have any statistical positive effect on our results.
• The added value of using arthroscopy needs more investigation with longer follow up and larger number of cases.

BackgroundPilon fractures usually result from high energy trauma, and are commonly associated with extensive soft tissue damage which prevents the use of open reduction and internal fixation.PurposeThis study was designed to evaluate the use of the Ilizarov external fixator in the treatment of pilon fractures of the ankle, and to determine whether arthroscopy of the ankle could improve the outcome.MethodsFrom February 2011 to May 2013 a total of 23 patients with unilateral closed pilon fractures were divided into two groups treated with and without arthroscopy during fixation with the Ilizarov external fixator. The fractures were classified according to the AO Rüdi and Allgőwer classification. Follow up ranged from 10 to 37 months with a mean of 18 months.ResultsAll cases were evaluated at follow up by the AOFAS and the Bone et al. grading system. According to Bone et al. there were 3 cases excellent, 4 cases good, 2 cases fair, and 2 cases poor in Group A (without arthroscopy), whereas there were 4 cases excellent, 6 cases good, 2 cases fair in Group B (with arthroscopy). The AOFAS score for Group A was 77.8 ± 5.8, and for Group B was 78.4 ± 6.9.ConclusionWe concluded that the Ilizarov external fixator is an excellent method in treating pilon fractures as it minimizes the need for extensive surgery. We also conclude that the use of arthroscopy during pilon fracture fixation did not add statistically significant improvement to our results and it needs longer term investigation to assess its advantage – if any – to the final outcome.Level of evidence: level 2.