The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients

IntroductionTreatment of tibia pilon fractures is challenging. Outcome after tibia pilon fractures depend on multiple factors. Aim of this study is to evaluate the potential variables that are known to affect the outcome after tibia pilon fractures.Patients and methodsForty patients with 42 tibia pilon fractures with a one-year follow-up, who had undergone surgical treatment between January 2007 and June 2011, were evaluated, retrospectively. Patients were divided into 3 groups regarding the choice of surgical treatment (Group A-22 patients treated with open reduction-internal fixation; Group B-9 patients treated with mini-open reduction-internal fixation and external fixation; and Group C-11 patients treated with closed reduction-external fixation). Fractures were classified using Müller-AO and Rüedi/Allgöwer classifications. Quality of reduction was evaluated using Ovadia and Beals’ criteria. All patients underwent functional assessment using AOFAS ankle-hindfoot scale and Teeny–Wiss scoring system at the last follow-up.ResultsMean age of the patients was 49 (20–80). There were eight 43-B3, six 43-C1, twelve 43-C2 and sixteen 43-C3 fractures according to Müller-AO classification and ten type 1, ten type 2 and twenty two type 3 fractures according to Rüedi/Allgöwer classification. There were 15 (35.7%) open fractures. No statistically significant relation was found between quality of reduction and type of surgery. Also no significant relation was found between the type of surgery and functional scores. No significant correlation was found between functional scores and Müller-AO classification, but functional scores were found significantly worse in Rüedi/Allgöwer type 3 fractures. Functional scores were found significantly related to the quality of reduction. Early complications were seen in 22 and late complications were seen in 9 fractures. No statistically significant relation was found between complications, type of surgery and functional scores.ConclusionThe most important factor affecting outcome in surgically treated tibia pilon fractures was quality of reduction. Poor functional scores were found independent from the type of surgery and quality of reduction in Rüedi/Allgöwer type 3 fractures, which was characterized with articular surface comminution and metaphyseal impaction.