Abstract
Introduction: Intra-articular pilon fractures of the distal tibia are complicated fractures with far-reaching long-term functional consequences. Despite improved surgical methods, the ideal management protocols and resulting recuperation patterns continue to be topics of recent investigation. This study aims to compare functional outcome, and rates of complications after surgical management of pilon fractures by open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO) and also to compare the effect of age on recovery and modes of complications.
Materials & Methods: This is a prospective observational cohort study of 183 type B or C pilon fracture patients treated at a single trauma center. The level of functional recovery 2 weeks, 6 weeks, 3 months, 6 months, and 12 months post-injury was measured by the Foot Function Index (FFI). Postoperative complications were noted, and the time to return to normal activities. Repeated-measures ANOVA was employed in the assessment of temporal changes in FFI scores.
Results & Discussion: There was significant improvement on all subscales of FFI during 12 months of time (P<0.001), with most improvement in the first 6 months. The mean duration of time to return to activity was 25.5±7.5 weeks. Complications were malunion (23.0%), nonunion (30.6%), deep infection (15.8%), loosening of implant (14.8%), and reoperation (36.6%). Age was correlated with increased complications. Compared with ORIF, MIPO achieved comparable 12-month functional recovery (FFI improvement) while demonstrating a lower, though not statistically significant, rate of deep infection, suggesting similar efficacy with a potential advantage in soft-tissue preservation.
Conclusion: Operative management of pilon fracture yields significant functional improvement, although complications are common. Prognosis depends on age. Preoperative planning should be meticulous, close observation necessary, and individualized rehabilitation in order to maximize outcome.