Abstract
Objectives
To assess the medium-term functional and radiological outcomes, as well as injury
mechanisms, fracture patterns and demographics of typical pilon fractures and pilon
variant fractures treated based on the four-column theory in adults.
Methods
A retrospective comparative study was performed. Demographics of typical pilon and
pilon variant fractures, injury mechanisms, OTA/AO classification, Rüedi-Allgöwer
and the four-column classification were analyzed for the cohort. Radiographic ankle
arthrosis (modified Kellgren-Lawrence 3/4), Burwell Charnley Score, and AOFAS score
were also analyzed.
Results
There were 142 pilon fractures met the inclusion and exclusion criteria for this study,
of which 77(54.23%) were females and 65 (45.77%) were males, with an average of 48
(range, 18-86)years. One hundred twenty-five posterior columns fractured in 142 pilon
fractures, and the posterior columns were most prone to fractures. Ninety cases of
posterior pilon fractures in 142 pilon fractures were single posterior column fractures
with or without medial or lateral malleolar fractures. The average age (51, range,
18-86 years) of low-energy pilon fractures was older than the average age (42, range,
19-66 years) of high-energy pilon fractures significantly. The average time (5, range,
0-17 days) from injury to definitive internal fixation of the low-energy group was
shorter than the average time (9, range, 0-21 days) from injury to definitive internal
fixation of the high-energy group significantly. The average of AOFAS (87, range,
56-100) of the low-energy group is higher than the average of AOFAS (82, range, 47-100)
of the high-energy group significantly. There were more male patients and more die-punch
or intercalary fractures in high energy groups significantly. There were more medial
and lateral malleolar fractures in low-energy groups. Compared with the non-multiple
column group, the multiple-column group had more Rüedi-Allgöwer type III cases, more
modified Kellgren-Lawrence 3/4 cases and lower AOFAS score significantly. However,
the numbers of Burwell Charnley Score type 1 and 2 cases were not significantly different
between the two groups.
Conclusions
Kinds of pilon variants should be recognized. Outcomes of high-energy pilon fractures
were worse than low-energy pilon fractures. The four-column theory can be applied
to typical pilon fracture and pilon variants in adults.
Keywords
Abbreviations:
MIPPO (minimally invasive percutaneous plate osteosynthesis), AOFAS (American Orthopaedic Foot and Ankle Society)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 10, 2022
Accepted:
August 6,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
