Ilizarov external fixator in the management of tibial pilon fractures: ankle hinged vs ankle fixed frame

Objectives: In this study, we aimed to answer the following questions: (i) Do patients with tibial pilon fractures treated with an ankle hinge Ilizarov external fixator have a better ankle function versus ankle fixed? (ii) Is the incidence of posttraumatic arthrosis lower in patients treated with an ankle hinge Ilizarov external fixator? Patients and methods: Between April 2002 and January 2008, data of 34 patients (26 males, 8 females; mean age 36.9 years; range 20 to 78 years) who were treated with Ilizarov external fixator due to tibial pilon fracture were retrospectively evaluated. The patients were divided into two groups including those with an ankle hinged Ilizarov external fixator (group A, n=16) and an ankle fixed Ilizarov external fixator (group B, n=18). Preoperative and postoperative complications in the patients and quality of reduction were evaluated. In the last follow-up visit, ankle plantar and dorsiflexion range of motion and length of tibia were goniometrically measured. The functional assessment of the patients was performed using Teeny and Wiss scale. Posttraumatic arthrosis in the standard ankle X-rays was investigated. Results: The mean degree of plantar flexion was significantly higher in group A (25 degrees in group A, 12.4 degrees in group B). In the last visit, satisfactory results were obtained in 62.5% patients of group A and in 38.8% patients of group B according to Teeny and Wiss scale. Repeated X-rays revealed posttraumatic arthrosis in 31.3% patients of group A (n=5) and in 55.5% patients of group B (n=10). Conclusion: The selection of an ankle hinged Ilizarov external fixator and early joint movement is an effective treatment method for the management of tibial pilon fractures usually accompanied by soft tissue injuries.