Treatment of Pilon fracture malunion with distal tibiaI osteotomy and reconstruction

Category: Ankle Introduction/Purpose: To evaluate the clinical outcomes of distal tibial osteotomy and alignment reconstruction for pilon fracture malunion. Methods: Between January 2010 and May 2012. 15 cases of pilon fracture malunion were treated with super-malleolar extra-articular osteotomy and alignment reconstruction. They were 12 males and 3 females with an average age of 30.8 years(from 24 to 39 years). The pre-operative X-ray and CT scan showed varus deformity in 9 cases anti valgus in 2 cases. There were 4 cases of anterior impact of the distal tibia and 4 cases of tibiotalar subluxation. All the patients complained about ankle pain, deformity, limited range of motion(ROM)and walking difficulty. X-ray was taken routinely to confirm the bone healing during post-operative follow-up. Scores of visual analogue scale(VAS), American Orthopaedic Foot & Ankle Society(AOFAS)and The Short Form-36(SF-36), ankle ROM and complications were also recorded. Results: 13 cases obtained all average follow-up of 23. 8 months (from 19 to 48 months)and 2 were lost to the follow-up. Bony union was achieved after an average of 3.8 months(from 3 to 7 months). The average VAS score declined significantly from 5.1±3.2 preoperatively to 1.4±0.8 postoperatively (P<0.05). A complete pain relief was achieved in 8 cases. The AOFAS ankle and hindfoot score, SF-36 score, ankle ROM at the last follow-up were improved significantly compared with the preoperative ones (P