Outcome analysis of management of tibial pilon fracture by medial locking compression plating

Abstract
Introduction: Fractures of the distal tibia can be challenging to treat because of limited soft tissue, the subcutaneous location and poor vascularity. Fractures of distal tibia remain a controversial subject despite advances in both nonoperative and operative care. The goal in expect care is to realign the
fracture, realign limb length and early functional recovery. The aim of our study is to analyze the functional outcome of distal tibial fractures treated by Medial Distal Tibial Locking Compression Plate (LCP). Materials and Methods: This prospective study conducted over a period of 4 yrs from May 2015 to November 2018 after ethical committee approval. Patients in age group of 18-65 yrs presenting with closed distal tibial fractures of Ruedi and Allgower type – I, II, III were included in this study. Compound fractures and Age <18 & >65 were excluded. Patients with associated calcaneal and talar
fractures were also excluded. Functional results were analysed with Iowa ankle evaluation score and radiological reduction is analysed with Teeny & Wiss scoring criteria. Results: The total number of patients included in this study was 30 with age range between 20-64 with a mean age of 32.8yrs. M:F 12:18. RTA being the most common mode of injury among them. Based of
Ruedi Allgower types 8 belonged to Type A while 10, 7, 5 belongs to Types C1,C2,C3 respectively. 16 of them had fibular fracture at same level while 8 had fibular fracture at different level while 6 had intact fibula. We had a minimum follow up of 1 yr and maximum follow up of 4 yrs with mean follow up of 2.8
yrs. Union was achieved in all cases between 12-16 weeks. The mean duration from hospital admission to definitive surgery was around 10-14days. The mean functional ankle scores were 80.5with a maximum of 94 and minimum of 74. Anatomic reduction was achieved in about 22 cases with good alignment.
Conclusion: Medial Tibial locking compression plating can be considered as a reliable modality of management of distal tibial fractures and it has to be done either within 24 hrs of the injury before the edema sets in or a delay of 8 to 12 days for the edema to settle down and the wrinkle sign appears.
Respect the soft tissues, do not operate too early or through compromised skin, instead wait till the soft tissues is amenable for surgery. Restoration of the articular surface and reestablishing its relationship to the tibial shaft is the primary goal of treatment. Good functional result depends on reasonable anatomic reduction of the articular surface either by direct or indirect methods.