Bourne RB, Rorabeck CH, Macnab J: Intra-articular fractures of the distal tibia: the pilon fracture. J Trauma 23: 591, 1983.
Chowdhry M, Porter K: The pilon fracture. Trauma 12: 89, 2010.
Calhoun JH, Li F, Ledbetter BR, et al: A comprehensive study of pressure distribution in the ankle joint with inversion and eversion. Foot Ankle Int 15: 125, 1994.
Boreeli J Jr, Ellis E: Pilon fractures: assessment and treatment. Orthop Clin North Am 33: 231, 2002.
Rüedi T: Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury 5: 130, 1973.
Assal M, Ray A, Stern R: The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing. J Orthop Trauma 21: 198, 2007.
Blauth M, Bastian L, Krettek C, et al: Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 15: 153, 2001.
Sirkin M, Sanders R, DiPasquale T, et al: A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18(suppl): S32, 2004.
Tong D, Ji F, Zhang H, et al: Two-stage procedure protocol for minimally invasive plate osteosynthesis technique in the treatment of the complex pilon fracture. Int Orthop 36: 833, 2012.
Pollak AN, McCarthy ML, Bess RS, et al: Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am 85: 1893, 2003.
Topliss CJ, Jackson M, Atkins RM: Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br 87: 692, 2005.
Marsh JL, Weigel DP, Dirschl DR: Tibial plafond fractures. How do these ankles function over time? J Bone Joint Surg Am 85: 287, 2003.
Conroy J, Agarwal M, Giannoudis PV, et al: Early internal fixation and soft tissue cover of severe open tibial pilon fractures. Int Orthop 27: 343, 2003.
Müller ME, Koch P, Nazarian S, et al.: The Comprehensive Classification of Fractures of Long Bones, Springer, New York, 1990.
Ovadia DN, Beals RK: Fractures of the tibial plafond. J Bone Joint Surg Am 68: 543, 1986.
Teeny SM, Wiss DA: Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 292: 108, 1993.
Lambers KTA, Van Den Bekerom MPJ, Doornberg JN, et al: Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only. J Bone Joint Surg Am 95: e1221, 2013.
Rüedi TP, Allgöwer M: Fractures of the lower end of the tibia into the ankle-joint. Injury 1: 92, 1969.
Krettek C, Bachmann S: Pilon fractures. Part 2: repositioning and stabilization technique and complication management [in German]. Chirurg 86: 187, 2015.
Anderson DD, Marsh JL, Brown TD: The pathomechanical etiology of post-traumatic osteoarthritis following intraarticular fractures. Iowa Orthop J 31: 1, 2011.
Mani H, Hsiao SF, Konishi T, et al: Adaptation of postural control while standing on a narrow unfixed base of support. Int J Rehabil Res 39: 92, 2016.
Feldman DS, Shin SS, Madan S, et al: Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor Spatial Frame. J Orthop Trauma 17: 549, 2003.
Milner SA, Davis TRC, Muir KR, et al: Long-term outcome after tibial shaft fracture: is malunion important? J Bone Joint Surg Am 84: 971, 2002.
Shah K, Quaimkhani S: Long-term outcome after tibial shaft fracture: is malunion important? J Bone Joint Surg Am 86: 436, 2004.
Joveniaux P, Ohl X, Harisboure A, et al: Distal tibia fractures: management and complications of 101 cases. Int Orthop 34: 583, 2010.
Horisberger M, Hintermann B, Valderrabano V: Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon) 24: 303, 2009.
Hirschmüller A, Konstantinidis L, Baur H, et al: Do changes in dynamic plantar pressure distribution, strength capacity and postural control after intra-articular calcaneal fracture correlate with clinical and radiological outcome? Injury 42: 1135, 2011.
Yaradılmış YU, Okkaoğlu MC, Kılıç A, et al: The mid-term effects on quality of life and foot functions following pilon fracture. Ulus Travma Acil Cerrahi Derg 26: 798, 2020.
Sommer C, Nork SE, Graves M, et al: Quality of fracture reduction assessed by radiological parameters and its influence on functional results in patients with pilon fractures—a prospective multicentre study. Injury 48: 2853, 2017.
Falzarano G, Pica G, Medici A, et al: Foot loading and gait analysis evaluation of nonarticular tibial pilon fracture: a comparison of three surgical techniques. J Foot Ankle Surg 57: 894, 2018.
Jansen H, Fenwick A, Doht S, et al: Clinical outcome and changes in gait pattern after pilon fractures. Int Orthop 37: 51, 2013.
Gülabi D, Toprak Ö, Şen C, et al: The mid-term results of treatment for tibial pilon fractures. Ulus Travma Acil Cerrahi Derg 18: 429, 2012.
Ketz J, Sanders R: Staged posterior tibial plating for the treatment of orthopaedic trauma association 43C2 and 43C3 tibial pilon fractures. J Orthop Trauma 26: 341, 2012.
Kiene J, Herzog J, Jürgens C, et al: Multifragmentary tibial pilon fractures: midterm results after osteosynthesis with external fixation and multiple lag screws. Open Orthop J 6: 419, 2012.
Leung F, Kwok HY, Pun TS, et al: Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures. Injury 35: 278, 2004.
Background: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of their treatment and their adverse effects on gait function. The aim of this was study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis, and plantar pressure distribution in patients with tibia pilon fractures.
Methods: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January of 2015 and January of 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria; ankle functional scores were evaluated with the Teeny-Wiss score; and ankle arthrosis was evaluated with the Takakura classification. At the last patient follow-up, foot loading analysis was performed, and the results were evaluated for their relation with postoperative reduction quality, ankle function, and ankle arthrosis.
Results: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range, 19–78 years). The mean follow-up was 34.3 months (range, 24–58 months). The mean Ovadia-Beals score was 12.35 ± 4.6 on the postoperative plain radiographs of the patients; the mean Teeny-Wiss score at the last follow-up was 76.82 ± 17.69; and the mean Takakura score was 1.47 ± 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior portion and 52.42% on the posterior portion of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial portion of the ankle and 57.85% loaded on the lateral portion of the foot.
Conclusions: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.