Outcomes following minimally invasive plate osteosynthesis (MIPO) application in tibial pilon fractures - A systematic review

Current Strategies in Pilon Fracture Management and Looking to the Future

Historically high complication rates encouraged the evolution of pilon fracture management. This article reviews these complex fractures, offering insight into the evolution of treatment with a glimpse into future management techniques, while superimposing our experience with included retrospective analysis of 41 pilon fractures treated at our institution by a single surgeon (T.M.C.) spanning 60 months. With improved understanding and advancing technology, multiple literature-supported strategies are available for the management of these limb-threatening traumas. Intriguing strategies needing further investigation may one day shift the paradigm; as for now, the foundational principles of pilon fracture management continue to anchor the treatment strategy.

Outcomes of Patients Treated for Open Pilon Fractures at a County Hospital

INTRODUCTION

Open pilon fractures represent a challenging injury for both patients and physicians. Patients must contend with prolonged non-weightbearing, wound complications, and the possibility of post-traumatic arthritis. Surgeons also deal with a fracture which is difficult to treat and that is prone to poor outcomes. To better understand these challenging injuries and identify details that may portend better patient outcomes, we performed a retrospective review of open pilon fractures treated at a level 1 trauma county hospital by orthopedic trauma-trained surgeons.

MATERIALS AND METHODS

A search was performed for patients treated for open pilon fractures at our institution. Demographics and fracture information for each patient, as well as pre and postoperative details for each patient, were collected. We also identified complications such as infection, nonunion, and the need for additional surgeries in patients. Patients were then compared to one another, and they were also stratified according to their Gustilo-Anderson classification of open fracture to identify differences.

RESULTS

Patients in our study who sustained type 3 open injuries were older, more often required additional surgeries, sustained nonunion of their fracture, became infected or underwent amputation than patients with type 1 and 2 injuries. 20% of all patients with type 3 open injuries underwent 4 or more additional procedures, while only 13% did not require additional surgery. In contrast, over half of all patients with type 1 and 2 open injuries did not require any additional surgeries.

CONCLUSIONS

Despite following currently recommended guidelines for the treatment of open pilon fractures, these injuries are still prone to complications. Elderly patients and those with type 3 injuries are especially at high risk for negative postoperative outcomes due to the increased severity of soft-tissue damage. Further research is necessary to identify optimal protocols for these devastating injuries, especially in vulnerable populations.

LEVELS OF EVIDENCE

Level III.

Limb Fractures Treated With the Novel Plate Osteosynthesis Application Technique: Second to Minimally Invasive Plates osteosynthesis

BACKGROUND

The main aim of this article was to propose a new concept of minimally invasive surgery for treating limb fractures, named as second to minimally invasive plates osteosynthesis (STMIPO).

METHODS

We have described the STMIPO technique in a step-wise and standardized manner based on our findings from a study involving six patients treated at our institution. All patients with fracture achieved satisfactory outcomes.

RESULTS

Ours clinical trials have shown that the STMIPO technique can be successfully applied in various limb fractures, including fibula fractures, tibial fractures, femur fractures, humerus fractures, ulna fractures, and radius fractures. All fracture patients achieved satisfactory outcomes.

CONCLUSION

As a new minimally invasive technology, the STMIPO technique can serve as an alternative solution for fractures that are difficult to reduce with minimally invasive plates osteosynthesis (MIPO).