[Fracture of the distal lower limb: two-stage surgical treatment with external fixator and locked-screw plate]

Late results after a new therapeutic protocol for soft tissue management in the treatment of tibial pylon fractures

The prospective study targets the tibial pylon fractures admitted in our clinic, to which a new treatment protocol was applied, consisting of two surgical steps, assessing in the end the results achieved at the discharge of the patient and later follows up. The study group consist of 196 patients (198 fractures), in the period 2012-2015.

The average evaluation time was of 16 months. The average age of the patients was 46.5 years (19-83 years), this type of fracture especially affecting active people. The etiology was dominated by high falls (109 cases), most of them being work related accidents. The most frequently applied osteosynthesis principle was staged osteosynthesis which consisted of first stage fibula semitubular plate osteosynthesis and external fixator tibia pylon, followed by minimally invasive or limited approach locked plate tibia pylon fixation. (64.14%) Olerud and Molander clinical score at more than one year after the last surgical intervention highlights good results: excellent results in the amount of 37% to 15% in the first lot, good results 52% to 29%, moderate success 7% to 39% and poor 4% to 17%.

Two stage surgery protocol with external fixation in emergency and minimally invasive internal fixation with locked plate performed after the dissappearance of the local edema, as the second surgical step, allows anatomically correct articular reconstruction without skin complications, with decrease of arthitic late complications.