# Severe Pilon Fractures: The Role of Quality of Reduction in Clinical and Functional Outcomes

## TL;DR

This study shows that using a non-invasive method with an Ilizarov fixator for severe pilon fractures leads to good healing and functional outcomes without major complications.

## Contribution

The study introduces a non-invasive treatment approach for pilon fractures that avoids the complications of traditional surgery.

## Key findings

- All fractures achieved successful union with the Ilizarov ring fixator.
- There was no significant correlation between reduction quality and functional outcomes.
- No major infections occurred during the treatment period.

## Abstract

Introduction

The purpose of the current study is to present the outcome of closed reduction and stabilization using an Illizarov ring fixator in severe pilon fractures and to investigate the correlation between reduction quality and clinical and functional outcomes.

Materials and methods

Thirty-three type III tibial plafond fractures, which had been treated with this method, were retrospectively analysed. Quality of reduction was classified according to the Teeny & Wiss (TW) criteria. Clinical and functional assessment was carried out using the Ovadia & Beals (OB) and Olerud & Molander (OM) scores.

Results

All fractures were successfully united. The mean time in the fixator was 6.3 months, and the mean follow-up was 50 months after frame removal. There were no major infections. There was no significant relationship between TW and OM (r=-0.34, p=0.13), TW and OB (r=0.35, p=0.23), neither Delay (from injury until surgery) and OM (r=-0.03, p=0.28), and Delay and OB (r=0.30, p=0.31).

Conclusions

The present study demonstrates that the major problems of open reduction and internal fixation of pilon type III fractures can be avoided by a non-invasive approach to the treatment of these fractures. The articular surface can be reconstituted with olive-tip wires and small fragment washers, early ligamentotaxis and fracture stabilization with the Ilizarov ring fixator. These simple steps could lead safely to union and a good clinical and functional outcome.