[Long-term results after conservative and surgical treatment of fractures of the distal end of the tibia].

This is a clinical and radiological follow-up on 78 patients with 84 Pilon tibial-fractures which were treated in our hospital between 1970-82. The fractures were arranged in three types after the classification of Rüedi, Matter, Allgöwer. 49 conservatively treated fractures were compared with 35 cases operated upon. The radiological follow-up focussed on posttraumatic development of arthrosis, the mobility of the ankle as well as on the posttraumatic result of reduction. The patient's own assessment concerning the result was found out by means of a questionnaire. The comparison of the fracture type I and II showed almost the same development of arthrosis after conservative and operative treatment, but the operated fractures of type III resulted in 33% in heavy arthrosis, whereas the cases treated conservatively showed heavy arthrosis in 50%. A close correlation exists between the quality of operative reduction and the development of arthrosis. A postoperative incongruity of the articular surface is followed by heavier arthrosis than a comparable incongruity after conservative treatment. An indication of an open reduction is given only if anatomical reconstruction can be predicted.