Therapeutic strategy in pilon fractures type C2 and C3: soft tissue damage changes treatment protocol.

The medical charts of 28 patients with type C2 and C3 fractures of the pilon tibial, who were operated between 1980 and 1990, were reviewed. All patients were evaluated clinically and radiologically after a mean time of 50 months. In 17 patients (60,7%) the pilon fracture was combined with severe soft tissue damage. In half of the cases (50%), a plate osteosynthesis was carried out. In six patients (21,4%) one or more reinterventions on the soft tissues were necessary, in eight patients (28,5%) one or more reinterventions on the bone. Eighteen patients (64,2%) had an excellent or good subjective end result in accordance to Ovadia and 15 patients (53,5%) an excellent or good objective end result. The high amount of secondary procedures in patients, treated primarily with plate and screw osteosynthesis, indicates that the standard protocol has to be changed in case of complex pilon fractures and severe soft tissue damage. We can avoid soft tissue problems with a step-wise reconstruction of the pilon: primarily a bridging external fixator and secondarily an internal fixation, when the situation of the soft tissues is stable.