Skip to main content
Log in

Clinical outcome and changes in gait pattern after pilon fractures

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Axial burst fractures of the distal tibia are challenging to treat and often lead to restricted function of the lower limb. The purpose of this study was to investigate the clinical outcome and changes in gait pattern in such patients.

Methods

Thirty-five patients in a level 1 trauma centre were followed up clinically and by gait analysis. The American Orthopaedic Foot and Ankle Society (AOFAS), visual analogue scale (VAS) foot and ankle scale and Phillips scores were applied. Dynamic pedography (emed-M; Novel, Germany) with analyses of load, pressure and force-time integral were undertaken to investigate possible changes in gait pattern.

Results

Mean follow-up was 50 (19–100) months. Mean AOFAS, VAS foot and ankle and Phillips scores were 65, 63 and 55 points, respectively. There were clear correlations between fracture severity in the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and functional outcome in AOFAS (−0.63; p < 0.01), VAS foot and ankle scale (−0.56; p < 0.01) and Phillips (−0.64; p < 0.01) scores. There was a high correlation of 0.74 (p < 0.01) between the severity of the injury in the AO-classification and onset of post-traumatic arthrosis. Dynamic pedography revealed lesser load bearing for the total foot, medial foot, heel, first metatarsal and medial forefoot for the affected limb, and increased load bearing was seen in the lateral midfoot region.

Conclusions

Fractures of the tibial pilon lead to restricted function of the lower limb. Clinical outcome correlates with fracture severity in the AO classification, the onset of post-traumatic arthrosis and changes in gait patterns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bacon S, Smith WR, Morgan SJ, Hasenboehler E, Philips G, Williams A, Ziran BH, Stahel PF (2008) A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: Open reduction and internal fixation versus external Ilizarov fixation. Injury 39(2):196–202. doi:10.1016/j.injury.2007.09.003

    Article  PubMed  Google Scholar 

  2. Conroy J, Agarwal M, Giannoudis PV, Matthews SJ (2003) Early internal fixation and soft tissue cover of severe open tibial pilon fractures. Int Orthop 27(6):343–347. doi:10.1007/s00264-003-0486-1

    Article  PubMed  CAS  Google Scholar 

  3. Blauth M, Bastian L, Krettek C, Knop C, Evans S (2001) Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 15(3):153–160

    Article  PubMed  CAS  Google Scholar 

  4. Patterson MJ, Cole JD (1999) Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 13(2):85–91

    Article  PubMed  CAS  Google Scholar 

  5. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr (2004) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18(8 Suppl):S32–S38

    Article  PubMed  Google Scholar 

  6. Tong D, Ji F, Zhang H, Ding W, Wang Y, Cheng P, Liu H, Cai X (2012) Two-stage procedure protocol for minimally invasive plate osteosynthesis technique in the treatment of the complex pilon fracture. Int Orthop 36(4):833–837. doi:10.1007/s00264-011-1434-0

    Article  PubMed  Google Scholar 

  7. Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF (2003) Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am 85-A(10):1893–1900

    PubMed  Google Scholar 

  8. Topliss CJ, Jackson M, Atkins RM (2005) Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br 87(5):692–697. doi:10.1302/0301-620X.87B5.15982

    Article  PubMed  CAS  Google Scholar 

  9. Marsh JL, Weigel DP, Dirschl DR (2003) Tibial plafond fractures. How do these ankles function over time? J Bone Joint Surg Am 85-A(2):287–295

    PubMed  Google Scholar 

  10. Muller ME NS, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones

  11. Richter MZS, Geerling J, Frink M, Knobloch K, Krettek C (2006) A new foot and ankle outcome score: Questionnaire based, subjective, Visual-Analogue-Scale, validated and computerized. Foot Ankle Surg 12:191–199

    Article  Google Scholar 

  12. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353

    PubMed  CAS  Google Scholar 

  13. Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, Laros GS (1985) A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am 67(1):67–78

    PubMed  CAS  Google Scholar 

  14. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502

    Article  PubMed  CAS  Google Scholar 

  15. Rüedi TP, Allgöwer M (1969) Fractures of the lower end of the tibia into the ankle joint. Injury 2:92–99

    Article  Google Scholar 

  16. Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, Mainard D, Vix N, Dehoux E (2010) Distal tibia fractures: management and complications of 101 cases. Int Orthop 34(4):583–588. doi:10.1007/s00264-009-0832-z

    Article  PubMed  Google Scholar 

  17. Lau TW, Leung F, Chan CF, Chow SP (2008) Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop 32(5):697–703. doi:10.1007/s00264-007-0384-z

    Article  PubMed  CAS  Google Scholar 

  18. Chen SH, Wu PH, Lee YS (2007) Long-term results of pilon fractures. Arch Orthop Trauma Surg 127(1):55–60. doi:10.1007/s00402-006-0225-3

    Article  PubMed  Google Scholar 

  19. Ketz J, Sanders R (2012) Staged posterior tibial plating for the treatment of Orthopaedic Trauma Association 43C2 and 43C3 tibial pilon fractures. J Orthop Trauma 26(6):341–347. doi:10.1097/BOT.0b013e318225881a

    Article  PubMed  Google Scholar 

  20. Kiene J, Herzog J, Jurgens C, Paech A (2012) Multifragmentary tibial pilon fractures: midterm results after osteosynthesis with external fixation and multiple lag screws. Open Orthop J 6:419–423. doi:10.2174/1874325001206010419

    Article  PubMed  Google Scholar 

  21. Leung F, Kwok HY, Pun TS, Chow SP (2004) Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures. Injury 35(3):278–283

    Article  PubMed  Google Scholar 

  22. Teeny SM, Wiss DA (1993) Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 292:108–117

    PubMed  Google Scholar 

  23. Egol KA, Wolinsky P, Koval KJ (2000) Open reduction and internal fixation of tibial pilon fractures. Foot Ankle Clin 5(4):873–885

    PubMed  CAS  Google Scholar 

  24. Horisberger M, Hintermann B, Valderrabano V (2009) Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis. Clin Biomech (Bristol, Avon) 24(3):303–307. doi:10.1016/j.clinbiomech.2008.12.005

    Article  Google Scholar 

  25. Hirschmuller A, Konstantinidis L, Baur H, Muller S, Mehlhorn A, Kontermann J, Grosse U, Sudkamp NP, Helwig P (2011) Do changes in dynamic plantar pressure distribution, strength capacity and postural control after intra-articular calcaneal fracture correlate with clinical and radiological outcome? Injury 42(10):1135–1143. doi:10.1016/j.injury.2010.09.040

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Dr. Sabine Karl of the Institute of Mathematics at the University of Wuerzburg for her help and advice on statistics.

Conflict of interest statement

The study was conducted in compliance with the current laws applying in Germany. None of the authors has any conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hendrik Jansen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jansen, H., Fenwick, A., Doht, S. et al. Clinical outcome and changes in gait pattern after pilon fractures. International Orthopaedics (SICOT) 37, 51–58 (2013). https://doi.org/10.1007/s00264-012-1716-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-012-1716-1

Keywords

Navigation