Surgical tactics for distal tibial fractures. Literature review

Background. Fractures of the distal tibial epimetaphysis (pilon fracture) account for 5–7 % of all tibial fractures and 10–15 % of all lower extremity bone fractures. The percentage of treatment failure in pilon fractures remains high and reaches 38–40 %. An important factor causing this is the lack of algorithms, accepted treatment protocols, and a system for predicting the effects of therapy. Purpose of the study: to analyze the features of modern surgical tactics in case of distal tibia fractures, to identify controversial and unresolved issues, to outline the possible reasons for a significant number of poor treatment outcomes, as well as to outline ways to improve them. Materials and methods. A review of 878 publications in the PubMed database over the past 15 years was conducted. 210 publications were selected and analyzed. The methods of analytical and descriptive statistics are applied. Results. Among the most debatable issues in the literature regarding which there is no consensus or a generally accepted approach that has evidence and justified tactics, the following should be highlighted: the choice of the time of surgical intervention; selection of method and means of fixation; rational tactics for osteosynthesis conversion; necessity and significance of fibula restoration during the treatment of pilon fractures; the importance of osteoplasty and the priority of restoring tibial anatomy according to the “column” principle; the place of primary arthrodesis in the surgical treatment for pilon fractures. Conclusions. These issues require further research with the development of new substantiated algorithmized treatment protocols based on a sufficient evidence base and a system for predicting the outcomes.