Different modifications of minimally invasive osteosynthesis in pilon fractures: comparative study results

Background. Minimally invasive surgical techniques can reduce the degree of surgical injury during osteosynthesis in peri- and intraarticular pilon fractures. However, these techniques do not always achieve anatomical reduction of the articular component and stable fixation of all columns of the distal tibia. Aim of the study — to test the hypothesis regarding the clinical advantages of multicolumn fixation for comminuted pilon fractures over traditional single-column fixation. Methods. The study enrolled 55 patients with extra- and intraarticular fractures of the distal tibia and fibula, all of whom underwent minimally invasive osteosynthesis. Patients were divided into two groups based on the number of fixed columns. These groups were comparable in terms of gender and age. The first group consisted of 28 patients who underwent osteosynthesis with one anatomically precontoured plate. The second group consisted of 27 patients who underwent osteosynthesis with two or more plates placed on different tibial columns. The quality of bone fragment reduction was analyzed using control X-rays performed the day after the operation. Functional outcomes were evaluated according to the AOFAS scale at 6 and 12 months post-operation. The incidence of early and delayed complications of osteosynthesis was also determined. Results. No statistically significant difference was found between the two study groups in terms of quality of reduction (p = 0.23). The median functional outcome score in the first group at 6 months was 63 points [IQR 50.00-73.00] and at 12 months was 74 points [IQR 65.00-83.25]. In the second group, the median scores were 75 points [IQR 67.50-81.00] and 85 points [IQR 71.00-94.50], respectively. Multicolumn fixation of the pilon fracture resulted in statistically significantly higher functional outcome scores at both follow-up periods: at 6 months (p = 0.015) and at 12 months (p = 0.028). The probability of complications in the first group was 4.4 times higher than in the second group: OR = 4.444 (95% CI 1.066-18.528). Conclusion. Multicolumn fixation of complete periarticular and intraarticular pilon fractures leads to better functional results compared to single-column fixation. It also reduces the risk of complications due to increased stability of the fragment fixation and the resistance of the implant-bone system to physiological stress.