Abstract

Samir Ben Salah58476*, Ayman Benabdellah58477, Issa Ali Eyal Slman58478, Adnane Lachkar58479, Hicham Yacoubi58480 and Najib Abdeljaouad58481

Background: Pilon fractures remain among the most frequent articular fractures, often secondary to a high-energy trauma, associated in the majority of cases with other bone lesions (fracture of the external malleolus and the dome of the talus). Thus, the soft tissue lining (thin and fragile) surrounding the distal leg may be open in open fractures or may be the site of suffering. the extent of which may vary in the case of a closed fracture, constituting in both cases a factor that will condition the choice of treatment, which must in all cases respect the state of the skin and not aggravate suffering that has already occurred.

Materials and methods: We present in this work our experience with a series of 57 cases admitted between 2013 and 2023 in our trauma department for the management of a pilon fracture, in which different therapeutic attitudes were adopted (minimally osteosynthesis, internal plate osteosynthesis, external osteosynthesis, orthopedic treatment). This period of 10 years allowed us to have a medium and long-term follow-up of our patients recorded on our own computerized medical record system.

Results: This study allowed us to open our minds to other surgical techniques, in particular minimal osteosynthesis for the management of pilon fractures. Indeed, this technique applied in 45.6% of our patients, allowed us to obtain very good results (84.5% of the fractures were consolidated after an average of 4 months). In terms of the quality of the bone reduction and the restoration of the articular surface, as well as in terms of function and complications (0% of material infection, 0% of skin necrosis and 0% of septic pseudarthrosis).

Conclusion: The condition of the skin opposite the tibial pilon, whether open or in pain, is an imperative condition for the choice of therapeutic method, which gives considerable value and place to minimally invasive osteosynthesis, especially when it allows intraoperative good bone reduction and good reconstruction of the articular surface.