Minimally Invasive Percutaneous Anterolateral Plate Osteosynthesis for Distal Tibial Pilon Fracture

Abstract

Background: Distal tibia fracture surgery can be quite difficult and have a lot of problems. In order to successfully treat distal tibial fractures, soft tissue recovery is crucial. Because of the adequate soft tissue cover on the anterolateral distal tibia, the use of anterolateral plates is on an upward trend. The aim of the study is to assess the effectiveness and side effects of a minimally invasive anterolateral locking device in management of distal tibial Pilon fractures.

Methods: It was an observational prospective cohort research. After receiving the ethical permission for our study, we recruited and treated adult patients with distal tibial fractures of the AO 43C type who  were hospitalized to our level I trauma center between March 2022 and August 2023. Following surgery, every patient was monitored for  a minimum of 9 months. The mechanism of trauma, comorbidities, classifications, fracture-surgery interval, radiological exposure, surgery duration, complications, and the American Orthopedic Foot and Ankle Society (AOFAS) score were collected.

Results: The 25  patients were monitored for 9 to 18 months. The anatomic reduction was achieved in all cases. With the exception of one case, the  majority of incisions healed well without necrosis two weeks following surgery. The healing time for the fractures was between 12 and 18  weeks (on average, 13.71.2 weeks). In the meantime, period of 4.95 months (3e12 months), full weight bearing was permitted. In any  event, no significant local wound complication requiring revision surgery was observed. Five instances had minor problems, including  two cases of delayed union, one case of a muscle hernia, one case of a superficial infection, and one case of sensory disturbance over the  anterolateral foot. The average distance (6–8 cm) between the posterolateral and anteromedial incisions was 7 cm. At one year following  surgery, the AOFAS scores were excellent in 15 patients and good in 10 patients (average: 86.5 points, with excellent and good rates of  100%).

Conclusions: The anterolateral plating is a good one-step treatment for tibial pilon fractures. Using locking plates and minimally  invasive procedures can reduce issues with soft tissue and bone healing.