Posterior Plating Versus Anterior to Posterior Screws in Fixation of Posterior Column in Pilon Fractures

Ain Shams University

Status: Completed

Conditions: Tibial Fractures

Treatments: Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia

Study type: Interventional

Funder types: Other

Identifiers

NCT05303389

M D 193 / 2020

Details and patient eligibility

About

Management of comminuted distal tibia fracture (pilon fracture) is still a challenging field. It is recently done guided by the new four column theory of distal tibia. Several approaches were advocated to address and fix each column. Fixation of posterior column is still a wide debate among orthopedic surgeons. This study is conducted to compare outcomes between two modalities for the management of posterior column fracture in pilon fractures.

Full description

The aim of this work is to assess and compare results of anterior to posterior screws versus posterior buttress plate in management of posterior column fracture in pilon fracture as regards functional, radiological outcomes and possible complications.

Optimal treatment of comminuted pilon fractures requires precise anatomical reduction. Several methods have been advocated to manage complex pilon fractures, but an optimal fixation technique remains controversial. On the basis of the anatomical characteristics of the ankle joint a four-column classification to guide the treatment of comminuted pilon fractures was proposed. The four-column classification can be summarized as follows: lateral column( the distal fibula), posterior column( the posterior part of the intermalleolus line with the distal tibial shaft), anterior column (the anterior part of the intermalleolus line with the distal tibial shaft) and medial column(the medial one-third of the tibial plafond with the distal tibial shaft).

A posterolateral incision is typically used to reduce and fix the posterior malleolar fragment to the tibial metaphysis which can be also done through the anterior incision using anterior to posterior screws.

Enrollment: 30 patients

Sex: All

Ages: 16+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Two, Three and four column pilon fracture

Exclusion criteria

• Pathological fractures.
• Pediatric age group with open physis.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 2 patient groups

Posterior plating group

Experimental group

Description:

Fix the posterior fragment using a buttress plate through a posterolateral approach by an interval between flexor hallucis longus and peroneii.

Treatment:

Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia

Anterior to posterior group

Active Comparator group

Description:

Fix the posterior fragment using anterior to posterior 4.0 mm cannulated screws under xray guidance.

Treatment:

Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia