Corrective Intra-articular Osteotomy for Malreductions of Tibial Pilon Fractures in Patients Less Than 55 Years Old

Research Type: Level 4 – Case series Introduction/Purpose: Tibial pilon malreductions are challenging to correctively reconstruct, and the relevant literature is limited. This study aims to assess whether corrective intra-articular osteotomy is worthwhile to treat relatively younger (< 55-year old) patients with intra-articular malreductions of pilon fractures. Methods: This is a retrospective observational study with a minimum follow-up of 2 years. From 2013 to 2021, 21 patients (mean age: 39.2±11.2 years) with intra-articular pilon malreductions ≥6weeks treated with intra-articular osteotomies were analyzed. The median interval time until intra-articular osteotomy was 76 (interquartile range [IQR], 49-149) days. Plain radiographs and computed tomography were used for radiographic assessments. Clinical outcomes were evaluated with visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36- Item Short-Form Health Survey (SF-36) score, and ankle range of motion (ROM). Results: The median follow-up duration was 34.6 (IQR, 26.1-74.3) months. The median articular displacement was reduced from 12.7mm preoperatively to 2.7mm postoperatively (P <.05). According to the Kellgren-Lawrence grading, 16 patients were assigned to stage II, 4 to stage III, and 4 to stage IV. In the 10 patients with available preoperative assessments, substantial improvement was found in the VAS score, from 5.90 to 2.0 at the final follow-up (P <.05). Similarly, the AOFAS ankle-hindfoot score and SF-36 scores improved (P <.05). Ankle ROM did not change a clinically meaningful amount. Progressive degenerative changes were noted in 2 of 10 patients where we had adequate preoperative imaging. Four patients had VAS scores ≥4 including 1 patient who is scheduled for an arthrodesis. Conclusion: In this small series, we found that the corrective osteotomies generally provided reasonable improvement at 3years in patients < 55 years old with intra-articular malreduction of pilon fractures. Prospective cohort studies are needed to determine if it is worthwhile in long-term outcome.