Comparison Of Early And Delayed Open Reduction And Internal Fixation In The Treatment Of Closed Tibial Pilon Fractures

Objective: The aim of this study was to compare the Clinical efficacy of early with delayed open reduction and internal fixation(ORIF)for treating closed type C pilon fractures.Methods: A retrospective study was performed on 46 patients with closed type C pilon fractures in the Department of orthopedics of the First Affiliated Hospital of Fujian Medical University since 2010,that matched according to age,gender,soft tissue condition and fracture pattern.According to the Operation timing,46 patients were divided into group A(early group: underwent surgery within 36 hours of the injury)and group B(delayed group: underwent surgery between 10 days and 3 weeks of the injury).In the delayed group,9 patients were treated first by temporary external fixation.All the closed fractures were managed by ORIF with locking plates.At follow-up,the clinical and radiographic results were retrospectively analyzed.The mean follow-up time was 25.09 ± 3.40 months(range,14 to 48 months)in group A and 26.30 ± 2.49 months(range,15 to 44 months)in group B.Results: There was no significant difference(P > 0.05)between the 2 groups regarding the rate of soft tissue complication(13% vs 26.1%,P=0.459 > 0.05),the rate of fracture union(86.9% vs 82.6%,P=0.681 > 0.05),and the final functional score(86.57 ±6.60 vs 85.96 ±8.60,P=0.737 > 0.05).The patients in group A had a significantly shorter mean time to fracture union(21.00 ± 2.66 weeks vs 23.48 ± 2.27 weeks,P < 0.05),operating time(82.09 ± 5.93 months vs 96.69 ± 9.19 months,P < 0.01),and hospital stay(9.47 ± 2.15 days vs 15.70 ± 2.30 days,P < 0.01).There was significant difference(P > 0.05)Conclusion: If soft tissue conditions are acceptable,early ORIF for treating closed type C pilon fractures can be safe and effective,with similar rates of wound complication,fracture union,and final good functional recovery but shorter operative time,union time,and hospital stay.These results favorably compare with delayed ORIF treatment.