Pilon-tibial-Frakturen: Behandlung, Komplikationen und Ergebnisse Nachuntersuchungen von Patienten der Klinik für Unfallchirurgie der Philipps-Universität Marburg unter besonderer Berücksichtigung von zwei unterschiedlichen Operationsverfahren

The importance of “biological” osteoynthesis in the treatment of pilon tibial fractures was investigated considering the generally bad prognosis of this kind of fracture. It was evaluated whether special surgical techniques allow to improve the result and whether indirect fracture reduction makes a difference compared to open reduction and anatomic restoration of the joint. Between 1985 – 1991, 54 patients were admitted to the University Hospital of Marburg with pilon tibial fractures . In 40 fractures an open reduction with a conventional AO technique was applied. In 12 further fractures the “biological” technique was used. Fourty one (41)% of all patients had severely damaged soft tissues. The fractures were classified according to the ABC-system of the AO from 1991. Fourty seven (47) fractures were examined for complications and result of treatment 12 to 86 months after surgery. Non of the fractures treated by “biological” technique developed complications of bone healing in contrast to 40% of the conventionally treated fractures. These differences were statistically significant for avascular bone necrosis (p = 0,041) and the total of bone complications (p = 0,021). Comparing both groups of treatment the group of “biological” technique resulted in significantly better outcomes in all sections of the examination (for the total result p = 0,006). With regard to fracture severeness there were no significant differences between both treatment groups. The study shows that complications in fracture healing have a main influence on the later outcome.