Ilizarov versus ORIF for Open AO Type-C Pilon Fractures

Objective: This study aimed to evaluate the clinical effectiveness of ORIF versus Ilizarov for the management of Type C closed pilon fractures of the distal tibia at 12 months follow up. Methods: This retrospective cross sectional study was conducted at Jinnah Postgraduate Medical Center (JPMC) between 29th May 2015 and 27th November 2019 that included patients 18 years and older diagnosed with open AO type C pilon fractures. The primary outcome was the patient-reported Disability Rating Index (DRI) months. While the secondary outcomes were quality of life assessment using the patient satisfaction form (SF-12) and AOFAS-Ankle Hindfoot Score. Radiographs were assessed for fracture healing, time to healing, and malalignment. Results: Fifteen patients underwent ORIF, while 26 patients were treated with Ilizarov, there was no statistically significant difference in DRI scores at 12 months between the two groups. In terms of clinical outcomes, both groups had comparable results throughout the follow-up period. The number of unplanned surgical procedures was not statistically significant (p=0.73), 26.92% (n=7) in the Ilizarov as compared to 33.33% (n=5) in the ORIF group. Conclusion: Among patients with an acute, displaced, intra-articular fracture of the distal tibia, neither external fixation nor locking plate fixation resulted in superior disability status at 12 months. Patient factors may need to be considered in deciding the optimal approach. (author)