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

Not Applicable

Completed

• Conditions: Tibial Fractures
• Interventions: Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia

• Registration Number: NCT05303389
• Lead Sponsor: Ain Shams University

Brief Summary

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.

Detailed 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.

Study Timeline

• Study Start: 2020-11-01
• Primary Completion: 2021-11-30
• Status Verified: 2022-03
• Study Completion: 2022-03-01
• Study First Submitted: 2022-03-10
• Study First Submitted QC: 2022-03-21
• Last Update Submitted: 2022-03-21
• Study First Posted: 2022-03-31
• Last Update Posted: 2022-03-31

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 30

Inclusion Criteria

• Two, Three and four column pilon fracture

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Exclusion Criteria

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

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Posterior plating group	Fixation of 2,3 or 4 column pilon fracture of the tibia	Fix the posterior fragment using a buttress plate through a posterolateral approach by an interval between flexor hallucis longus and peroneii.
Anterior to posterior group	Fixation of 2,3 or 4 column pilon fracture of the tibia	Fix the posterior fragment using anterior to posterior 4.0 mm cannulated screws under xray guidance.

Primary Outcome Measures

Name	Time	Method
The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system	up to one year	A system measuring function, alignment and pain in the operated ankle. The score maximum is 100 points, where a higher score indicates better recovery .

Trial Locations

Locations (1)

Ain Shams University; 🇪🇬 Cairo, Egypt