J Korean Foot Ankle Soc.  2020 Jun;24(2):81-86. 10.14193/jkfas.2020.24.2.81.

Efficacy of Temporal Fixation Using Threaded Trans-Calcaneal Pin in Patients with Ankle Fracture-Dislocation or Tibia Pilon Fractures

• Park DH
• Gwak HC
• Kim JH
• Lee CR
• Kwon YU
• Choo HJ
• Park CS

• KMID: 2502914
• DOI: http://doi.org/10.14193/jkfas.2020.24.2.81

Abstract

Purpose
Ankle fractures with dislocations and pilon fractures at the distal tibia are usually associated with soft tissue damage caused by high-energy damage. Recently, a two-stage operation to perform internal fixation after the application of external fixation devices for stabilizing soft tissues has been accepted as the treatment of choice. This paper reports the clinical result of these injuries treated with threaded trans-calcaneal pin external fixation devices.
Materials and Methods
Thirty-three patients diagnosed with ankle fractures with dislocations or tibial pilon fractures without open wounds. They underwent surgical treatment with threaded trans-calcaneal pin external fixation from January 2008 to February were enrolled in this study. This study evaluated the visual analogue scale (VAS), foot function index (FFI), and Olerud & Molander score as well as whether complications occurred.
Results
The average VAS showed a meaningful decrease (p<0.001) from 7.4 before surgery to 2.6 after application of the external fixation device, and 1.4 at 12 months after surgery. The FFI also decreased significantly from 84.3 preoperatively to 20.3 at 12 months postoperatively (p<0.001). The Olerud & Molander score averaged 71.4 points, showing good clinical results. Complete bone union was observed in all patients. One patient each underwent debridement due to wound necrosis and infection in the pin insertion site. At the final follow-up, seven patients had posttraumatic ankle joint arthritis, according to a radiological examination.
Conclusion
Manual reduction and external fixation using a threaded trans-calcaneal pin is a suitable surgical technique that is easy to perform and shows good clinical outcomes in stabilizing soft tissue damage in fractures and dislocations of ankle fracture or tibia pilon fractures in foot and ankle injury.

Keyword

External fixation; Mono fixator; Ankle injury; Calcaneal pin

Figure

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  Figure. 1 Pin insertion site at calcaneus (dot).

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  Figure. 2 (A, B) Clinical photo after external fixator application.

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  Figure. 3 Centrally treaded pin inserted to calcaneus.

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  Figure. 4 Preoperative X-ray of ankle; anteroposterior (A) and lateral (B) view.

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  Figure. 5 Postoperative X-ray of external fixator applied state; anteroposterior (A) and lateral (B) view.

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  Figure. 6 Ankle anteroposterior (A) and lateral (B) X-ray after conversion operation.

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