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

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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Tibial Fractures

Intervention / Treatment
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* Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Two, Three and four column pilon fracture Exclusion Criteria: Pathological fractures. Pediatric age group with open physis.

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Posterior plating group<br>Fix the posterior fragment using a buttress plate through a posterolateral approach by an interval between flexor hallucis longus and peroneii. | Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia<br>* anterior to posterior screws in classic arm and posterolateral approach in new arm group<br>|
| Active Comparator: Anterior to posterior group<br>Fix the posterior fragment using anterior to posterior 4.0 mm cannulated screws under xray guidance. | Procedure: Fixation of 2,3 or 4 column pilon fracture of the tibia<br>* anterior to posterior screws in classic arm and posterolateral approach in new arm group<br>|

What is the study measuring?
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Primary Outcome Measures

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