Title : External fixation (EXFIX) Vs. Calcaneal Pin Traction (CPT) in staged management of pilon fractures with low-grade soft tissue injury: A prospective comparative analysis
Abstract:
Background: Pilon fractures are high-energy injuries involving the distal tibial plafond and are often associated with significant soft tissue compromise. Staged management is essential, with initial temporising strategies aimed at protecting soft tissues prior to definitive fixation. While external fixation (ExFix) remains the standard temporising method, calcaneal pin traction (CPT) is frequently employed in resource-constrained environments. This study aims to compare clinical and functional outcomes between CPT and ExFix in managing pilon fractures with Tscherne grade 1/2 soft tissue injuries.
Methods: In this prospective comparative study, patients with closed pilon fractures were treated with either CPT or ExFix as the initial temporising measure. Baseline demographics, injury characteristics, and time to definitive fixation were recorded. Visual Analogue Scale (VAS) scores were assessed at 48 hours post-procedure to evaluate early pain control. Intraoperative reduction quality was assessed using the Burwell–Charnley criteria. Postoperative complications, including pin tract infections and non-union, were documented. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at six months. Statistical analysis was performed using STATA software.
Results: Patients in the ExFix group demonstrated lower mean VAS scores, indicating superior early pain relief (p<0.05). There was no statistically significant difference between the groups in time to definitive surgery or in the quality of articular reduction. At six months, AOFAS scores were comparable between the CPT and ExFix cohorts. The rates of complications, including superficial pin tract infections and non-union, were similar across both groups.
Conclusion: Both CPT and ExFix are effective temporising options for pilon fractures with low-grade soft tissue injury. Although ExFix offers superior early pain control, CPT is a clinically viable alternative, particularly in resource-limited settings.
Disclosure: The authors declare no conflicts of interest.
