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

NCT ID: NCT05303389

Last Updated: 2022-03-31

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-11-01
• Study Completion Date: 2022-03-01

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.

Conditions

Tibial Fractures

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Posterior plating group

Fix the posterior fragment using a buttress plate through a posterolateral approach by an interval between flexor hallucis longus and peroneii.

Group Type: EXPERIMENTAL

Fixation of 2,3 or 4 column pilon fracture of the tibia

Intervention Type: PROCEDURE

anterior to posterior screws in classic arm and posterolateral approach in new arm group

Anterior to posterior group

Fix the posterior fragment using anterior to posterior 4.0 mm cannulated screws under xray guidance.

Group Type: ACTIVE_COMPARATOR

Fixation of 2,3 or 4 column pilon fracture of the tibia

Intervention Type: PROCEDURE

anterior to posterior screws in classic arm and posterolateral approach in new arm group

Interventions

Fixation of 2,3 or 4 column pilon fracture of the tibia

anterior to posterior screws in classic arm and posterolateral approach in new arm group

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Two, Three and four column pilon fracture

Exclusion Criteria

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

• Minimum Eligible Age: 16 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Ain Shams University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Tamer Fayyad, MD

Role: PRINCIPAL_INVESTIGATOR

Ain Shams University

Locations

Ain Shams University

Cairo, , Egypt

Countries

Egypt

References

Baraka MM, Fayyad TA, Thakeb MF, Lamei MA, Al Kersh MA. Posterior Plating Versus Anterior to Posterior Screws in Fixation of Posterior Column in Pilon Fractures. J Orthop Trauma. 2025 Jun 1;39(6):288-295. doi: 10.1097/BOT.0000000000002966.

Reference Type: DERIVED

PMID: 39976678 (View on PubMed)

Other Identifiers

M D 193 / 2020

Identifier Type: -

Identifier Source: org_study_id