{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:13:23Z","timestamp":1783509203284,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,1]]},"abstract":"<jats:title\/>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The treatment of pilon tibia fractures is challenging. Anatomical reduction of the joint surface is essential. Excessive soft-tissue dissection may interfere with the blood supply and can result in nonunion. We sought to compare the outcomes of distal tibia fractures treated with medial locking plates versus circular external fixators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively evaluated 41 consecutive patients with closed pilon tibia fractures treated with either minimally invasive locking plate osteosynthesis (n = 21) or external fixation (EF) (n = 20). According to the Ruedi and Allgower classification, 23 fractures were type B and 18 were type C. Soft-tissue injury was evaluated according to the Oestern and Tscherne classification. Time to fracture union, complications, and functional outcomes were assessed annually for 3 years with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Mean \u00b1 SD values in the plate group were as follows: age, 42.4 \u00b1 14 years; union time, 19.4 \u00b1 2.89 weeks (range, 12\u201326 weeks); and AOFAS ankle scores, 86.4 \u00b1 2.06, 79.5 \u00b1 1.03, and 77.9 \u00b1 0.80 at 1, 2, and 3 years, respectively. Four patients in the plate group needed secondary bone grafting during follow-up. In the EF group (mean \u00b1 SD age, 40.7 \u00b1 12.3 years), all of the patients achieved union without secondary bone grafting at a mean \u00b1 SD of 22.1 \u00b1 1.7 weeks (range, 18\u201324 weeks). In the EF group, mean \u00b1 SD AOFAS ankle scores were 86.6 \u00b1 1.69, 82.1 \u00b1 0.77, and 79.7 \u00b1 1.06 at 1, 2, and 3 years, respectively. There were no major complications. However, there were soft-tissue infections over the medial malleolus in five patients in the plate group and grade 1-2 pin-tract infections in 13 patients and grade 3 pin-tract infections in one patient in the EF group. Post-traumatic arthritis was detected in eight plate group patients and seven EF group patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Minimally invasive plating and circular EF methods have favorable union rates with fewer complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/14-120","type":"journal-article","created":{"date-parts":[[2017,3,8]],"date-time":"2017-03-08T10:26:16Z","timestamp":1488968776000},"page":"3-10","source":"Crossref","is-referenced-by-count":5,"title":["Mid-Term Results of Minimally Invasive Plate Osteosynthesis and Circular External Fixation in the Treatment of Complex Distal Tibia Fractures"],"prefix":"10.3390","volume":"107","author":[{"given":"Yunus","family":"Imren","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Uskudar State Hospital, Istanbul, Turkey. Dr. Imren is now with the Department of Orthopaedics and Traumatology, Okmeydani Training and Research Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engin Eren","family":"Desteli","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Uskudar State Hospital, Istanbul, Turkey. Dr. Imren is now with the Department of Orthopaedics and Traumatology, Okmeydani Training and Research Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Erdil","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan H\u00fcseyin","family":"Ceylan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, L\u00fctfiye Nuri Burat State Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Tuncay","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cengiz","family":"Sen","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"ref181","first-page":"2","article-title":"Distale femurfraktturen: transartikulare rekonstruktion, perkutane plattenosteosynthese und retrograde nagelung","volume":"99","author":"Krettek","year":"1996","journal-title":"Unfallchirurg"},{"key":"ref311","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-642-69499-8_1","article-title":"\u201cPathophysiology and Classification of Soft Tissue Injuries Associated with Fractures,\u201d","author":"Oestern","year":"1984","journal-title":"Fractures with Soft Tissue Injuries"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/01.TA.0000051934.96670.37","article-title":"The death of articular chondrocytes after intra articular fracture in humans","volume":"56","author":"Murray","year":"2004","journal-title":"J 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the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation","volume":"39","author":"Bacon","year":"2008","journal-title":"Injury"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.injury.2010.04.006","article-title":"Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature","volume":"42","author":"Stufkens","year":"2011","journal-title":"Injury"},{"key":"ref251","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.injury.2010.04.006","article-title":"Long-term outcome after 1822 operatively treated ankle fractures: a systematic review of the literature","volume":"42","author":"Stufkens","year":"2011","journal-title":"Injury"},{"key":"ref441","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/00003086-200006000-00010","article-title":"Pilon fractures: treatment protocol based on severity of soft tissue injury","volume":"375","author":"Watson","year":"2000","journal-title":"Clin Orthop"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S1048-6666(01)80007-0","article-title":"Minimaly invasive fixation of tibial pilon fractures","volume":"11","author":"Probe","year":"2001","journal-title":"Oper Tech Orthop"},{"key":"ref291","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1053\/j.jfas.2008.02.013","article-title":"Tibial pilon fracture repair using Ilizarov external fixation, capsuloligamentotaxis, and early rehabilitation of the ankle","volume":"47","author":"Bozkurt","year":"2008","journal-title":"J Foot Ankle Surg"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1749-799X-4-35","article-title":"Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia","volume":"4","author":"Vasiliadis","year":"2009","journal-title":"J Orthop Surg Res"},{"key":"ref261","first-page":"81","article-title":"Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature","volume":"72","author":"Ahmad","year":"2012","journal-title":"J Trauma"},{"key":"ref351","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/00005131-200103000-00002","article-title":"Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques","volume":"15","author":"Blauth","year":"2001","journal-title":"J Orthop Trauma"},{"key":"ref281","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/BTO.0b013e318149fc3e","article-title":"Percutaneous fixation of distal tibial fractures using locking plates","volume":"22","author":"Shanmugam","year":"2007","journal-title":"Tech Orthop"},{"key":"ref231","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00264-005-0038-y","article-title":"Ilizarov treatment of complex tibial pilon fractures","volume":"30","author":"Vidyadhara","year":"2006","journal-title":"Int Orthop"},{"key":"ref201","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.2106\/00004623-199611000-00003","article-title":"Operative treatment of fractures of the tibial plafond: a randomized, prospective study","volume":"78","author":"Wyrsch","year":"1996","journal-title":"J Bone Joint Surg Am"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/S0020-1383(03)00172-4","article-title":"Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures","volume":"35","author":"Leung","year":"2004","journal-title":"Injury"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.injury.2007.07.024","article-title":"An update on the management of high-energy pilon 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method","volume":"6","author":"Israelite","year":"1996","journal-title":"Oper Tech Orthop"},{"key":"ref381","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/S1048-6666(01)80007-0","article-title":"Minimaly invasive fixation of tibial pilon fractures","volume":"11","author":"Probe","year":"2001","journal-title":"Oper Tech Orthop"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00264-005-0038-y","article-title":"Ilizarov treatment of complex tibial pilon fractures","volume":"30","author":"Vidyadhara","year":"2006","journal-title":"Int Orthop"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/j.injury.2010.08.041","article-title":"Tibial pilon fractures: which method of treatment?","volume":"41","author":"Calori","year":"2010","journal-title":"Injury"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1007\/s00264-008-0629-5","article-title":"Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia","volume":"33","author":"Leonard","year":"2009","journal-title":"Int Orthop"},{"key":"ref41","first-page":"148","article-title":"Percutaneous plate fixation of fractures of the distal tibia","volume":"70","author":"Francois","year":"2004","journal-title":"Acta Orthop Belg"},{"key":"ref421","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00003086-199604000-00028","article-title":"Ilizarov treatment of pilon fractures","volume":"325","author":"McDonald","year":"1996","journal-title":"Clin Orthop Relat Res"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/BTO.0b013e318149fc3e","article-title":"Percutaneous fixation of distal tibial fractures using locking plates","volume":"22","author":"Shanmugam","year":"2007","journal-title":"Tech Orthop"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/00003086-199604000-00028","article-title":"Ilizarov treatment of 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