Functional outcome in closed Type C Tibial Pilon Fracture Fixed with Hybrid External Fixator-An Observational Prospective Study

Background: Tibial pilon fractures are complex intra-articular injuries of the distal tibial plafond commonly associated with severe comminution and soft-tissue compromise. Hybrid external fixation provides stable fracture fixation while minimizing additional soft-tissue injury. The objective is to evaluate the functional outcome of closed AO type C tibial pilon fractures treated with hybrid external fixation using the AOFAS ankle–hindfoot score. Material and Methods: This prospective observational study included 20 patients with closed AO type C tibial pilon fractures treated with hybrid external fixation at Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru. Patients were followed for 12 months. Functional outcome was assessed using the AOFAS score at 3, 6, and 12 months. Fracture subtype, fibular fixation, union, and complications were also evaluated. Results: The mean AOFAS score improved from 43.10 ± 5.05 at 3 months to 65.05 ± 7.64 at 6 months and 81.25 ± 9.45 at 12 months, showing significant improvement over time (p<0.001). At final follow-up, 20% of patients had excellent, 40% good, 25% fair, and 15% poor outcomes, with 60% achieving good-to-excellent results. Mean AOFAS scores differed significantly among AO C1, C2, and C3 fracture subtypes (F=7.254, p=0.005), with better functional outcomes observed in C1 fractures and poorer outcomes in the more complex C3 fractures. Pin-tract infection occurred in 20% of patients and delayed union in 10%, while no non-union was observed. Conclusion: Hybrid external fixation provided satisfactory functional outcomes and reliable union in closed AO type C tibial pilon fractures while minimizing extensive soft-tissue dissection. Functional outcome was significantly influenced by fracture severity, with more complex C3 fractures demonstrating comparatively poorer results.

Keywords: Tibial pilon fracture, AO type C, hybrid external fixation, AOFAS score, external fixator, functional outcome.