ABSTRACT
Seventeen patients with 18 intra-articular pilon fractures associated with severe soft tissue swelling were managed by two-staged protocol of treatment. The first step composed of the reduction and stabilization of the fibular fracture, immediate calcaneal pin traction to maintain length and axial alignment, ice packing and elevation of the affected limb, blisters were left intact, nonsteroidal anti- inflammatory drugs and I.V. antibiotics. The second step was done 10-15 days post-trauma, which composed of open reduction, anatomical restoration of articular surface and stable internal fixation using low-profile plate screws. On the quantitative assessment by three scoring systems [clinical, anatomical and arthritis scores], there were 78% satisfactory results. The fractures healed at an average of 17.9 weeks. No patients had nonunion. There was a statistical significant effect of the type of fracture on the duration of healing and on the final results. All unsatisfactory results were among C3 and C2 fractures and non among the less comminuted fractures [AO classification]. The degree of soft tissue swelling significantly affected the final results. No unsatisfactory results among grade I soft tissue swelling was detected. The average follow up period was 25.5 months [14-42 months]. Delayed open reduction and internal fixation after the period of traction and soft tissue care gave satisfactory results for such severe intra-articular fractures