• Olivier Borens, Peter Kloen, Jeffrey Richmond, Goetz Roederer, David S Levine, and David L Helfet.
• The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
• Arch Orthop Trauma Surg. 2009 May 1;129(5):649-59.

ObjectiveTo determine the results of "biologic fixation" with a minimally invasive plating technique using a newly designed low profile "Scallop" plate in the treatment of pilon fractures.DesignRetrospective case series.SettingA tertiary referral center.Patients/ParticipantsSeventeen patients were treated between 1999 and 2001 for a tibial plafond fracture at the Hospital for Special Surgery with a newly designed low-profile plate. Eleven of the fractures (65%) were high-energy injuries. Two fractures were open.InterventionStaged surgical treatment with open reduction and fixation of the fibular fracture and application of an external fixator was performed in 12 cases. As soon as the soft tissues and swelling allowed, i.e. skin wrinkling, the articular surface was reconstructed and simply reduced, if necessary through an small incision, and the articular block was fixed to the diaphysis using a medially placed, percutaneously introduced flat scallop plate. In the remaining five cases the operation was performed in one session.Main Outcome MeasurementsTime to healing and complications including delayed union, non-union, instrument failure, loss of fixation, infection, quality of reduction and number of reoperations were evaluated. Quality of results and outcome were graded using the ankle-hindfoot-scale and a modified rating system.ResultsAll patients went on to bony union at an average time of 14 weeks. There were no plate failures or loss of fixation/reduction. Two superficial wound-healing problems resolved with local wound care. At an average follow up of 17 months (range 6-29 months) eight patients (47%) had an excellent result; seven (41%) had a fair result whereas two (12%) had a poor result. The average ankle-hindfoot-score was 86.1 (range 61-100). Four patients have had the hardware removed and one of them is awaiting an ankle arthrodesis.ConclusionsBased on these initial results, it appears that a minimally invasive surgical technique including new low profile plate can decrease soft tissue problems while leading to fracture healing and obtaining results comparable with other more recent series. We believe that this new "Scallop Plate" is effective for the treatment of pilon fractures and should be used in conjunction with a staged procedure in the acute trauma setting.

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