Outcome Following Open Reduction and Internal Fixation of Open Pilon Fractures

Abstract

Open reduction and internal fixation of open pilon fractures was accomplished with an acceptable outcome and a low prevalence of soft-tissue complications. We believe these results can be reproduced through routine use of an individualized treatment algorithm including the use of staged procedures, meticulous soft-tissue management, liberal use of temporizing external fixation, and a patient-specific approach to fixation and soft-tissue coverage.

Course of treatment and rate of successful salvage following the diagnosis of deep infection in patients treated for pilon fractures (AO/OTA: 43)

“…4,6,12 We believe this is related in some part, to the large percentage of open fractures in our population (over 30 of the 57 infections were open fractures and 142 of 355 (40%) identified in the general cohort) compared to most of the previously published literature (38.7%, 4 22%, 5 and 20% 12 ). Additionally, the high incidence of 43C fractures (37/47, 78.7%) may also be a contributing factor for such a hig.…”

“…1e3 The thin soft tissue envelope surrounding the ankle is susceptible to disruption with violent injury, resulting in open fracture wounds that commonly require secondary coverage procedures. 4,5 Even when not associated with open wounds, the closed soft tissue injury is often severe enough to alter surgical treatment in a variety of ways. The combination of these factors, in addition to the frequently seen osteoarticular comminution and tenuous vascular status, both chronic and acute, make pilon fractures some of the most complex injuries treated by orthopedic surgeons.…”

The mid-term results of treatment for tibial pilon fractures

“…However, the most commonly used method is the ORIF approach. [2,[4][5][6] External fixation of intraarticular fractures relies on distraction. [2] In the literature up to 1969, good results for pilon fractures were achieved in fewer than 50%.…”

Risk factors of deep infection in operatively treated pilon fractures (AO/OTA: 43)

“…1e3 The thin soft tissue envelope surrounding the ankle is susceptible to disruption with violent injury, and resultant open fracture wounds commonly require secondary coverage procedures. 4,5 Even when not associated with open wounds, the closed soft tissue injury is often severe enough to alter surgical treatment in a variety of ways. 6 The combination of these soft tissue injuries, and the frequently seen osteoarticular comminution make surgical treatment complex, with long term morbidity remaining high.…”