Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures

Beckwitt, Colin H.; Monaco, Spencer J.; Gruen, Gary S.

doi:10.1177/2473011418780437

Cited by 8 publications

(9 citation statements)

References 28 publications

(23 reference statements)

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“…In these articles, the outcomes were reported as the total number of the complication of interest for 1 treatment group compared with another treatment group, but without distinction as to whether the complication occurred in AO 43-C1 or AO 43-C3 injury or the status of the skin at the time of injury. The remaining 13, with 8 articles reporting a staged approach [3,15,[24][25][26][27][28][29] and 5 articles pertaining to primary arthrodesis [8,[20][21][22][23] were evaluated and analyzed. The 13 studies examined in this review included 377 total fractures, 228 of which involved AO 43-C3 pilon fractures.…”

Section: Resultsmentioning

confidence: 99%

“…None of the 13 studies examined all the assessed variables in this review. Only one of the studies was a comparative study [23], the rest were case series.…”

Section: Resultsmentioning

confidence: 99%

“…The authors classified treatment groups in the included studies according to the use of fusion procedures. Five studies [8,[20][21][22][23] used fusion procedures, 8 studies used other types of treatment [3,15,[24][25][26][27][28][29] (Table 1). Weighted analysis, using sample sizes reported in each article, was used to compare these 2 patient groups on key indices.…”

Section: Discussionmentioning

confidence: 99%

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Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

et al. 2021

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Background Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries. Methods A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications. Results The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group. Conclusions At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

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Section: Resultsmentioning

confidence: 99%

“…None of the 13 studies examined all the assessed variables in this review. Only one of the studies was a comparative study [23], the rest were case series.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

et al. 2021

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“…PICO Question 1: Short-Term Complications Using primary arthrodesis for severely comminuted pilon fractures is not a novel concept. Beckwitt et al examined the differences in patient outcomes between primary arthrodesis and primary ORIF in AO-43C3 pilon fractures and found that patients treated with the arthrodesis approach had a lower rate of nonunion (23). While this study was notable in that the average follow-up was 73.7 months, like the other studies included in this review, it did not have a treatment arm involving staged treatment (primary ORIF was the comparator group).…”

Section: Discussionmentioning

confidence: 97%

Should Complex Comminuted C3-Type Tibial Pilon Fractures Be Fused or Fixated? A Systematic Review

Chaudhry

Papadelis

Hayes

et al. 2021

Preprint

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Background: Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed (1) treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and (2) primary ankle arthrodesis as a management option for these types of complex injuries.Methods: A systematic literature search was performed on PubMed from 1990-2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures.The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications.Results: The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group.Conclusions: At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

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“…Arthrodesis: Some studies consider primary arthrodesis for severely comminuted pilon fractures. Beckwitt et al [66] reports a lower rate of nonunion and similar functional outcomes to ORIF in a relatively young cohort of patients with these injuries. They continue to conclude that performing primary arthrodesis in severely comminuted pilon fractures reduces the need for further operations.…”

Section: Intramedullary Nail (Imn)mentioning

confidence: 88%

Comparison of surgical treatment methods in patients with closed tibia pilon fractures: A systematic review and meta-analysis of clinical and functional outcomes

Apostolides¹,

Morcos²,

Mott³

et al. 2020

Int. J. Orthop. Sci.

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Background: Previous studies comparing surgical fixation methods in patients with tibial pilon fractures have controversial results. This study aims to identify which surgical method provides the best clinical and functional outcomes in adult patients with closed tibial pilon fractures. Methods: Databases including grey literature were searched for studies comparing surgical treatment methods in adult patients with closed tibial pilon fractures. PICO criteria were used to select studies. Statistical analysis was conducted with RevMan Version 5.4. The effect of compared methods was estimated using the mean difference, relative risk and corresponding 95% confidence intervals. Results: Three RCTs and one cohort study met our inclusion criteria and were included in the metaanalysis. All studies compared External fixation combined with limited internal fixation (LIFEF) with Open reduction internal fixation (ORIF) and had an overall high risk of bias. There was no difference in superficial infection rates (p=0.55), but there was a marginal difference in osteomyelitis rates (p=0.07) and wound dehiscence (p=0.05), favoring LIFEF. Malunion and arthritis rates (p=0.53 and p=0.27 respectively) were similar. Finally, none of the two treatment methods offered a better functional score (p=0.53). Conclusion:Both LIFEF and ORIF can be used in patients with closed tibial pilon fractures, when the condition of soft tissues allows. Overall, they offer similar early and long-term outcomes, however, patients treated with ORIF are in higher risk of developing osteomyelitis and wound dehiscence, as shown in this meta-analysis. More high-quality studies comparing treatment methods for tibial pilon fractures are needed, as treatment remains controversial.

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Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures

Cited by 8 publications

References 28 publications

Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

Should Complex Comminuted C3-Type Tibial Pilon Fractures Be Fused or Fixated? A Systematic Review

Comparison of surgical treatment methods in patients with closed tibia pilon fractures: A systematic review and meta-analysis of clinical and functional outcomes

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