Staged treatment of pilon fractures

Deivaraju, Chenthuran; Vlasak, Richard; Sadasivan, Kalia K.

doi:10.1016/j.jor.2015.01.028

Cited by 18 publications

(12 citation statements)

References 20 publications

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“…The eight studies that met the inclusion criteria comprised one randomized controlled trial, one prospective cohort study, and six retrospective nonrandomized studies (Table 1). [9][10][11][12][13][14][15][16] The eight eligible studies involved 360 fractures in 359 patients. Of these 360 fractures, 175 were treated with two-stage ORIF and 184 were treated with LIFEF.…”

Section: Resultsmentioning

confidence: 99%

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

et al. 2018

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ObjectivesTwo-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures.MethodsWe conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis.ResultsThe two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups.ConclusionTwo-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures.Level of evidence2.

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Section: Resultsmentioning

confidence: 99%

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

et al. 2018

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“…They found a rate of healing of 88.13%, 3% with deep infection and 5% with superficial infection. 13 Deivaraju et al 14 analyzed the two-stage treatment, using a medial plate or an anterolateral plate during ORIF. They found comparable results in terms of quality of reduction and soft-tissue complications; however, they observed a higher incidence of infection and nonunion with medial plates.…”

Section: Discussionmentioning

confidence: 99%

“…1,8 It is also important to appropriately handle the soft tissues. 9 There is some controversy in the literature regarding the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation (ORIF): One stage (<48 h) 7,10,11 or two stages (staged treatment), placing an external fixator (EF) or a plaster splint in the first stage, delaying definitive ORIF until the soft tissues are healed, 8,9,[12][13][14] et cetera.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation

Carbonell-Escobar¹,

Rubio-Suárez²,

Ibarzábal-Gil³

et al. 2017

Journal of Clinical Orthopaedics and Trauma

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“…The reports vary however, with some authors favoring it [50] , while others not finding any advantage by its use [51] . A combination of an anteromedial with a lateral approach is usually preferred [40] , but Deivaraju et al [52] , found that overall, anterolateral plating was superior to medial plating in terms of bone healing complications. In addition, the routine use of locking plates in these injuries is questionable, as they do not seem to offer any advantage over non-locking plates [53] .…”

Section: Definitive Management Of Tibial Pilon Fracturesthe Evidencementioning

confidence: 99%

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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Staged treatment of pilon fractures

Abstract: Staged anterolateral plating is superior to staged medial plating in the management of pilon fractures.

Cited by 18 publications

References 20 publications

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures

Analysis of the variables affecting outcome in fractures of the tibial pilon treated by open reduction and internal fixation

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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