OBJECTIVES: The optimal treatment for pilon fractures remains controversial. We have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries and the purpose of this study was to determine the safety and efficacy of this strategy. DESIGN: Cohort study. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Ninety-five patients with Orthopaedic Trauma Association type 43.C pilon fractures. INTERVENTION: Primary ORIF. MAIN OUTCOME MEASUREMENT: Primary: Wound dehiscence or deep infection requiring surgery; secondary: quality of fracture reduction, functional outcomes (SF-36 and Foot and Ankle Outcome Score). RESULTS: Primary ORIF was performed within 24 hours in 70% of cases and within 48 hours in 88%. Reduction was judged to be anatomic in 90% cases. Six patients developed a deep wound infection or dehiscence that required surgical débridement, four after open fractures (four of 21 [19%]) and two after closed fractures (two of 74 [2.7%]). Complications were associated with local scarring, chronic alcohol abuse, schizophrenia, diabetes, and peripheral neuropathy. CONCLUSIONS: Provided surgery is performed expeditiously by experienced orthopaedic trauma surgeons, most tibial pilon fractures can be stabilized by primary ORIF within a safe and effective operative window with relatively low rates of wound complications, a high quality of reduction, and functional outcomes that compare favorably with the published results for all other reported surgical treatments of these severe injuries.
OBJECTIVES: The optimal treatment for pilon fractures remains controversial. We have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries and the purpose of this study was to determine the safety and efficacy of this strategy. DESIGN: Cohort study. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Ninety-five patients with Orthopaedic Trauma Association type 43.C pilon fractures. INTERVENTION: Primary ORIF. MAIN OUTCOME MEASUREMENT: Primary: Wound dehiscence or deep infection requiring surgery; secondary: quality of fracture reduction, functional outcomes (SF-36 and Foot and Ankle Outcome Score). RESULTS: Primary ORIF was performed within 24 hours in 70% of cases and within 48 hours in 88%. Reduction was judged to be anatomic in 90% cases. Six patients developed a deep wound infection or dehiscence that required surgical débridement, four after open fractures (four of 21 [19%]) and two after closed fractures (two of 74 [2.7%]). Complications were associated with local scarring, chronic alcohol abuse, schizophrenia, diabetes, and peripheral neuropathy. CONCLUSIONS: Provided surgery is performed expeditiously by experienced orthopaedic trauma surgeons, most tibial pilon fractures can be stabilized by primary ORIF within a safe and effective operative window with relatively low rates of wound complications, a high quality of reduction, and functional outcomes that compare favorably with the published results for all other reported surgical treatments of these severe injuries.
Authors: Thomas H Carter; Andrew D Duckworth; William M Oliver; Samuel G Molyneux; Anish K Amin; Timothy O White Journal: JBJS Essent Surg Tech Date: 2019-09-11
Authors: Thomas S Obermeyer; David Yonick; Kristen Lauing; Stuart R Stock; Rachel Nauer; Patrick Strotman; Ravi Shankar; Richard Gamelli; Michael Stover; John J Callaci Journal: J Orthop Trauma Date: 2012-12 Impact factor: 2.512
Authors: Kirsten Kortram; Hans Bezstarosti; Willem-Jan Metsemakers; Michael J Raschke; Esther M M Van Lieshout; Michael H J Verhofstad Journal: Int Orthop Date: 2017-07-25 Impact factor: 3.075
Authors: Aresh Sepehri; Gerard P Slobogean; Nathan N O'Hara; Phillip McKegg; Joshua Rudnicki; Jared Atchison; Robert V O'Toole; Marcus F Sciadini; Christopher T LeBrun; Jason W Nascone; Aaron J Johnson; Ida Leah Gitajn; Jonathan T Elliott; John A Scolaro; Raymond A Pensy Journal: J Orthop Trauma Date: 2021-12-01 Impact factor: 2.512
Authors: Mohammadreza Minator Sajjadi; Adel Ebrahimpour; Mohammad A Okhovatpour; Amin Karimi; Reza Zandi; Amir Sharifzadeh Journal: Arch Bone Jt Surg Date: 2018-09