Jeffrey M Potter1, Quirine M J van der Vliet2, John G Esposito2, Michael F McTague3, Michael Weaver3, Marilyn Heng4. 1. Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada. 2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA. 3. Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA. Electronic address: MHENG@mgh.harvard.edu.
Abstract
INTRODUCTION: In the staged management of tibial pilon fractures, overlap between definitive internal fixation and external fixation pin sites has been investigated as a risk factor for infection with equivocal conclusions. Our aim was to determine if overlap or proximity of definitive internal fixation to external fixation pin sites influences the risk of deep infection. PATIENTS AND METHODS: We reviewed 280 AO/OTA 43B or 43C type distal tibia fractures in 277 patients at two level-one trauma centers. Patients underwent staged management using early temporizing external fixation followed by definitive open reduction and plate fixation. Primary outcome was the association between pin site overlap and the development of deep infection. Secondary outcome was the relationship between development of deep infection and the distance from pin site to definitive fixation. RESULTS: The average duration between external fixation and definitive internal fixation was 14 days. 24% of fractures developed deep infection requiring surgical intervention. There was no association between pin site overlap and the development of deep infection (p = 0.18). There was no relationship between infection and the distance between proximal plate extent and pin site (p = 0.13). DISCUSSION: We identified no association between pin site overlap and the development of deep infection. We suggest that temporizing external fixation pins should be placed so as to obtain optimal stability of the construct with lesser emphasis on aiming to be absolutely outside the zone of future fixation. LEVEL OF EVIDENCE: Level III Therapeutic Retrospective Comparative study.
INTRODUCTION: In the staged management of tibial pilon fractures, overlap between definitive internal fixation and external fixation pin sites has been investigated as a risk factor for infection with equivocal conclusions. Our aim was to determine if overlap or proximity of definitive internal fixation to external fixation pin sites influences the risk of deep infection. PATIENTS AND METHODS: We reviewed 280 AO/OTA 43B or 43C type distal tibia fractures in 277 patients at two level-one trauma centers. Patients underwent staged management using early temporizing external fixation followed by definitive open reduction and plate fixation. Primary outcome was the association between pin site overlap and the development of deep infection. Secondary outcome was the relationship between development of deep infection and the distance from pin site to definitive fixation. RESULTS: The average duration between external fixation and definitive internal fixation was 14 days. 24% of fractures developed deep infection requiring surgical intervention. There was no association between pin site overlap and the development of deep infection (p = 0.18). There was no relationship between infection and the distance between proximal plate extent and pin site (p = 0.13). DISCUSSION: We identified no association between pin site overlap and the development of deep infection. We suggest that temporizing external fixation pins should be placed so as to obtain optimal stability of the construct with lesser emphasis on aiming to be absolutely outside the zone of future fixation. LEVEL OF EVIDENCE: Level III Therapeutic Retrospective Comparative study.
Authors: Douglas R Haase; Lucas R Haase; Tyler J Moon; Marcus Trotter; Joshua K Napora; Brent T Wise Journal: Eur J Orthop Surg Traumatol Date: 2022-08-18