Early internal fixation and soft tissue cover of severe open tibial pilon fractures

Abstract

We studied 32 consecutive patients with open distal tibial pilon fractures. All patients had radical debridement with immediate skeletal stabilisation and early soft-tissue cover with a vascularized muscle flap. The minimum follow-up was 1 (range 1-8) year. There were four superficial infections, two deep infections and two amputations. There were no long-term problems with union and no patient required an ankle fusion. Patients were assessed using the SF-36 questionnaire. There were significant differences from the US norm in physical function score ( p<0.01), role physical score ( p<0.05) and physical component score ( p<0.01). Physical component score of 38.5 was significantly better ( p<0.01) when compared with amputees from severe lower-extremity trauma. Our protocol for management resulted in a good functional outcome with low infection and amputation rates.

Fig. 1.

Anteroposterior and lateral views of an open AO type 43C fracture in a 30-year-old male (a, b). Immediate post-operative radiographs after skeletal stabilisation and soft tissue cover showing good articular reconstruction (c, d). Anteroposterior and lateral radiographs at 5 months showing union with abundant callus formation (e, f)