The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study

Abstract

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.