Surgical treatment of open pilon fractures

Abstract

Objective: To discuss the methods, timing and clinical outcomes of surgical treatment for open pilon fractures.

Methods: From April 2003 to July 2008, 28 patients with open pilon fractures were treated. All had type C fractures according to the Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation (AO/ASIF) classification. Three operative methods were applied, the methods being determined by the types of fracture, soft tissue damage and time interval after injury. Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated by the Burwell-Charnley score.

Results: All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1. The healing time was from 2.5 to 11 months (average 4.7 months). Two cases had delayed union. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases, good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis.

Conclusion: It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications.

Figure 1

A 49 year‐old man with a low‐energy open pilon fracture (Gustilo I & C1) (a) Photograph showing open soft tissue injury (Gustilo I). (b) Preoperative anteroposterior and lateral radiographs showing Pilon fracture of type C1. (c) Postoperative radiographs showing the fractures have been anatomically reduced and fixed with plates. (d) Anteroposterior and lateral radiographs demonstrating fractures have healed 1 year after surgery.

Figure 2

A 22 year‐old man with a high‐energy open pilon fracture (Gustilo II & C2) (a) Photograph showing open soft tissue injury (Gustilo II). (b) Preoperative radiographs showing Pilon fracture of type C2. (c) Postoperative radiographs showing the fractures have been anatomically reduced and fixed with external fixation, and the tibial fracture fixed with limited internal fixation. (d) Anteroposterior and lateral radiographs demonstrating the fractures have healed 1.5 year after surgery.

Figure 3

A 37 year‐old man with a super high‐energy open pilon fracture (Gustilo IIIB &C3) (a) Photograph showing open soft tissue injury (Gustilo IIIB) (b) Preoperative radiographs showing Pilon fracture of type C3. (c) Postoperative radiographs showing the fractures have been anatomically reduced and fixed with external fixation, the tibial fixed with limited internal fixation, and the fibula with a plate. (d) Anteroposterior and lateral radiographs demonstrating the fractures have healed 1.5 year after surgery.