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

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.