The treatment of infected tibial pilon fractures.

A total of 33 patients with infection after pilon fracture were retrospectively reviewed from 1988 to 1992. Twenty patients were transfered from peripheral hospitals with active osteitis, 13 patients were treated primarily in our hospital. Factors inducing infection in this group of patients are discussed critically. All patients underwent radical debridement. Restoration of bone stability was required in 72%. Due to the extent of infection, segmental resection had to be perfomed on 7 patients. Resulting soft tissue defects were closed with free flaps in 11 cases. Infection was controlled in 31 patients (93%), but only 8 could be classified as "cured" (24%). Two patients had amputations after failure of treatment. Despite successful therapy, the functional results are poor. Therefore, avoiding infection, has top priority in the post fracture treatment. The correct form of osteosynthesis adapted to the soft tissue lesion can lower infection rates significantly. Soft tissue defects, resulting from open fractures or after primary treatment, have to be closed by flap transfer within a short period of time. The management of the soft tissue is at least as important as the reconstruction of the bone in the treatment of pilon fractures.