Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia

Abstract

A series of 49 pilon fractures in a tertiary referral centre treated definitively by open reduction and internal fixation have been assessed and the complications of such injuries examined. A retrospective analysis of case notes, radiographs and computerised tomographs over a sevenyear period from 1999-2006 was performed. Infection was the most common postoperative problem. There were seven cases of superficial infection. There was a single case of deep infection requiring intravenous antibiotics and removal of metalwork. Other notable complications were those of secondary osteoarthritis (three cases) and malunion (one case). The key finding of this paper is the 2% incidence of deep infection following the direct operative approach to these fractures. The traditional operative approach to such injuries (initially advocated by Rüedi and Allgöwer in Injury 2:92-99, 1969) consisted of extensive soft tissue dissection to gain access to the distal tibia. Our preferred method is to access the tibia via the "direct approach" which involves direct access to the fracture site with minimal disturbance of the soft tissue envelope. We therefore believe that open reduction and internal fixation of pilon fractures via the direct approach to be a safe technique in the treatment of such devastating injuries.

Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

“…The vascularity of the soft tissue sleeve surrounding the distal tibia is tenuous and aggressive handling with extensive periosteal stripping will disturb the nutrition to the myocutaneous tissue and underlying bone [2].…”

“…Keywords: external fixation, locking compression plate (LCP); minimally invasive percutaneous plate osteosynthesis (MIPPO), image intensifier, the soft tissue envelope [2].…”

“…The soft tissues around the ankle and distal tibia are easily compromised by trauma and subsequent operative fracture treatment [1,2]. Salvage of these challenging problems more often than not requires a staged treatment based on thorough debridement(s), antibiotic treatment until infection is eliminated followed by reconstruction [3][4][5][6][7][8].…”

Factors affecting the results of tibial pilon fractures treated with open reduction internal fixation

“…Another important factor is the fact that mostly such fractures occur as a result of high-energy traumas. Especially, as much as the presence of a segmental fracture and bone loss at the distal metaphysis of the tibia as a result of the fragmentation and collapse of varying degrees stemming from vertical compression complicates a stable osteosynthesis, soft tissue damage also disrupts the local blood flow, hampering bone union [1,2,12].…”

“…1-5% of all lower extremity fractures and 7-10% of all tibia fractures are tibial pilon fractures [1,2]. In addition to the difficulty faced in the anatomic reduction and the stable fixation of such fractures, the accompanying soft tissue damage increases the frequency of postoperative complications [3][4][5][6].…”