Does external fixator pin site distance from definitive implant affect infection rate in pilon fractures?

Hadeed, Michael M.; Evans, Cody L.; Werner, Brian C.; Novicoff, Wendy M.; Weiss, David B.

doi:10.1016/j.injury.2018.10.041

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…Another study found a rate of 16.5% of infection after internal osteosynthesis, followed by damage control with external fixation in the fractures of the tibial pylon, finding no correlation between infection and pin path overlapping to surgical accesses. 7 The overlapping correlation of the pins with surgical incisions, associated with infection, is also analyzed in a prospective study in which the external fixators installed for damage control are instruments for reducing fractures during definitive osteosynthesis. 1 In our sample, we observed that between the accident and the definitive osteosynthesis procedure, nine patients (18%) underwent a clinically proven inflammatory and infectious process in the path of the installed Schanz pins, all with evidence of soft tissue tension against the pins.…”

Section: Discussionmentioning

confidence: 99%

Interference of External Damage Control Fixation in Definitive Osteosynthesis

et al. 2022

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Introduction: Indications for provisional external fixation prior to the definitive treatment of fractures are associated with the control of local and systemic damage and the impossibility of definitive osteosynthesis in the emergency. Objective: To identify complications associated with external fixation prior to definitive internal osteosynthesis. Methods: This is a comparative, prospective study (Level II). Inclusion criteria: patients treated as emergencies (November 2019 and March 2020) who underwent provisional external correction followed by definitive osteosynthesis. We look for signs of inadequacies in external correction and correlation with infections (erythema, hyperemia, fistulae in the path of the pins or surgical scars), systemic symptoms of infection, and radiographic parameters for treatment up to eight weeks after surgery. Results: The average time for conversion to definitive osteosynthesis was 15.9 days and 47 lower limbs and three upper limbs were fixed. Of the participants who had deep infections, three (6%) showed signs during initial treatment (external fixator) and nine (18%), after definitive internal osteosynthesis. We found no correlation between provisional external correction and complications in the definitive treatment with osteosynthesis. Conclusion: The use of temporary external fixation before definitive internal osteosynthesis in fractures of the appendicular skeleton failed to increase complication rates even if the path of the implants in both procedures overlapped. Level of Evidence II, Comparative Prospective Study.

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Section: Discussionmentioning

confidence: 99%

Interference of External Damage Control Fixation in Definitive Osteosynthesis

et al. 2022

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“…In the setting of staged management, fibular fixation is commonly performed at the time of external fixation if managed by the surgeon providing definitive treatment. Both open and percutaneous techniques for fibular fixation have been described 29,35,59 . Incision planning must consider the need for an adequate skin bridge between incisions 106 .…”

Section: Surgical Approaches For Definitive Managementmentioning

confidence: 99%

Management of High-Energy Tibial Pilon Fractures

Mittwede

Wawrose

Belayneh

et al. 2023

Journal of Bone and Joint Surgery

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ä Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.ä Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.g., smoking) should be addressed perioperatively.ä Delayed internal fixation with interval temporizing external fixation represents the preferred technique for managing most high-energy pilon fractures presenting with characteristically substantial soft-tissue trauma. In some cases, surgeons elect to utilize circular fixation for these scenarios.ä Although there have been treatment advances, the results have been generally poor, with high rates of posttraumatic arthritis, despite expert care.ä Primary arthrodesis may be indicated in cases with severe articular cartilage injury that, in the opinion of the treating surgeon, is likely unsalvageable at the time of the index management.ä The addition of intrawound vancomycin powder at the time of definitive fixation represents a low-cost prophylactic measure that appears to be effective in reducing gram-positive deep surgical site infections.Tibial pilon fractures in younger patient populations are frequently devastating high-energy intra-articular injuries and pose a difficult clinical problem in both academic and community practices. Representing approximately 5% to 7% of all tibial fractures 1-4 , pilon fractures are impaction injuries of the weightbearing surface of the distal tibia 5-8 . These most frequently occur in men in their fourth and fifth decades via an axial loading mechanism from motor vehicle trauma or a fall from a height 1,5-10 . The term "pilon" was first described in 1911 by Destot, due to the injury mechanism being analogous to a mortar and "pestle." 11 Extensive soft-tissue trauma is predictable and increases the risk of surgical complications (e.g., infection, nonunion, malunion), as well as the need for secondary intervention, including revision procedures and/or amputation 6,[12][13][14] . Despite treatment advances over the past several decades, long-term functional outcomes reveal persistent disability and the development of posttraumatic arthritis [15][16][17] , thereby negatively impacting the quality of life [18][19][20][21] . As many as ‡50% of patients may develop posttraumatic arthritis within 4 years after the injury 14,16 , and pilon fractures are among the worst musculoskeletal injuries for both functional and healthrelated outcomes 1,15,22 . In this article, an evidence-based critical discussion of the evaluation, classification, management, and strategies for optimization of these injuries is presented. Initial Management Clinical EvaluationTibial pilon fractures secondary to high-energy trauma are often accompanied by trauma to the head, spine, chest, or abdomen Disclosure: ...

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“…1 The rates of SSI in tibial plafond and tibial plateau fractures undergoing open reduction and internal fixation (ORIF) may be as high as 13.8%-24.2%. [2][3][4][5][6] Specifically, OTA/AO 7 type 41C and 43C fractures are associated with increased rates of SSI compared with type A and type B fractures. 4 Various studies have also identified several risk factors to be associated with SSI in orthopaedic fracture surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] Specifically, OTA/AO 7 type 41C and 43C fractures are associated with increased rates of SSI compared with type A and type B fractures. 4 Various studies have also identified several risk factors to be associated with SSI in orthopaedic fracture surgery. Open fractures, compartment syndrome, operative time, tobacco use, external fixation, hypertension, and male gender are risk factors for SSI in patients undergoing ORIF of their tibial plafond and tibial plateau fractures.…”

Section: Introductionmentioning

confidence: 99%

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How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

Zelle

Kore

2022

Journal of Orthopaedic Trauma

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Introduction: Orthopaedic trauma demonstrates a relatively high rate of surgical site infections (SSI) as compared with other surgical specialties. SSIs provide significant clinical challenges and create significant health care costs. Incisional negative pressure wound therapy (iNPWT) has reduced the risk of SSI in orthopaedic surgery and other surgical specialties. Purpose:The purpose of this study is to investigate potential cost savings with the use of iNPWT (3M Prevena Therapy, 3M, St. Paul, MN) in high-risk orthopaedic trauma patients with closed OTA/AO 41C and 43C fractures.Methods: This is a retrospective cohort study performed at a single, level-1 trauma center using data from a lower extremity fracture registry. Using the results from the registry and baseline infection rates derived from the literature, a health economic model was developed to evaluate the potential cost savings.Results: A total of 79 patients included in the registry underwent open reduction and internal fixation of OTA/AO 41C and 43C fractures. A total of 10.1% developed a SSI. For those who received iNPWT, the rate of SSI was 7.4%. A health economic model suggests that the use of iNPWT may reduce the costs per patient by approximately $1381 to $4436 per patient. Conclusions:This health economic assessment and model suggests that judicious use of iNPWT may reduce health care costs in patients undergoing open reduction and internal fixation of OTA/AO 41C and 43C fractures.

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Does external fixator pin site distance from definitive implant affect infection rate in pilon fractures?

Cited by 15 publications

References 19 publications

Interference of External Damage Control Fixation in Definitive Osteosynthesis

Interference of External Damage Control Fixation in Definitive Osteosynthesis

Management of High-Energy Tibial Pilon Fractures

How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

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