Does Surgical Approach Influence the Risk of Postoperative Infection After Surgical Treatment of Tibial Pilon Fractures?

Esposito, John G.; Vliet, Quirine M.J. van der; Heng, Marilyn; Potter, Jeffrey; Cronin, Patrick K.; Harris, Mitchel B.; Weaver, Michael J.

doi:10.1097/bot.0000000000001655

Cited by 25 publications

(23 citation statements)

References 18 publications

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“…One of the early problems in pilon fracture surgery is soft tissue complications. Wound complications reaching 37% to 40% have been reported in the literature [16][17]. To reduce these soft tissue complications; After waiting for sufficient time after external fixation, techniques such as plating (2-stage treatment), treatment with indirect reduction techniques in possible fractures, using smaller and lower profile implants, avoiding anteromedial incision were used.…”

Section: Discussionmentioning

confidence: 99%

Do different surgical techniques in tibia pilon fractures change the results of the midterm?

Biçici¹,

Bingöl²

2020

Turk J Med Sci

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Background/aim: Pilon fracture is difficult to treat fractures due to many complications that can develop after surgery. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques.Materials and methods: 89 pilon fractures of 87 patients treated for pilon fracture were evaluated. Patients were examined in 3 different groups (one step, two step surgery and Ilizarov). Functional results, postoperative complications and ankle AOFAS scores were evaluated.Results: The mean AOFAS score of the all patients was 77.67. There was no significant difference between 3 surgical techniques (P = 0,880). While skin complication was not seen in patients who underwent double-stage surgery and Ilizarov (0%); It was seen in 6 (15.7%) patients who underwent single-stage surgery. Treatment results were found to be better in type 1 and type 2 fractures, while in type 3 fractures (P = 0.004).Conclusion: Despite the different surgical approaches and implants applied, no difference was found between the midterm ankle functional results of the patients. Two-stage surgery and Ilizarov is a safe and effective treatment approach to reduce morbidity and early complications in pilon fractures.

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Section: Discussionmentioning

confidence: 99%

Do different surgical techniques in tibia pilon fractures change the results of the midterm?

Biçici¹,

Bingöl²

2020

Turk J Med Sci

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“…In small incisions as for example used in minimally invasive techniques the distance between the incisions can be even smaller ( 44 ). Furthermore, a recent retrospective study on 581 patients with surgically treated tibial pilon fractures shows that the approach chosen does not seem to have any effect on the rate of post-operative infections ( 45 ).…”

Section: Approachesmentioning

confidence: 99%

“…Historically, the infection rate following operative treatment of tibial pilon fractures used to be unacceptably high, with up to 50% ( 13 , 24 , 28 ). This changed significantly with the introduction of the two –staged treatment protocol of tibial pilon fractures, which led to reported infection rates of ~9–19% in recent studies ( 45 , 82 , 83 ). The most common complications after operative treatment of tibial pilon fractures are summarized in Table 1 .…”

Section: Additional Treatment Of Soft Tissuementioning

confidence: 99%

Management of Pilon Fractures—Current Concepts

et al. 2021

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Tibial pilon fractures were first described by Étienne Destot in 1911. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Therefore, long -term outcome is often poor and correct initial management crucial. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures.

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“…5,6 Distal tibia pilon fractures, compared to ankle fractures, are at increased risk of wound complications secondary to their high-energy nature and at-risk soft tissue envelope. 7,8 Therefore, the benefits of IMN fixation of fibula for pilon fractures may be even more pronounced, although to date there is limited literature on the use of fibula IMN in the setting of pilon fractures. 9,10 The purpose of this study was to compare complications and revision surgeries after fibula IMN fixation in pilon versus ankle fractures.…”

Section: Introductionmentioning

confidence: 99%

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

Faber

Parry

Haidukewych

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Intramedullary nail (IMN) fixation of the fibula in malleolar ankle fractures has been shown to result in less wound complications then plate fixation. Therefore, IMN fibula fixation may also be associated with lower rates of wound complications when used for higher-risk pilon fractures. The purpose of this study was to compare complications of fibula IMN fixation in pilon versus malleolar ankle fractures. Methods: A retrospective cohort comparison was performed at an urban level one trauma center involving fibula fractures in 47 patients with AO/Orthopaedic Trauma Association (OTA) type 43 fractures and 48 patients with AO/OTA type 44 fractures being treated with fibula IMN fixation. Complications, fibula-specific complications, revision surgeries, and implant removals were reviewed. Results: There was no detectable difference in complications (27% vs. 23%, 95% confidence interval of the odds ratio (CIOR) 0.5 to 3.2), fibular-specific complications (6% vs. 10%, CIOR 0.1 to 3.5), revision surgeries (4% vs. 4%, CIOR 0.1 to 7.5), or symptomatic fibula implant removals (13% vs. 21%, CIOR 0.1 to 1.6) between pilon and ankle fracture groups, respectively. There was one (2%) fibular nonunion and one wound complication (2%) in each of the fracture groups. Conclusion: Fibula IMN fixation of pilon versus ankle fractures resulted in a similar number of complications. Comparative studies of fibula IMN and plate fixation are necessary to determine if the benefits of fibula IMN in ankle fractures extends to pilon fractures. Level of evidence: Level III, retrospective cohort.

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Does Surgical Approach Influence the Risk of Postoperative Infection After Surgical Treatment of Tibial Pilon Fractures?

Cited by 25 publications

References 18 publications

Do different surgical techniques in tibia pilon fractures change the results of the midterm?

Do different surgical techniques in tibia pilon fractures change the results of the midterm?

Management of Pilon Fractures—Current Concepts

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

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