Effect of Lymphedema Treatment for Management of Acute Pilon Fractures

Abstract

Pilon fractures are high-energy injuries that often result in considerable edema and compromise of the soft tissue envelope of the ankle. These injuries are typically staged with an external fixator until the soft tissue is amenable for definitive fixation. This study was conducted to determine the effects of lymphedema treatment for the management of pilon fractures. Patients who underwent open reduction and internal fixation of pilon fractures between 2007 and 2014 at the authors' level II trauma center were identified by Current Procedural Terminology codes indicative of placement of an external fixator (20690) and open reduction and internal fixation of a pilon fracture (27826, 27827, or 27828). The primary efficacy endpoint to determine negative outcomes was 90 days after definitive fixation. Eighty-two patients with 84 pilon fractures met inclusion criteria. Forty-eight ankles (57%) received lymphedema treatment. There were no significant differences in population demographics between the control and treatment groups. Median times to internal fixation in the control and treatment groups were 20 days (inter-quartile range, 15.5-30 days) and 11 days (interquartile range, 6-18 days), respectively. This difference was statistically significant (P=.001). Additionally, there was no significant difference in the overall incidence of wound complications between the control and treatment groups (P=.246). Compression wrapping for posttraumatic edema was effective in reducing the time needed for soft tissues to be appropriate for definitive surgical fixation of pilon fractures without increasing the risk of wound complications. These promising results warrant future study. [Orthopedics. 2017; 40(4):e668-e674.].

Post-traumatic lymphedema: review of the literature and surgical treatment options

“…Multiple LVAs are usually required [35] . In this case, the patient was treated with 3 LVAs distal to the ulcer site, and experienced resolution of the lymphorrhea and ulceration 2 weeks later without recurrence [19] . A single LVA was also described to treat isolated penile lymphedema without recurrence of swelling despite complete removal of compressive garments at 6 months [27] .…”

“…In the available literature, however, there are no reports of attempts at immediate or delayed lymphatic reconstruction in the setting of replantation. In striking contrast, minor musculoskeletal injuries, with contusion as the only clinical sign, can also lead to the development of secondary lymphedema [17][18][19] .…”

“…Several case reports support this in their description of lymphedema following high energy, but very focal trauma. Three case reports discuss focal injuries to the anteromedial leg, which resulted in lymphocele, lymphorrhea, or intractable ulcers [17][18][19] . Two case reports involve PTL secondary to isolated penile trauma.…”

“…Lymphovenous anastomosis (LVA) has been described for a case of intractable ulcer with lymphorrhea in the setting of post-traumatic and obesity-induced lymphedema [19] . Lymphovenous anastomosis bypasses obstructed lymphatic channels by connecting patent upstream lymphatics to nearby, low-pressure subdermal veins and shunting fluid directly into the venous system [37] .…”

Comparative Analysis of Treatment Outcomes in Patients With Types B and C Pylon Fractures

“…этот факт, с учетом особенностей анатомии данной облас-ти, неизбежно приводит к трофическим нару-шениям мягких тканей, покрывающих зону перелома [4,[11][12][13]. С практической точки зрения интересен тот факт, что достигнутые результаты лечения коррелируют с тяжестью перелома и травмой мягких тканей, а так-же качеством хирургического лечения [2,7].…”