Pilon Fractures: Treatment With Combined Internal and External Fixation

Tornetta, Paul; Weiner, Lon S.; Bergman, Marc; Watnik, Neil F.; Steuer, J.; Kelley, Mark A.; Yang, Edward C.

doi:10.1097/00005131-199312000-00001

Cited by 235 publications

(106 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study showed a 10% rate of compartment syndrome treated with fasciotomies, very much in line with the existing literature, and the timing of the application of the external fixator did not correlate with the diagnosis of compartment syndrome. The reported rate of compartment syndrome in tibial plafond fractures in the literature is less than 5% [3,14]. Nearly 7% of the patients in our current series were diagnosed with compartment syndrome requiring fasciotomy.…”

Section: Discussionmentioning

confidence: 49%

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Haller

Holt

Rothberg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background High-energy tibial plateau and tibial plafond fractures have a high complication rate and are frequently treated with a staged approach of spanning external fixation followed by definitive internal fixation after resolution of soft tissue swelling. A theoretical advantage to early spanning external fixation is that earlier fracture stabilization could prevent further soft tissue damage and potentially reduce the occurrence of subsequent infection. However, the relative urgency of applying the external fixator after injury is unknown, and whether delay in this intervention is correlated to subsequent treatment complications has not been examined. Questions/purposes Is delay of more than 12 hours to spanning external fixation of high-energy tibial plateau and plafond fractures associated with increased (1) infection risk; (2) compartment syndrome risk; and (3) time to definitive fixation, length of hospitalization, or risk of secondary surgeries? We further stratified our results based on injury site: plateau and plafond. In practical clinical terms, many of these high-energy C-type articular fractures will arrive at the regional trauma center in the evening and this investigation attempted to explore if these injuries need to be placed in temporizing fixators that evening or if they may be safely addressed in a dedicated trauma room the next morning. Methods We performed a retrospective review of all patients at a Level I university trauma center with highenergy tibial plateau and plafond fractures who underwent staged treatment with a spanning external fixation followed by subsequent definitive internal fixation between 2006 and 2012. Patients who received a fixator within 12 hours of recorded injury time were classified as early external fixation; those who received a fixator greater than 12 hours from injury were classified as delayed external fixation. There were 80 patients (42 plateaus and 38 plafonds) in the early external fixation cohort and 79 patients (45 plateaus and 34 plafonds) in the delayed external fixation cohort. Deep infection rate was 13% in plateau fractures and 18% in plafond fractures. Rates of infection, compartment One of the authors (ENK) has received research support funding from the Department of Defense Congressionally Directed Medical Research Program and VA Early Feasibility Program. One of the authors (TFH) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DePuy Synthes (West Chester, PA, USA) in the amount of less than USD 10,000. One of the authors (ENK) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: CoNextions (Sandy, UT, USA) in the amount of more than USD 10,000, OrthoGrid (Salt Lake City...

show abstract

Section: Discussionmentioning

confidence: 49%

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Haller

Holt

Rothberg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…They described an anatomic reduction in none, a good reduction in 69%, fair in 20% and poor in 11%. Soft tissue complications and deep infections are not frequent when external fixation is combined with minimally invasive surgery: Wyrsch [11] had infections in 5%, Tornetta [4] in 1 out of 17 cases, Barbieri [14] in 3 out of 37 cases. Bacon S et al [15] performed a study of ORIF Vs IEF and stated that the time for union in ORIF group as 10 months and IEF group as 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…In 1922, a French Radiologist, Destot applied the term "Pilon fractures" for the ankle fractures that involve the weight-bearing distal tibial articular surface [1] . In 1968, Ruedi's publications explained fracture types, classification, treatment methods and principles [2] , which were later supported by Heim [4] and Ovadia & Beals [3] . Tornetta used ankle sparing external fixator to allow early range of motion 4 .…”

Section: Introductionmentioning

confidence: 99%

“…In 1968, Ruedi's publications explained fracture types, classification, treatment methods and principles [2] , which were later supported by Heim [4] and Ovadia & Beals [3] . Tornetta used ankle sparing external fixator to allow early range of motion 4 . To avoid the complications of external fixation Sirkin et al and Patterson & Cole popularized Staged management of these fractures [5,6] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radiological and functional assessment of the tibial pilon fractures treated by Ilizarov external fixation

P¹,

Palla²,

Shah³

2017

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

show abstract

“…Nonunion and the need for secondary interventions due to delayed healing are especially common for distal tibial fractures (McFerran et al 1992, Bone et al 1993, Teeny et al 1993, Anglen 1999, Pugh et al 1999, Ristiniemi et al 2007). Thus, early or primary bone grafting is recommended as an essential part of treatment of distal tibial fractures (Ruedi and Allgöver 1969, Teeny et al1993, Tornetta et al 1993, Marsh et al 1995, Sirkin and Sanders 2001, Pugh et al 1999, French and Tornetta 2000, whereas diaphyseal fractures usually heal without secondary interventions.…”

mentioning

confidence: 99%

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

et al. 2007

View full text Add to dashboard Cite

IntroductionThe vascularity of surrounding soft tissues, which is related to muscle cover, is important for the healing of traumatic bone loss. Muscle cover on the distal tibia is limited compared to the diaphyseal and proximal tibia, and delayed healing of fractures in this area is common. We evaluated the healing of traumatic bone loss in the proximal, diaphyseal, and distal tibia.Patients and methods 23 open tibial fractures with substantial bone loss (mean 52 (34-104) mm) were treated using a staged method with antibiotic-impregnated beads and later autologous bone grafting at second-stage surgery on average 8 weeks after the injury.Results 22 fractures healed after mean 40 (20-79) weeks. The average healing time in the distal tibia (mean 30 weeks) was 7 weeks shorter (95% CI: 12-26 weeks) than in the proximal tibia (37 weeks), and 16 weeks shorter (95% CI: 3-29 weeks) than in the tibial shaft (47 weeks). The length of the bone and the type of soft tissue cover (free muscle or secondary suture) had no effect on healing time.Interpretation Our study suggests that the method we used is applicable in all parts of the tibia, although the healing of bone loss is slower in the diaphyseal tibia than in the proximal and distal tibia.

show abstract

Pilon Fractures: Treatment With Combined Internal and External Fixation

Cited by 235 publications

References 0 publications

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Radiological and functional assessment of the tibial pilon fractures treated by Ilizarov external fixation

Staged method using antibiotic beads and subsequent autografting for large traumatic tibial bone loss

Contact Info

Product

Resources

About