The Results of Early Primary Open Reduction and Internal Fixation for Treatment of OTA 43.C-Type Tibial Pilon Fractures: A Cohort Study

White, T O; Guy, Pierre; Cooke, Cameron; Kennedy, Stephen A.; Droll, Kurt P.; Blachut, Piotr A.; O’Brien, Peter J.

doi:10.1097/bot.0b013e3181d04bc0

Cited by 104 publications

(57 citation statements)

References 22 publications

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“…Of note, the authors of these same 2 studies reported that staged treatment protocols were applied to other patients at their respective institutions during the respective study periods, which raises the concern of potential selection bias by applying primary ORIF to a selected patient population. 37,38 Furthermore, less than 10% of the fractures included in this systematic review were treated by primary ORIF, which can be suggested as an indicator that the current practice pattern within the orthopaedic trauma community leans toward staged approaches for these injuries.…”

Section: Discussionmentioning

confidence: 99%

Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis

Bullock

Ornell

Naranjo

et al. 2022

Journal of Orthopaedic Trauma

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ScienceDirect, and the Cochrane Library, were used in our systematic literature search. Search results were restricted to articles transcribed in English/Spanish and publication date after January 1, 2000, to present day.Study Selection: Inclusion criteria were studies reporting postoperative infection data for OTA/AO type 41C, 43C, or equivalent fractures of skeletally mature individuals. A minimum of 6 total fractures of interest and a frequency of 75% overall were required. Studies reporting on pathologic fractures, stress fractures, or lowenergy fracture types were excluded.Data Extraction: Two authors independently screened abstracts, evaluated full-text manuscripts, and extracted relevant data from included studies. Any instances of discrepancy were resolved within the study committee by consensus.Data Synthesis: Outcomes were expressed using direct proportions (PR) with a 95% confidence interval. The effects of comorbidities on infection rates were reported using odds ratios with a 95% confidence interval. All analyses used a DerSimonian-Laird estimate with a random-effects model based on heterogeneity. The presence of publication bias was evaluated using funnel plots and Egger's tests. Conclusions:Patients with these specific fractures develop infections at a notable frequency. The rates of deep infections were approximately 6% in tibial plateau fractures and 9% in tibial plafond fractures. These results may be useful as a reference for patient counseling and other future studies aimed at minimizing postoperative infection for these injuries.

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Section: Discussionmentioning

confidence: 99%

Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis

Bullock

Ornell

Naranjo

et al. 2022

Journal of Orthopaedic Trauma

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“…Literature reported that infection rate ranges from 0% to 55% [ 12 ]. However, recently a cohort study documented that the infection rate of early ORIF is only 2.7% and a good reduction rate is 90% [ 13 ]. Two-stage open reduction and internal fixation, proposed by Patterson and Cole, are regarded as a method that protects soft tissue and reduces infection rate [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis

et al. 2021

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Background Tibial Pilon fractures are severe fractures accompanied by soft tissue injury. Although open reduction and internal fixation (ORIF) are effective in treating Pilon fractures, there is a controversy over time to surgery due to reported postoperative complications. However, there is no systematic review evaluating the difference of postoperative complications between early and delayed ORIF for treating pilon fractures. Methods Relevant literature written in English will be searched through PubMed, Cochrane Library, Embase, MEDLINE, and Web of Science. The study aims to compare the effects and complications of early and delayed ORIF for treating fresh pilon fractures in adult patients. The primary outcome will be infection rate, fracture union time, nonunion and malunion rate. And the secondary outcome will be metalwork removal, amputation, and ankle function grade. Two reviewers will independently assess the eligibility of the studies according to the pre-defined inclusion and exclusion criteria. A meta-analysis for the available data will be conducted using Revman 5.3. To measure effect size, odds ratios (ORs) and mean difference will be used for dichotomous and continuous data, respectively. Statistical heterogeneity will be explored. And a random-effects model or a fixed-effects will be used in pooled data on the basis of the existence or absence of heterogeneity. Subgroup analysis will be conducted to identify sources of heterogeneity and sensitivity analysis to test the results’ robustness. We will assess the risk of bias by four different quality assessment tools according to the study design. Publication bias will be evaluated by funnel plot. The study data will be stored in the Open Science Framework website. PROSPERO registration number CRD42020207465

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“…Tibial pilon fractures resulting from high-energy mechanisms typically involve substantial comminution and soft tissue injury. Over the years, several treatment methods have been used for the management of these fractures [30][31][32]. Although there is no standardized method of fixation [33], most surgeons favor a staged approach to allow resolution of soft tissue swelling, which typically involves temporary ankle-bridging external fixation with or without fibular internal fixation followed by definitive ORIF [8,[10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

et al. 2021

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Background Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries. Methods A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications. Results The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group. Conclusions At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

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The Results of Early Primary Open Reduction and Internal Fixation for Treatment of OTA 43.C-Type Tibial Pilon Fractures: A Cohort Study

Cited by 104 publications

References 22 publications

Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis

Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis

Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis

Fusion versus fixation in complex comminuted C3-type tibial pilon fractures: a systematic review

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