Two-Staged Delayed Open Reduction and Internal Fixation of Severe Pilon Fractures

Patterson, Michael; Cole, James

doi:10.1097/00005131-199902000-00003

Cited by 354 publications

(203 citation statements)

References 17 publications

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“…Deep infection rates for patients undergoing staged treatment of tibial plafond fractures in the previously reported literature are 0% to 6% [9,12]. Our reported 18% deep infection rate is much higher than the rates reported in the literature.…”

Section: Discussioncontrasting

confidence: 54%

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

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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...

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Section: Discussioncontrasting

confidence: 54%

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

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“…Attempts at early definitive fixation of highenergy injuries have been shown to result in an increased rate of complications, including skin slough and deep infection [7,9,22,30]. Conversely, staged fracture care (provisional external fixation followed by definitive internal fixation) has been shown to result in favorable functional outcomes with decreased rates of soft tissue complications [10,18,29,34].…”

Section: Descriptionmentioning

confidence: 99%

Classifications In Brief: The Tscherne Classification of Soft Tissue Injury

Ibrahim

Swenson

Sassoon

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…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] . Ankle spanning fixator may be used as the definitive method to stabilize the distal tibia [7,8,9] .…”

Section: Introductionmentioning

confidence: 99%

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

P¹,

Palla²,

Shah³

2017

Int. J. Orthop. Sci.

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Two-Staged Delayed Open Reduction and Internal Fixation of Severe Pilon Fractures

Cited by 354 publications

References 17 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?

Classifications In Brief: The Tscherne Classification of Soft Tissue Injury

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

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