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Early internal fixation and soft tissue cover of severe open tibial pilon fractures
J Conroy1, M Agarwal, P V Giannoudis
1Department of Orthopaedics and Trauma, St. James University Hospital, Leeds, LS9 7TF, UK.
Insights
This study on open distal tibial pilon fractures shows that radical debridement and early soft-tissue cover lead to good functional outcomes. The management protocol resulted in low infection and amputation rates, with good union rates.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Reconstructive Surgery
Background:
- Open distal tibial pilon fractures are severe injuries requiring complex management.
- Effective treatment strategies are crucial to minimize complications and optimize functional recovery.
Purpose of the Study:
- To evaluate the outcomes of a specific management protocol for open distal tibial pilon fractures.
- To assess functional results, union rates, and complication rates including infection and amputation.
Main Methods:
- Study included 32 consecutive patients with open distal tibial pilon fractures.
- Protocol involved radical debridement, immediate skeletal stabilization, and early soft-tissue coverage with vascularized muscle flaps.
- Patients were followed for a minimum of 1 year and assessed using the SF-36 questionnaire.
Main Results:
- Low rates of superficial (4) and deep (2) infections were observed.
- Two amputations were necessary.
- No long-term union problems or need for ankle fusion occurred.
- SF-36 scores indicated significant differences in physical function compared to US norms, but functional outcomes were favorable compared to amputees from severe trauma.
Conclusions:
- The described management protocol for open distal tibial pilon fractures yields good functional outcomes.
- This approach is associated with low infection and amputation rates.
- Early aggressive management can lead to successful limb salvage and satisfactory functional recovery.
Abstract:
We studied 32 consecutive patients with open distal tibial pilon fractures. All patients had radical debridement with immediate skeletal stabilisation and early soft-tissue cover with a vascularized muscle flap. The minimum follow-up was 1 (range 1-8) year. There were four superficial infections, two deep infections and two amputations. There were no long-term problems with union and no patient required an ankle fusion. Patients were assessed using the SF-36 questionnaire. There were significant differences from the US norm in physical function score ( p<0.01), role physical score ( p<0.05) and physical component score ( p<0.01). Physical component score of 38.5 was significantly better ( p<0.01) when compared with amputees from severe lower-extremity trauma. Our protocol for management resulted in a good functional outcome with low infection and amputation rates.