Complications encountered in the treatment of pilon fractures

A total of 52 tibial plafond (pilon) fractures in 51 patients were retrospectively reviewed from the years 1985-1990 to define the rate of complications encountered during their management. All fractures were managed under faculty supervision at a level I trauma center and its two affiliated institutions. The follow-up period was scrutinized to determine whether or not a complicating event occurred. Major local complications, termed events, were defined as those requiring unplanned surgery due to infection, wound breakdown with subsequent flap coverage, and failure of fixation or fracture healing. Reduction accuracy and final clinical results were not specifically examined. There were 14 (27%) type I, 17 (33%) type II, and 21 (40%) type III Ruedi-Allgower fracture types. The majority (79%) of the fractures were closed and 89% were treated by open reduction and internal fixation. The overall local complication rate was 54%. A total of 21 (40%) pilon fractures (six type I, six type II, and nine type III) had major local complicating events requiring 77 additional operations. Patient follow-up time ranged from 1 week (the occurrence of a major local complication) to 200 weeks (no complication), with a mean of 67 weeks. Kaplan-Meier survivorship (K-M) analysis was utilized to statistically estimate the complication rate in this patient population accounting for the occurrence of censored events. The K-M-determined event rate was 42 +/- 7%. Ten (of 21) pilon fractures had events by 3 weeks, while only two occurred beyond 40 weeks.