Treatment protocol for open AO/OTA type C3 pilon fractures with segmental bone loss

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Reconstructive Surgery

Background:

• Open pilon fractures, specifically AO/OTA type C3 with segmental bone loss, represent severe injuries.
• Effective treatment strategies for limb salvage in these complex fractures remain challenging.

Purpose of the Study:

• To evaluate the outcomes of a standard, staged treatment protocol for patients with open AO/OTA type C3 pilon fractures and segmental bone loss.
• To assess complication rates, need for additional procedures, and time to bony union.

Main Methods:

• Retrospective case series of 10 patients with AO/OTA type C3 pilon fractures and segmental metaphyseal bone loss.
• Treatment involved immediate debridement and external fixation, followed by open reduction, plate fixation, and antibiotic beads, and finally, delayed bone grafting.
• Outcomes measured included complications and fracture healing time.

Main Results:

• The 3-stage protocol was successfully completed in all 10 patients.
• No acute infections or wound necrosis occurred after the second stage.
• Two cases of late infection arose after bone grafting, with one requiring amputation.
• Nine out of 10 patients achieved bony union at an average of 24 weeks.

Conclusions:

• Limb salvage for severe open pilon fractures is challenging but achievable.
• A staged approach involving external fixation, open reduction with antibiotic beads, and delayed bone grafting is associated with a low complication rate and predictable healing in select patients with favorable soft tissues.