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Type C tibial pilon fractures: short- and long-term outcome following operative intervention
A D Duckworth1, J G Jefferies2, N D Clement1
1Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
Insights
This study on complex tibial plafond fractures found that primary open reduction internal fixation (ORIF) can lead to satisfactory outcomes for patients. Infection risks were linked to comorbidities and staged fixation protocols.
Area of Science:
- Orthopedic surgery
- Traumatology
- Biomedical engineering
Background:
- Complex tibial plafond fractures (AO type C) present significant treatment challenges.
- Outcomes for these severe injuries require careful evaluation of fixation methods.
Purpose of the Study:
- To report outcomes of primary fixation versus staged protocols for AO type C tibial plafond fractures.
- To assess short-term infection rates and long-term functional outcomes.
Main Methods:
- Retrospective study of 99 patients with 102 AO type C distal tibia fractures over 11 years.
- Primary outcomes: infection (short-term) and Foot and Ankle Outcome Score (FAOS) (long-term).
- Treatment groups: primary ORIF vs. primary external fixation with delayed ORIF.
Main Results:
- 17.6% infection rate, associated with comorbidities, open fractures, and staged fixation.
- At mean 6-year follow-up, mean FAOS was 76.2.
- 72% of patients reported satisfaction with outcomes.
Conclusions:
- Primary ORIF can achieve satisfactory outcomes in selected patients with severe tibial plafond fractures.
- This study represents the largest series on AO type C tibial pilon fracture fixation outcomes.
- Careful patient selection is crucial for successful surgical management.
Aims:
The aim of this study was to report the outcome following primary fixation or a staged protocol for type C fractures of the tibial plafond.
Patients And Methods:
We studied all patients who sustained a complex intra-articular fracture (AO type C) of the distal tibia over an 11-year period. The primary short-term outcome was infection. The primary long-term outcome was the Foot and Ankle Outcome Score (FAOS).
Results:
There were 102 type C pilon fractures in 99 patients, whose mean age was 42 years (16 to 86) and 77 were male. Primary open reduction internal fixation (ORIF) was performed in 73 patients (71.6%), whilst 20 (19.6%) underwent primary external fixation with delayed ORIF. There were 18 wound infections (17.6%). A total of nine (8.8%) were deep and nine were superficial. Infection was associated with comorbidities (p = 0.008), open fractures (p = 0.008) and primary external fixation with delayed ORIF (p = 0.023). At a mean of six years (0.3 to 13; n = 53) after the injury, the mean FAOS was 76.2 (0 to 100) and 72% of patients were satisfied.
Conclusion:
This is currently the largest series reporting the outcome following fixation of complex AO type C tibial pilon fractures. Despite the severity of these injuries, we have demonstrated that a satisfactory outcome can be achieved in the appropriate patients using primary ORIF. Cite this article: Bone Joint J 2016;98-B:1106-11.
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