Is Definitive Plate Fixation Overlap With External Fixator Pin Sites a Risk Factor for Infection in Pilon Fractures?

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Infection control

Background:

• Pilon fractures are severe lower-extremity injuries requiring complex surgical management.
• Staged treatment involving external fixation followed by internal fixation is common.
• Concerns exist regarding potential infection risks from overlapping fixation methods.

Purpose of the Study:

• To investigate whether overlap between definitive plate fixation and external fixator pin sites is a risk factor for deep infection in pilon fractures.
• To analyze the relationship between the proximity of fixation methods and postoperative infection rates.

Main Methods:

• Retrospective cohort study of 146 patients with pilon fractures treated between 2012 and 2018.
• Analysis of demographic, radiographic, and operative data.
• Measurement of the distance between external fixator pin sites and definitive plate fixation.
• Primary outcome: development of deep postoperative infection.

Main Results:

• Deep wound infections occurred in 15% of patients (22/146).
• Plate-pin site overlap was present in 40% of cases (58/146).
• No statistically significant difference in deep infection rates was found between patients with and without plate-pin site overlap (12% vs. 17%, P = 0.484).
• The degree of overlap and distance from plate to pin site did not correlate with infection risk.

Conclusions:

• Overlap of definitive plate fixation with external fixator pin sites is not a risk factor for deep infection in staged treatment of high-energy pilon fractures.
• Current findings suggest that this specific overlap does not compromise the safety of staged pilon fracture fixation.