Related Experiment Video
Updated: Jun 30, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
The Direct Anterior Approach for AO/OTA43B and 43C Pilon Injuries
Laura E Sokil1, Liam Wong1, Elizabeth Roti1
1Oregon Health and Science University, Portland, OR, USA.
Insights
The direct anterior (DA) approach shows promise for pilon fracture fixation, with a lower reoperation rate within one year compared to other surgical methods. This study suggests DA is a viable option for open reduction and internal fixation of these complex fractures.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Skeletal Reconstruction
Background:
- Pilon fractures are associated with high complication rates, including wound healing issues, infections, and posttraumatic arthrosis.
- Reconstructive procedures for pilon fractures carry additional risks of early complications.
- The direct anterior (DA) approach has not been extensively studied for initial pilon fracture repair.
Purpose of the Study:
- To evaluate the performance of the direct anterior (DA) approach for internal fixation of pilon fractures.
- To compare the reoperation rates of the DA approach with other surgical techniques for pilon fractures.
- To hypothesize that the DA approach would not result in a higher reoperation rate compared to other methods.
Main Methods:
- Retrospective review of operative Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 43B and C pilon fractures from 2013-2022.
- Kaplan-Meier analysis to estimate the likelihood of reoperation within one year.
- Multivariable logistic regression to identify reoperation risk factors.
Main Results:
- A total of 135 fractures in 130 patients were analyzed, with an overall reoperation rate of 40.7%.
- No significant differences were found in reoperation rates for infection, nonunion, posttraumatic osteoarthritis, or hardware removal between the DA and other approaches.
- Multivariate analysis indicated the DA approach was associated with a significantly lower rate of reoperation within one year (OR 0.25, P=0.015).
Conclusions:
- The direct anterior (DA) approach demonstrates effective performance for the internal fixation of AO/OTA 43B and C pilon fractures.
- The DA approach showed a favorable risk of reoperation at one year and a comparable overall reoperation rate to other surgical methods.
- The DA approach should be considered a valuable option for open reduction and internal fixation in the surgical management of pilon fractures.
Background:
Pilon fractures carry high rates of early wound healing, infectious complications, and late posttraumatic arthrosis. When reconstructive procedures are indicated, these patients are at further risk for early complications. Perhaps using the same direct anterior (DA) approach for initial repair and later reconstruction might mitigate these risks, but the DA approach has not been explored for initial repair. This study aimed to evaluate the performance of the DA approach for internal fixation of pilon fractures. We hypothesized that the reoperation rate for fractures treated with the DA approach would not differ from other surgical approaches in our series.
Methods:
A retrospective chart and radiographic review of operative Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 43B and C fractures from 2013 to 2022 were undertaken. Using Kaplan-Meier estimations, the likelihood of reoperation within 1 year of index surgery was analyzed. Reoperation risk factors were determined using multivariable logistic regression analyses created using a backward stepwise process.
Results:
A total of 135 fractures in 130 patients were eligible for review. The overall reoperation rate was 40.7%. There was no significant difference between DA and all other approaches for rate of reoperation for infection (2.3% vs 10%, P = .21), nonunion (15.9% vs 16.5%, P > .99), posttraumatic osteoarthritis (PTOA) (9.1% vs 7.8%, P > .99), and removal of symptomatic hardware (25% vs 36.3%, P = .27). In multivariate regression analysis, DA approach was associated with a lower rate of reoperation within 1 year (odds ratio 0.25, 95% CI 0.07-0.71, P = .015).
Conclusion:
The direct anterior approach can perform well for fixation of AO/OTA 43B and C fractures. Our retrospective series showed a favorable risk of reoperation at 1 year and a similar overall reoperation rate compared with all other combinations of approaches. Many factors determine the surgical approach to pilon fractures. This study has shown that the DA approach merits consideration as an option for open reduction and internal fixation.
More Related Videos
12:25C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
Published on: September 16, 2022
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
