Journal of orthopaedic trauma · 2010
The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study.
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White Tim O, Guy Pierre, Cooke Cameron J, Kennedy Stephen A, Droll Kurt P, Blachut Piotr A, O'Brien Peter J
Аннотация
OBJECTIVES: The optimal treatment for pilon fractures remains controversial. We have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries and the purpose of this study was to determine the safety and efficacy of this strategy.
DESIGN: Cohort study.
SETTING: Level I trauma center.
PATIENTS/PARTICIPANTS: Ninety-five patients with Orthopaedic Trauma Association type 43.C pilon fractures.
INTERVENTION: Primary ORIF.
MAIN OUTCOME MEASUREMENT: Primary: Wound dehiscence or deep infection requiring surgery; secondary: quality of fracture reduction, functional outcomes (SF-36 and Foot and Ankle Outcome Score).
RESULTS: Primary ORIF was performed within 24 hours in 70% of cases and within 48 hours in 88%. Reduction was judged to be anatomic in 90% cases. Six patients developed a deep wound infection or dehiscence that required surgical débridement, four after open fractures (four of 21 [19%]) and two after closed fractures (two of 74 [2.7%]). Complications were associated with local scarring, chronic alcohol abuse, schizophrenia, diabetes, and peripheral neuropathy.
CONCLUSIONS: Provided surgery is performed expeditiously by experienced orthopaedic trauma surgeons, most tibial pilon fractures can be stabilized by primary ORIF within a safe and effective operative window with relatively low rates of wound complications, a high quality of reduction, and functional outcomes that compare favorably with the published results for all other reported surgical treatments of these severe injuries.
DESIGN: Cohort study.
SETTING: Level I trauma center.
PATIENTS/PARTICIPANTS: Ninety-five patients with Orthopaedic Trauma Association type 43.C pilon fractures.
INTERVENTION: Primary ORIF.
MAIN OUTCOME MEASUREMENT: Primary: Wound dehiscence or deep infection requiring surgery; secondary: quality of fracture reduction, functional outcomes (SF-36 and Foot and Ankle Outcome Score).
RESULTS: Primary ORIF was performed within 24 hours in 70% of cases and within 48 hours in 88%. Reduction was judged to be anatomic in 90% cases. Six patients developed a deep wound infection or dehiscence that required surgical débridement, four after open fractures (four of 21 [19%]) and two after closed fractures (two of 74 [2.7%]). Complications were associated with local scarring, chronic alcohol abuse, schizophrenia, diabetes, and peripheral neuropathy.
CONCLUSIONS: Provided surgery is performed expeditiously by experienced orthopaedic trauma surgeons, most tibial pilon fractures can be stabilized by primary ORIF within a safe and effective operative window with relatively low rates of wound complications, a high quality of reduction, and functional outcomes that compare favorably with the published results for all other reported surgical treatments of these severe injuries.