Strategies in trauma and limb reconstruction · 2026
Management of a Pilon Fracture Complicated by Drug-induced Hypersensitivity Syndrome, Fungal Infection and Limb Length Discrepancy: A Case Report.
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Обработка статьи · этапы, ошибки и управление
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Shimokawa Kanu, Matsubara Hidenori, Nakazawa Yusuke, Demura Satoru
Аннотация
AIM AND BACKGROUND: Pilon fractures are rare but severe injuries associated with high-energy trauma, often resulting in significant articular and soft tissue damage. Their management is challenging due to complications such as infection, nonunion, and post-traumatic arthritis, which often require complex staged surgical interventions. Drug-induced hypersensitivity syndrome (DIHS), a life-threatening reaction characterised by rash and systemic involvement, presents additional challenges in orthopaedic contexts due to its association with high-dose corticosteroid therapy and increased infection risk.
CASE DESCRIPTION: We report the case of a 70-year-old man with a Gustilo-Anderson type IIIA open pilon fracture complicated by fungal infection, leg length discrepancy (LLD), and DIHS. Initial treatment involved debridement, and stabilisation with a modular external fixator. Due to fungal infection and LLD, the external fixator was replaced with a Taylor Spatial Frame (TSF) for limb lengthening at the proximal tibia. The patient subsequently developed a skin rash, fever and liver damage, and was diagnosed with DIHS. High-dose prednisolone (PSL) was started and gradually tapered over 2 months. During this period, limb lengthening progressed effectively, achieving a total elongation of 42 mm. During definitive reconstruction, plate conversion was performed to stabilise the lengthened bone. A tantalum spacer was used to correct the remaining LLD, and tibio-talo-calcaneal arthrodesis with retrograde intramedullary nailing was employed for distal reconstruction. Postoperatively, the patient achieved solid bone fusion, minimal LLD (5 mm), and independent ambulation at 1 year. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 90 points.
CONCLUSION: This case highlights the complexities of managing pilon fractures complicated by infection, LLD, and DIHS. It underscores the importance of staged treatment strategies, including limb lengthening, and planning for definitive reconstruction.
CASE DESCRIPTION: We report the case of a 70-year-old man with a Gustilo-Anderson type IIIA open pilon fracture complicated by fungal infection, leg length discrepancy (LLD), and DIHS. Initial treatment involved debridement, and stabilisation with a modular external fixator. Due to fungal infection and LLD, the external fixator was replaced with a Taylor Spatial Frame (TSF) for limb lengthening at the proximal tibia. The patient subsequently developed a skin rash, fever and liver damage, and was diagnosed with DIHS. High-dose prednisolone (PSL) was started and gradually tapered over 2 months. During this period, limb lengthening progressed effectively, achieving a total elongation of 42 mm. During definitive reconstruction, plate conversion was performed to stabilise the lengthened bone. A tantalum spacer was used to correct the remaining LLD, and tibio-talo-calcaneal arthrodesis with retrograde intramedullary nailing was employed for distal reconstruction. Postoperatively, the patient achieved solid bone fusion, minimal LLD (5 mm), and independent ambulation at 1 year. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 90 points.
CONCLUSION: This case highlights the complexities of managing pilon fractures complicated by infection, LLD, and DIHS. It underscores the importance of staged treatment strategies, including limb lengthening, and planning for definitive reconstruction.