The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two stage Approach

Document Type : RESEARCH PAPER

Authors

1 Taleghani Hospital, Research Development Unit, Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Taleghani hospital, research development unit, Department of orthopaedic surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Taleghani hospital, research development unit, Department of orthopedics surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is an
important factor in choosing treatment options. Two major methods of treatment are considered as one-stage open
reduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter is
most accepted in literature. In the current study, we compared the results of these two methods.
Methods: In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21
patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection
(superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, pain
intensity, and patients’ satisfaction with AOFAS score, were compared between the two groups.
Results: There was no significant difference between the two groups in measured variables except hospital stay
which was significantly longer for the two-stage group.
Conclusion: Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type C
and Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.
Level of evidence: II

Keywords

Main Subjects

References

1. Calori GM, Tagliabue L, Mazza E, de Bellis U,
Pierannunzii L, Marelli BM, et al. Tibial pilon
fractures: which method of treatment? Injury. 2010;
41(11):83-90.
2. Kilian O, Bündner MS, Horas U, Heiss C, Schnettler R.
Long-term results in the surgical treatment of pilon
tibial fractures. A retrospective study. Chirurg. 2002;
73(1):65-72.
3. Çeçen GS, Gülabi D, Yanık E, Pehlivanoğlu G, Bekler H,
Elmalı N. Effect of BMI on the clinical and radiological
outcomes of pilon fractures. Acta Orthop Traumatol
Turc. 2014; 48(5):570-5.
4. Lau TW, Leung F, Chan CF, Chow SP. Wound
complication of minimally invasive plate
osteosynthesis in the distal tibia fractures. Int Orthop.
2007; 32(5):697-703.
5. Chan R, Taylor BC, Gentile J. Optimal management
of high-energy pilon fractures. Orthopedics. 2015;
38(8):e708-14.
6. Tang X, Tang PF, Wang MY, Lü DC, Liu MZ, Liu CJ.
Pilon fractures: a new classification and therapeutic
strategies. Chin Med J (Engl). 2012; 125(14):2487-
92.
7. Abd-Almageed E, Marwan Y, Esmaeel A, Mallur
A, El-Alfy B. Hybrid external fixation for
Arbeitsgemeinschaft für Osteosynthesefragen (AO)
43-C tibial plafond fractures. J Foot Ankle Surg. 2015;
54(6):1031-6.
8. Borens O, Kloen P, Richmond J, Roederer G, Levine
DS, Helfet DL. Minimally invasive treatment of
pilon fractures with a low profile plate: preliminary
results in 17 cases. Arch Orthop Trauma Surg. 2009;
129(5):649-59.
9. Yoon RS, Bible J, Marcus MS, Donegan DJ, Bergmann
KA, Siebler JC, et al. Outcomes following combined
intramedullary nail and plate fixation for complex
tibia fractures: a multi-centre study. Injury. 2015;
46(6):1097-101.
10. Richards JE, Magill M, Tressler MA, Shuler FD, Kregor
PJ, Obremskey WT, et al. External fixation versus ORIF
for distal intra-articular tibia fractures. Orthopedics.
2012; 35(6):e862-7.
11. Paluvadi SV, Lal H, Mittal D, Vidyarthi K. Management
of fractures of the distal third tibia by minimally
invasive plate osteosynthesis - A prospective series of
50 patients. J Clin Orthop Trauma. 2014; 5(3):129-36.
12. Bacon S, Smith WR, Morgan SJ, Hasenboehler E,
Philips G, Williams A, et al. A retrospective analysis
of comminuted intra-articular fractures of the
tibial plafond: open reduction and internal fixation
versus external Ilizarov fixation. Injury. 2008;
39(2):196-202.
13. Gupta A, Anjum R, Singh N, Hackla S. Outcome of distal
both bone leg fractures fixed by intramedulary nail
for fibula & MIPPO in tibia. Arch Bone Jt Surg. 2015;
3(2):119-23.
14. Tang X, Liu L, Tu CQ, Li J, Li Q, Pei FX. Comparison
of early and delayed open reduction and internal
fixation for treating closed tibial pilon fractures. Foot
Ankle Int. 2014; 35(7):657-64.
15. Dickson KF, Montgomery S, Field J. High energy
plafond fractures treated by a spanning external
fixator initially and followed by a second stage
open reduction internal fixation of the articular
surface-preliminary report. Injury. 2001; 32(Suppl
4):SD92-8.
16. Patterson MJ, Cole JD. Two-staged delayed
open reduction and internal fixation of severe
pilonfractures. J Orthop Trauma. 1999; 13(2):85-
91.
17. Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley
J, Seligson D. Tibial pilon fractures: a review of
incidence, diagnosis, treatment, and complications.
Acta Orthop Belg. 2011; 77(4):432-40.
18. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr.
A staged protocol for soft tissue management in
the treatment of complex pilonfractures. J Orthop
Trauma. 2004; 18(8 Suppl):S32-8.
19. Hoiness P, Stromsoe K. The influence of the timing
of surgery on soft tissue complications and hospital
stay: a review of 84 closed ankle fractures. Ann Chir
Gynaecol. 2000; 89(1):6-9.
20. Saithn A, Moody W, Jenkinson E, Almazedi B, Sargeant
I. The influence of timing of surgery on soft tissue
complications in closed ankle fractures. Eur J Orthop
Surg Traumatol. 2009; 19(7):481-4.
21. Singh BI, Balaratnam S, Naidu V. Early versus delayed
surgery for ankle fractures: a comparison of results.
Eur J Orthop Surg Traumatol. 2005; 15(1):23-7.
22. Leung F, Kwok HY, Pun TS, Chow SP. Limited open
reduction and Ilizarov external fixation in the
treatment of distal tibial fractures. Injury. 2004;
35(3):278-83.
23. Chen DW, Li B, Aubeeluck A, Yang YF, Zhou JQ, Yu GR.
Open reduction and internal fixation of posterior
pilon fractures with buttress plate. Acta Ortop Bras.
2014; 22(1):48-53.
24. Gao H, Zhang CQ, Luo CF, Zhou ZB, Zeng BF. Fractures
of the distal tibia treated with polyaxial locking
plating. Clin Orthop Relat Res. 2009; 467(3):831-7.
25. Scolaro J, Ahn J. Pilon fractures. Clin Orthop Relat Res.
2011; 469(2):621-3.
26. Dillin L, Slabaugh P. Delayed wound healing, infection,
and nonunion following open reduction and internal
fixation of tibial plafond fractures. J Trauma. 1986;
26(12):1116-9.
27. Kapukaya A, Subasi M, Arslan H, Tuzuner T. Nonreducible,
open tibial plafond fractures treated with
a circular external fixator (is the current classification
sufficient for identifying fractures in this area?).
Injury. 2005; 36(12):1480-7.
28. Wyrsch B, McFerran MA, McAndrew M, Limbird
TJ, Harper MC, Johnson KD. Operative treatment
of fractures of the tibial plafond. A randomized,
prospective study. J Bone Joint Surg. 1996;
78(11):1646-57.
29. Karbalaeikhani A, Saied A, Heshmati A. Effectiveness
of the gastrocsoleous flap for coverage of soft tissue
defects in leg with emphasis on the distal third. Arch
Bone Jt Surg. 2015; 3(3):193-7.
30. Ronga M, Longo UG, Maffulli N. Minimally invasive
locked plating of distal tibia fractures is safe and
effective. Clin Orthop Relat Res. 2010; 468(4):975-82.
31. Nehme A, Tannous Z, Wehbe J, Moucharafieh R,
Maalouf G. Arthroscopically assisted reconstruction
and percutaneous screw fixation of a pilon tibial
malunion. J Foot Ankle Surg. 2007; 46(6):502-7.
32. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA,
Myerson MS, Sanders M. Clinical rating systems for
the ankle-hindfoot, midfoot, hallux, and lesser toes.
Foot Ankle Int. 1994; 5(7):349-53.
33. He X, Hu Y, Ye P, Huang L, Zhang F, Ruan Y. The
operative treatment of complex pilon fractures: a
strategy of soft tissue control. Indian J Orthop. 2013;
47(5):487-92.
34. Lavini F, Dall’Oca C, Mezzari S, Maluta T, Luminari E,
Perusi F, et al. Temporary bridging external fixation
in distal tibial racture. Injury. 2014; 45(6):S58-63.
35. White TO, Guy P, Cooke CJ, Kennedy SA, Droll KP,
Blachut PA, et al. The results of early primary open
reduction and internal fixation for treatment of OTA
43.C-type tibial pilon fractures: a cohort study. J
Orthop Trauma. 2010; 24(12):757-63.
36. Li Q, Zhao WB, Tu CQ, Yang TF, Fang Y, Zhang H, et
al. Locking compression plate (LCP) combined with
minimally invasive percutaneous plate osteosynthesis
(MIPPO) for the treatment of pilon fracture. Zhongguo
Gu Shang. 2014; 27(12):1029-32.
37. Blauth M, Bastian L, Krettek C, Knop C, Evans S.
Surgical options for the treatment of severe tibial
pilon fractures: a study of three techniques. J Orthop
Trauma. 2001; 15(3):153-60.
The Archives of Bone and Joint Surgery
Volume 6, Issue 5
September 2018
Pages 412-419

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History

  • Receive Date: 17 July 2017
  • Revise Date: 22 December 2017
  • Accept Date: 30 December 2017

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