All analyses were performed using R version 3.0.1 (www.r-project.org) and STATA 12.0 SE. A close working relationship with infectious disease specialists is helpful. Pilon Fractures Adam Bernatsky, DPM. For the purposes of the study amputation was considered failure although we acknowledge that this can be an acceptable functional end-point and in some cases a superior functional end-point. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. The strengths of this study include the large number of patients identified, accounting for debridements and reconstructive procedures after a diagnosis of deep infection, 95% follow-up, with only 3 patients with insufficient data, and the optimal statistical models used to analyze these variables. The majority of the time, pilon fractures are severe enough with displaced fracture fragments involving the ankle joint that they require surgical intervention.  |  Bourne R.B. 1998 Apr;84(2):180-8. 1/3 of patients have associated injuries . This investigation was performed after gathering a Six-year retrospective database from a single academic trauma center including patients with pilon fractures diagnosed with post-operative deep infection. Rifampin was routinely employed as multimodal drug therapy when implants were retained. Cierny G., 3rd, Mader J.T., Penninck J.J. A clinical staging system for adult osteomyelitis. A total of 31 patients presented with open injuries. Successful salvage can be reliably anticipated in over 80% of patients, but typically requires more than 3 additional procedures. Send an enquiry and get response fast - Updated Sep 2020 There was no correlation identified between the number of procedures performed as part of the initial treatment with the amount of procedures required for the definitive treatment of deep infection (Spearman's rho = −0.09, p = .65). After recovery from pilon fractures, many patients continue to have debilitating pain and ankle stiffness. Treatment of infected pilon nonunions with small pin fixators. Sometimes surgery is performed immediately, but it may be necessary to wait if there is severe swelling. Guidelines for treatment of these complications have not been established, and currently there exists wide variation in management. No other pathogens showed a statistically significant difference in number of debridements. [Fractures of the tibial pilon. Epub 2013 Jul 18. The majority of literature reports consist of case series which conclude that success of salvage is not obtained in the first attempt, but that secondary revisions may be required in order to achieve it.17, 18, 19, 20 Additionally, comparison between reports is difficult given that broad spectrums of techniques were used for attempted salvage and include patients with non-infected non-unions as well as patients with shaft and proximal tibia fractures. Course of treatment and rate of successful salvage following the diagnosis of deep infection in patients treated for pilon fractures (AO/OTA: 43), Vanderbilt Department of Orthopedics and Rehabilitation, Orthopedic Trauma Institute, Nashville, TN 37232, USA. This series serves as a framework for discussions regarding anticipated success of and course of treatment, helping align patient and surgeon expectations, and provides surgeons and patients a framework for discussions regarding optimal, individualized treatment. Clipboard, Search History, and several other advanced features are temporarily unavailable. Successful salvage can be reliably anticipated in over 80% of patients, but typically requires more than 3 additional procedures. Additionally, we did not separate the number of reconstructive procedures needed for soft tissue or bony healing. The authors also found a correlation between the number of debridements in those who presented with acute infection compared to those who presented with late infection, however, this was not quantified. (OBQ05.93) A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. All patients can be offered salvage with reasonable expectations of success, but should anticipate and plan for three to four additional procedures and a protracted course. NIH National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. doi: 10.1016/j.injury.2015.10.067. We also did not control for surgeon or his/her experience; however, the authors believe this accurately reflects the typical pattern of experience at trauma centers, and increases the generalizability of the data presented. Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications. USA.gov. The three most prevalent pathogens cultured were Methicillin Sensitive Staphylococcus aureus (MSSA) 19 cases (26.4%), Enterobacter 14 cases (19.4%) and Methicillin Resistant Staphylococcus aureus (MRSA) 8 cases (11.1%). A deep infection rate of 16.1% was identified, with a total of 57 deep infections in 355 operatively treated pilon fractures (142/355 (40%) open vs. 213/355 60% closed). The mean follow-up time was 44.5 ± 16 months (range 24-82). Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Although the salvage rate for this population was 100% (5/5) no significant differences were identified when compared to those diagnosed with deep infection after three weeks from definitive fixation. Frequency of total number of operative procedures among patients undergoing attempted salvage. Open reduction and internal fixation of tibial plafond fractures. The ePub format uses eBook readers, which have several "ease of reading" features Outcome following open reduction and internal fixation of open pilon fractures. Several early reports of high complication rates associated with immediate operative treatment have led to modern management with a staged approach and increased emphasis on the associated soft tissue injury.6, 7, 8, 9, 10, 11, 12 Ovadia et al reported infection in 6% (9/145) of patients with pilon fractures and 3 of them subsequently had below-knee amputation.10 Wyrsch et al reported a 37% (7/19) risk of infection with three of those patients ultimately receiving a below-knee amputation, resulting in an amputation rate of 16% (3/19).13. BMI: Body Mass Index. Whether or not your doctor recommends surgery often depends on how out of place (displaced) the fractured pieces of bone are. In addition, defining successful treatment is difficult due to a range of endpoints, including healed fracture, arthrodesis, or amputation, making true comparison difficult. Zalavras C.G., Patzakis M.J., Thordarson D.B., Shah S., Sherman R., Holtom P. Infected fractures of the distal tibial metaphysis and plafond: achievement of limb salvage with free muscle flaps, bone grafting, and ankle fusion. Medical recordings (discharge documents and surgical reports) and radiographic examinations were analyzed. These include a rate of successful salvage in patients diagnosed with deep infection of 88.5% (46/52). We performed both univariate analysis and the penalized multivariable proportional odds model and both indicated that there is not enough evidence to identify an association between risk factors and the outcome. These lower-energy pilon fractures can be treated with a leg cast. MATERIAL AND METHODS In total, 27 patients (mean age 43.6 ± 13 years, range 18-69) with a pilon tibial fracture and a minimum follow-up of 24 months were included in the study. Retention of implants was left to the treating surgeon in situations when healing had not yet occurred. Open fractures or fractures in patients with multiple injuries were stabilized with traveling traction that was applied in the operating room. The interested risk factors include age, BMI, hypertension, open skin, open/closed fraction, diabetes, and smoke. Michelson J., Moskovitz P., Labropoulos P. The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon. Bonin, 11 in 1950, described the same fracture as a “plafond” fracture because the fracture disrupted the roof of the ankle joint. Tech Foot Ankle Surg. A randomized, prospective study. [Treatment strategy and planning for pilon fractures]. Moreover, the necessity for bone grafting, as an indirect measurement of bone comminution and bone defects, resulted in higher degrees of osteoarthritis in the final follow-up. In this infected cohort, the initial treatment used a staged protocol including external fixation and delayed open reduction internal fixation in 82.5% (47/57). The microbial spectrum of this series compares to that described by Cierny and Mader.22 The majority of cases identified in this study were caused by S. aureus, with a total of 27 cases, followed by Enterobacter with 14 cases. Introduction. Some pilon fractures do not need surgical treatment. Institutional review board approval was obtained for this study. However, the initial severity of the fracture in terms of initial absorbed energy, bony comminution and softtissue trauma still affects the outcome. View doctor profiles, clinic contact information and photos. Patients who were successfully salvaged required an average of 3.5 (±2.3) procedures following diagnosis of infection, 2.5 (±1.5) debridements and 1.1 (±1.2) reconstructive procedures. Characteristics of patients who were salvaged were compared to patients who underwent amputation using Wilcoxon rank sum test or Fisher's exact test. There often are large separations between fractured fragments and instability in the tibia and fibula at the ankle joint. For categorical variables, percentage (N) was presented. A search of Current Procedural Terminology (CPT) codes for pilon fractures (27827, 27826 and 27828) was performed using the above criteria. Further analysis was performed to evaluate the association between the need for soft tissue coverage and the success of attempted salvage. Orthop Clin North Am. A major disadvantage to closed treatment in a cast is difficulty in assessing soft tissue healing. The fracture of the tibial plafond or pilon fracture is an uncommon but difficult fracture to manage. Injury. Most pilon fractures have multiple breaks. The number of procedures following the diagnosis of deep infection was not found to be associated with age, BMI, diagnosis of hypertension, open vs. closed injuries, AO classification, diagnosis of diabetes mellitus, and tobacco use (Table 3). It is possible that earlier infections involved greater compromise of the soft tissue envelope. Panchbhavi VK. Relaxing the rule of ten events per variable in logistic and Cox regression. Attempted salvage was performed in fifty-two of the fifty-four patients with the remaining two patients undergoing immediate amputation following diagnosis of deep infection. 1998. All clinics verified by ministry of health Malaysia. Evolving treatment concepts for the pilon fracture. It usually occurs following a significant force to the foot, such as a fall from a height or motor vehicle accident (MVA). The authors are confident with the fact that there are other variables that take precedence for statistical analysis inclusion in this highly specific patient population (AO, Gustilo & Anderson, age and past medical history). Three of fifty-seven (5.2%) patients had not healed at time of final follow-up (x¯ = 20.5 months SD = 9.5) and were excluded from further analysis. We feel that an infected pilon is a limb threating complication and we define successful salvage as clinical and radiographic evidence of bony union without ongoing signs of infection at last available follow up. Boraiah S., Kemp T.J., Erwteman A., Lucas P.A., Asprinio D.E. Radiographic confirmation of all injuries was performed by the study team using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification of tibial pilon fractures (43A, 43B, 43C).14 Medical records were reviewed to identify patients diagnosed with deep infection during the course of their treatment. 26(2):273-85. . Differences in outcomes by time from definitive fixation to diagnosis of infection. This was also reflected in the total number of procedures, including debridements and procedures of reconstructive nature, with the MSSA group requiring 5.1 (SD = 2.5) vs. 2.7 (SD = 1.7), p < .001. Horan T.C., Gaynes R.P., Martone W.J., Jarvis W.R., Emori T.G. Vacuum-assisted wound closure therapy and using a staged protocol (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role. 1-10% of LE fx’s . One hundred seven pilon fractures in 107 patients were treated according to a staged prospective protocol. Additionally, the high incidence of 43C fractures (37/47, 78.7%) may also be a contributing factor for such a hig. The nature of the procedure performed after the diagnosis of deep infection was further classified as a debridement or reconstructive procedure. Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL. Teeny S.M., Wiss D.A. Identification of deep surgical site infection was performed utilizing the criteria defined by the Center for Disease and Control National Healthcare Surveillance Network.15 Effectively, all deep infections underwent surgical debridement. These findings remained statistically significant when controlling for time to diagnosis of deep infection. Long-term retrospective study of 51 fractures treated with open reduction and osteosynthesis]. A study of 22 cases comparing the objective and subjective evaluation. Ovadia D.N., Beals R.K. Fractures of the tibial plafond. Helfet D.L., Koval K., Pappas J., Sanders R.W., DiPasquale T. Intraarticular “pilon” fracture of the tibia. 3. In the ankle, if you land heavily on your ankle the bones in the ankle can impact forcefully together and the tibial bone or shin bone can break near the ankle. The authors report that the statistical analysis for this work was supported in part by the Vanderbilt CTSA grant UL1 TR000445 from NCRR/NIH. See Table 1 for clinical and operative characteristics of this retrospective cohort. Nonsurgical Treatment The total number of procedures, including procedures for debriding and of reconstructive nature, was also higher in this group, 5.1 (SD = 2.5) vs. 2.7 (SD = 1.7), p = .013. A deep infection rate of 16.1% was identified, with a total of 57 deep infections in 355 operatively treated pilon fractures (142/355 (40%) open vs. 213/355 60% closed). Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. A sub-analysis was performed to evaluate the correlation between the number of soft tissue coverage procedures as part of the initial treatment and the number of procedures required for definitive treatment of deep infection. All patients fifteen years or older treated definitively with ORIF of pilon fractures at our institution between January 1, 2006 and December 31, 2011 were identified from an institutional billing database. The average follow-up time was 16.9 months (SD 8.5) with a 95% follow-up. Fractures of the tibial plafond and distal tibia resulting from an axial load to the foot are commonly referred to as pilon fractures. The thin soft tissue envelope surrounding the ankle is susceptible to disruption with violent injury, resulting in open fracture wounds that commonly require secondary coverage procedures.4, 5 Even when not associated with open wounds, the closed soft tissue injury is often severe enough to alter surgical treatment in a variety of ways. Rev Chir Orthop Reparatrice Appar Mot. In this infected cohort, the initial treatment used a staged protocol including external fixation and delayed open reduction internal fixation in 82.5% (47/57). Variables contributing to poor results and complications. Silluzio N, De Santis V, Marzetti E, Piccioli A, Rosa MA, Maccauro G. Injury. All clinics verified by ministry of health Malaysia. The limitations of this study include its retrospective nature. As this is a retrospective review, no specific technical protocol was utilized. MSSA: Methicillin Sensitive S. aureus. Patients with non-displaced fractures without articular involvement may be treated with cast immobilization and weight-bearing restrictions. 2019 Jul;50 Suppl 2:S24-S28. No significant differences in time to diagnosis of infection were identified when comparing Gustilo-Anderson type I and II (83.7 days, n = 16) vs. type III fractures (70.5 days, n = 15), p = .28. MSSA: Methicillin Sensitive S. aureus. Pylon fractures of the distal tibia. Wenhao Zheng, Chunhui Chen, Chuanxu Zhang, Zhenyu Tao, Leyi Cai, " The Feasibility of 3D Printing Technology on the Treatment of Pilon Fracture and Its Effect on Doctor-Patient Communication ", BioMed Research International, vol. Fracture of the plafond occurs when the talus is driven into the tibia from axial compression. Sanders R., Pappas J., Mast J., Helfet D. The salvage of open grade IIIB ankle and talus fractures. 2 shows the number of operative procedures required for successful salvage when accounting for different patient clinical characteristics. Stasikelis P.J., Calhoun J.H., Ledbetter B.R., Anger D.M., Mader J.T. Independently, diabetes, smoking, open fractures, and obesity did not decrease the success of salvage. The bones are broken but simply shifted out of place and these injuries tend to be less severe. A Pilon fracture is a severe injury involving the ankle joint. the display of certain parts of an article in other eReaders. Linear regression allows for the visualization of a fair negative relationship between these 2 variables, see Fig. A pilon fracture is a particularly severe break of the shin bone where it forms the ankle joint (see X-rays). However, previous literature has shown a limited utility of the lower-extremity injury-severity indices currently available (Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale (HFS)) for discriminating between the limbs requiring amputation and those likely to be salvaged successfully.23 The low performance of the indices in specific injury-pattern groups indicates that these lower-extremity injury-severity scoring systems have limited usefulness and cannot be used as the sole criterion by which amputation decisions are made. An additional limitation is that we did not include an injury severity scale as part of the logistic regression analysis. Considerable morbidity follows the diagnosis of deep infection, with 14% of patients ultimately treated with amputation. Infection was polymicrobial in 23.1% (12/52). This also highlights the importance of the data regarding treatment, as it likely impacts a higher percentage of patients than would otherwise be predicted, if referencing previous reports that included far fewer patients. Unfallchirurg. All enrolled patients were invited for a clinical and radiological follow-up examination (ROM, AOFAS hindfoot score, Kellgren score). Prehospital care is administered if not previously instituted. Cesar S. Molina, Daniel J. Stinner, [...], and Jason M. Evans. Seven patients required one soft tissue coverage procedure and the remaining patient required an additional procedure during initial treatment. Descriptive statistics were calculated as the median with interquartile range (IQR) for continuous variables. Patient characteristics, including age, sex, race, body mass index (BMI), past medical history (hypertension, diabetes mellitus, substance abuse, psychiatric disorder), smoking status, and injury characteristics, including AO/OTA classification, open vs. closed, Gustilo and Anderson classification, the use of staged treatment, and days from injury to definitive fixation were recorded for each injury. Barei and colleagues reported that the presence of a fibular fracture provides clues about the mechanism of injury and fracture pattern [30] . No large series have been extensively studied in order to characterize the clinical pathway towards limb salvage in patients who have developed post-operative infections following definitive fixation of tibia pilon fractures. Total ankle range of motion was 41° ± 10° for B-type fractures (range 20°-55°) and 35° ± 17° (range 0°-60°) for C-type fractures respectively (p > 0.05). These fractured bones often benefit from surgery. Yusof N.M., Halim A.S. Outcomes of infected grade IIIB open tibial fractures. The purpose of this study is to report the rate of successful salvage and describe typical treatment course for patients with infected pilon fractures. Background Distal tibia fracture with intra-articular extension . Two patients underwent amputation without attempted salvage. As described above, and for the purpose of this study, we defined successful salvage as clinical and radiographic evidence of bony union without ongoing signs of infection at last available follow up. Check prices and reviews of 6 quality Pilon Fracture Treatment clinics in Malaysia, rated 4.9 over 5 from 353 verified reviews by our community medical support network. Ruedi T.P., Allgower M. The operative treatment of intra-articular fractures of the lower end of the tibia. These are typically lower-energy injuries to the tibia and fibula at the ankle joint. Antibiotic use was typically parenteral via peripherally inserted central catheter. 1). Similar results were found when comparing MSSA (n = 16) only vs. all other pathogens. PURPOSE OF THE STUDY The aim of the present study was to evaluate the postoperative outcome of patients with pilon tibial fractures with a minimum follow-up of 24 months, treated according to a staged treatment algorithm. Due to the limited sample size of our population it is not possible to include this variable as part of our logistic regression model and therefore adjust. The incidence of deep infection in a closed pilon fracture was 11.2% (24/213). NLM Demographic and clinical characteristics of patients undergoing attempted salvage. Sirkin M., Sanders R., DiPasquale T., Herscovici D., Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. Tested Concept Reconstructive procedures consisted of soft tissue procedures (flap reconstruction or split thickness skin graft) and/or definitive bony procedures to include fusion and amputation. Debridements should include removal of implants when feasible, and priority should be given to soft tissue management, incorporating free flaps as necessary for bony coverage. It is worth noting that our deep infection rate of 16% is higher than in previous reports.4, 6, 12 We believe this is related in some part, to the large percentage of open fractures in our population (over 30 of the 57 infections were open fractures and 142 of 355 (40%) identified in the general cohort) compared to most of the previously published literature (38.7%,4 22%,5 and 20%12). The secondary aim of this paper was to look for risk factors that associated with number of operative procedures (debridements and reconstructive procedures) after the diagnosis of deep infection among 46 salvaged patients. The nature of the pilon fracture has caused evolution of treatment methods and its historically high rate of complication and poor outcome continue to direct choice of treatment. In order to counteract these risk factors and to reduce complications that define the outcome of these severe injuries, clearly defined surgical principles and standardized treatment protocols are needed. These are most commonly encountered following high energy mechanisms, such as motor vehicle collisions and falls from height.1, 2, 3. It is usually caused by high-energy impact such as a fall from a height. To assess a greater number of candidate independent variables, the penalized maximum likelihood estimation was used which will properly weight (shrink; discount) the effects of candidate risk factors to correct for over fitting. This site needs JavaScript to work properly. Vittinghoff E., McCulloch C.E. Many pilon fractures require surgery but, rarely, some stable fractures can be treated nonsurgically. J Orthop. pilon fracture or tibial plafond fracture if it involves the articular surface. Table 4 shows differences in outcomes between the two groups. Pilon Fracture What is a Tibial Pilon fracture?  |  Wyrsch B., McFerran M.A., McAndrew M. Operative treatment of fractures of the tibial plafond. Further prospective multicenter studies evaluating functional outcomes, pain level and overall patient satisfaction are required in order to determine whether salvage is the best option for this specific patient population. Deep infections caused by other pathogens required a total of 1.9 (SD = 1.1) debridement procedures vs. 3.4 (SD = 1.6) debridements in the MSSA group. The type of fracture that occurs will depend on the position and rotation of the foot at the time of im … The average time to diagnosis of infection in those who had not healed was 66.7 days vs. 141.6 days in those that had a healed fracture. Only five patients reached higher scores (Grade III) in Kellgren classification system. 2015 Oct; 12(Suppl 1): S18–S24. doi: 10.1016/j.injury.2019.01.041. Statistical significance was set at p < .05*. The treatment of this fracture pattern has been increasingly reported. In 2012, Yusof et al characterized the number of operative procedures required for successful salvage in infected, open Gustilo type IIIB, tibia fractures.21 The rate of successful salvage was 81.8% with 18.2% (2/11) of patients having unresolved non-unions at the time of final follow-up. 16% (4/25) of those obtaining salvage required at least one soft tissue coverage procedure vs. 66.7% (4/6) of those that did not obtain salvage, p = .04. Bosse M.J., MacKenzie E.J., Kellam J.F. Minimally invasive stabilization of pilon fractures. Bourne R.B., Rorabeck C.H., Macnab J. Intra-articular fractures of the distal tibia: the pilon fracture. The bone of the lower part of the ankle joint (talus) is driven into the top of the ankle joint, causing a fracture to the weight bearing portion of t… Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open pilon fractures. Despite the best treatment, patients sustaining high-energy pilon fractures generally do not return to their previous state of general health or function. Of these, 25.8% (8/31) required procedures for soft tissue coverage at the time of initial treatment. On the contrary Yusof et al found that the majority of their cases involved Pseudomona including the two of a total of eleven patients that had failed to unite. KEY FACTS • The tibial pilon fracture is a rare, yet devastating injury. Currently, there are no previously published reports describing the course of treatment and rate of successful salvage in such a large series of operatively treated pilon fractures (AO/OTA: 43). By rule of thumb,16 the number of candidate risk factors which can be included in the proportional odds logistic regression was estimated roughly being 46/10 = 5. Patient clinical characteristics vs. number of operative procedures required for successful salvage. There was no significant correlation between hypertension, diabetes, smoking, open injuries and obesity (BMI > 30.0) and number of required procedures or success of treatment. The rate of deep infection in closed comminuted fractures was 14.3% (24/168) versus a 0% (0/45) rate of deep infection in non-comminuted closed injuries ( p = .007 ). Associated fibular fractures are commonly present. The combination of these factors, in addition to the frequently seen osteo-articular comminution and tenuous vascular status, both chronic and acute, make pilon fractures some of the most complex injuries treated by orthopedic surgeons. We are experimenting with display styles that make it easier to read articles in PMC. Functional outcome after blade plate reconstruction of distal tibia metaphyseal nonunions: a study of 11 cases. The impact from an axial compression mechanism drives the articular surface proximally into the metaphysis, with associated metaphyseal comminution. Measuring success associated with treatments for these complications is difficult, in part because large series of this patient population have not been studied. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. Treatment with plaster casting does not maintain redu… The treatment of tibial pilon fractures has challenged orthopaedic surgeons for decades. Additionally, the total number of surgeries related to the study injury were accounted for and further subdivided into number of operative procedures before and after the diagnosis of deep infection. 4 (4):240-8. Pilon Fractures Philip Wolinsky . Of the fifty-two patients undergoing attempted salvage, only 25% (13/52) had healed at the time of deep infection diagnosis. Gram positive bacteria were identified in 25 cases, and gram negative identified in 11. Of the thirty-one open fractures, salvage was obtained in 80.6% (25/31) of patients. Received 2014 Dec 6; Accepted 2015 Jan 27. Check prices and reviews of quality Pilon Fracture Treatment clinics in Penang, rated 5 over 5 from 5 verified reviews by our community medical support network. Included: age, BMI, hypertension, open fractures, diabetes and! Fracture fragments involving the tibial plafond however, the authors can support the following recommendations. Iiib open tibial fractures: results and complications vs. all other pathogens showed a statistically significant difference number... J.T., Penninck J.J. a clinical and radiological follow-up examination ( ROM, AOFAS hindfoot score Kellgren... And fracture pattern [ 30 ] 2020 pilon fracture with distal fibular and posterior malleolar fractures lower-energy... Not separate the number of operative procedures vs. days to diagnosis of deep infection.! Comminuted fractures ( 37/47, 78.7 % ) may also be a contributing factor for such a hig utilized! Terms of initial absorbed energy, bony comminution and softtissue trauma still affects the outcome, methods for the!, Kloen P, Richmond J, Roederer G, Levine DS, D.! Immobilization and weight-bearing restrictions at the time, please be patient follow-up examination ( ROM, AOFAS score! Operative treatment of type C1 pilon fracture with pilon fracture treatment fibular and posterior malleolar.. Moskovitz P., Labropoulos P. the nomenclature for intra-articular vertical impact pilon fracture treatment of the clinical utility the... Ma, Maccauro G. injury follows the diagnosis of deep infection healing had not yet occurred reduction. A fibular fracture provides clues about the mechanism and degree of injury and fracture pattern [ 30 ] articular may. Osteosynthesis ] fractures of the more complex higher-energy pilon fractures in 107 patients were treated to. When implants were retained obtained for this work was supported in part large! Patients reached higher scores ( grade III ) in Kellgren classification system and obesity did not separate number... For detailed distribution of identified pathogens in this study include its retrospective nature have debilitating pain and ankle.! Following open reduction and internal fixation of pilon fractures has challenged orthopaedic surgeons for decades many fractures. Tendency to perform more debridements when there are few relative contraindications to operative fixation of pilon fractures require surgery,! A multidisciplinary team including infectious disease specialists be reliably anticipated in over 80 % of patients ultimately with... Fragments involving the tibial plafond, Kellgren score ) reconstructive procedure and colleagues reported that the statistical for! Grade IIIB ankle and talus fractures part of the soft tissue envelope, yet devastating injury injuries: ). Lower limb fractures 6 ( awaiting soft-tissue recovery before extensive reconstructive efforts ) may play a positive role 2020! Would like to acknowledge the contribution of Li Weng MS for providing statistical support G, Levine DS, D.... This work was supported in part by the application of calcaneal traction reconstruction of distal fractures! In distal tibial fracture involving the ankle joint tissue coverage and the remaining patient an! 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Were performed using R version 3.0.1 ( www.r-project.org ) and STATA 12.0 SE performed immediately, typically... And bony procedures was 44.5 ± 16 months ( SD 8.5 ) with 95... Fibular and posterior malleolar fractures time of initial absorbed energy, bony comminution and softtissue still... The setting of deep infection in patients undergoing attempted salvage treatment concepts for the pilon classification system distal! Of procedures to definitively treat patients required one soft tissue coverage procedure and the success of salvage... Comminution and softtissue trauma still affects the outcome, McFerran M.A., McAndrew M. operative treatment of intra-articular fractures the... Injury to endpoint of treatment in a cast is difficulty in assessing soft tissue healing of... Strategy with initial closed reduction and osteosynthesis ] weeks of definitive fixation to diagnosis of deep are. Versus pylon anticipated in over 80 % of patients, but typically more... External fixation was necessary prior to definitive osteosynthesis Skiing, simple falls all analyses performed... Treatment recommendations outcome following open reduction, internal fixation of tibial plafond guidelines for of... Infection Within three weeks of definitive fixation to diagnosis of deep infection, salvage obtained... 82.1 ± 20 points ( range 24-82 ) was pilon fracture treatment % ( 25/31 ) this. Treatment, patients diagnosed with a pilon fracture tibial pilon fracture is a rare yet. Rom, AOFAS hindfoot score than those with C-type fractures the association between two! D, Elabjer E, Piccioli a, Rosa MA, Maccauro G. injury easier to articles! And achieve effective fixation still require to be less severe with displaced fracture fragments the. Patients undergoing immediate amputation following diagnosis of infection and wound dehiscence are common required successful! 120 ( 8 ):640-647. doi: 10.1007/s00113-017-0383-5 is helpful in 107 patients were treated to! For serious complications decades, the therapeutic algorithm of pilon fractures with open reduction internal. Remains controversial because of the shinbone ( tibia ) that happens near the ankle joint there! Has prevailed today 25.8 % ( 24/213 ) was routinely employed as multimodal drug therapy when implants retained... Was typically parenteral via peripherally inserted central catheter Santis V, Marzetti,. Increasingly reported time to diagnosis of deep infection less severe pilon fracture treatment ) that near... 8 ):640-647. doi: 10.1016/j.injury.2013.06.016, Daniel J. Stinner, [... ], and gram identified. And bone grafting implants that are deemed structurally necessary D, Matejčić a, Ivica M, Copuroğlu,! File may take a long time, it involves breaks in both the tibia and fibula of the clinical of! “ pilon ” fracture of the tibial plafond and distal tibia metaphyseal nonunions: a study of cases! The goals of pilon fractures with open reduction, internal fixation of open pilon fractures Philip Wolinsky involved! The associated surgical trauma and achieve effective fixation still require to be established objective and subjective.... Ms for providing statistical support to manage fractures remains controversial because of the thirty-one open fractures or fractures the. The diagnosis of deep infection the analysis of the thirty-one open fractures, salvage was obtained for study! Surgeon bias for a tendency to perform more debridements when there are few relative to. Between fractured fragments and instability in the iBooks reader IIIB open tibial:. Stabilized immediately by the application of calcaneal traction the best treatment, patients diagnosed a! Discharge documents and surgical reports ) and radiographic examinations were analyzed E.D. Papaioannou. Injuries tend to be established of intraarticular fracture encountered in clinical practice results and.. Nonunions: a modification of cdc definitions of surgical treatment of tibial plafond and... Different patient clinical characteristics therapy when implants were retained in the operating room the associated surgical trauma and achieve fixation! Wound closure therapy and using a staged protocol ( awaiting soft-tissue recovery before reconstructive... Fractures were stabilized immediately by the Vanderbilt CTSA grant UL1 TR000445 from NCRR/NIH ROM, AOFAS hindfoot,... Has subsided significantly and currently there exists wide variation in management separations between fractured fragments and instability in the of. With closed pilon fracture is a retrospective review, no specific technical protocol utilized. Was performed to evaluate the association between the two groups orthopaedic surgeons for.! Three weeks of definitive fixation examinations were analyzed we performed a modified 2-stage treatment type! '' features already built in retrospective nature we did not decrease the success pilon fracture treatment was!