Session IV - Foot & Ankle

Fri., 10/6/06 Foot & Ankle, Paper #19, 10:15 am

Primary Internal Fixation of AO Type C Pilon Fractures Is Safe

Tim White, MD, FRCS (n); Stephen Kennedy, MD (n);
Cameron Cooke, MD (n); Kurt Droll, MD, FRCSC (n);
Piotr Blachut, MD, FRCSC (n); Peter O'Brien, MD, FRCSC (n);
Division of Orthopaedic Trauma, University of British Columbia,
Vancouver, British Columbia, Canada

Purpose: 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.

Methods: A consecutive cohort of 95 patients with AO type C pilon fractures underwent primary ORIF. Of these patients, 21 had open fractures. 68 fractures were sustained in falls, 21 in motor vehicle collision, 5 in crushing injuries, and 1 in an aircraft crash. The principal outcome measure was wound dehiscence or infection requiring surgery. Radiologic and functional outcomes were assessed at a mean of 5 years using the SF36 and the Foot and Ankle Outcome Score.

Results: Primary ORIF was performed within 24 hours in 70% of cases, and within 48 hours of injury in 88% of cases. Reduction was anatomic in 90% of cases. Six (6%) patients developed a wound infection or dehiscence that required surgical debridement. Four complications occurred after open fractures, and two after closed fractures. Of these two, one occurred in a patient with local scarring from previous trauma, insulin-dependent diabetes mellitus, and chronic alcohol abuse, and the other in a patient with schizophrenia, diabetes, and peripheral neuropathy. Overall, the deep infection rate was 4 of 21 (19%) for open fractures and 2 of 74 (3%) for closed fractures. Radiographic follow-up revealed a low incidence of severe osteoarthritic degeneration. Functional outcomes revealed a reduced level of general health and mild disability.

Conclusion: Provided surgery is performed expeditiously by experienced orthopaedic trauma surgeons, AO type C pilon fractures can be stabilized safely and effectively by primary ORIF with very low rates of wound complications, a high quality of reduction, and a good long-term outcome that compares very favorably to all other reported modalities of treatment.

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· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.