Session IV - Foot & Ankle

Open Reduction and Internal Fixation of Pilon Fractures Using a Lateral Approach

Andrew Grose, MD³ (n); Michael J. Gardner, MD³ (n);

Carolyn Hettrich, MD³ (n); Felicity Fishman, MD² (n);

Dean G. Lorich, MD² (n); David E. Asprinio, MD¹ (n);

David L. Helfet, MD³ (e-Member, Synthes Board of Directors);

¹Westchester Medical Center, Valhalla, New York, USA;

²New York-Presbyterian Hospital, New York, New York, USA;

³Hospital for Special Surgery, New York, New York, USA

Purpose: The lateral approach to the ankle has not been described previously for its use in the open reduction and internal fixation (ORIF) of pilon fractures. The purpose of this report was to review all patients who underwent ORIF of pilon fractures treated at our institutions to assess the utility of this approach for achieving anatomic reduction and avoiding soft-tissue complications.

Methods: All 44 fractures (in 43 patients) treated by the senior authors with ORIF using the lateral approach as the primary approach were retrospectively reviewed. Data regarding medical comorbidities, mechanism of injury, soft-tissue injury sustained during the injury, treatment, wound healing, and secondary surgeries were recorded. Fractures were classified using the AO-OTA system with most being type C3. 17 fractures were open injuries (11 type III). Fracture reductions were scored using the criteria of Teeny and Wiss.

Results: Good or anatomic fracture reduction was achieved in 41 fractures (93%) and a fair reduction obtained in 3 fractures. Two patients were treated for deep infection (4.5%), and two patients developed a wound dehiscence (4.5%). There were no amputations.

Conclusions: We showed a 93% rate of good reductions and only a 4.5% rate of deep infection using the lateral approach as the primary approach for ORIF of high-energy pilon fractures. When applied in a staged fashion, this surgical approach provides excellent protection to the soft-tissue envelope by creating thick flaps, while allowing excellent visualization for reconstruction of the anterior and lateral tibial plafond.