Skip to main content
NCBI home page
International Orthopaedics logoLink to International Orthopaedics
. 2003 Jul 8;27(6):343–347. doi: 10.1007/s00264-003-0486-1

Early internal fixation and soft tissue cover of severe open tibial pilon fractures

J Conroy 1, M Agarwal 1, P V Giannoudis 1,✉, S J E Matthews 1
PMCID: PMC3461889  PMID: 12851785

Abstract

We studied 32 consecutive patients with open distal tibial pilon fractures. All patients had radical debridement with immediate skeletal stabilisation and early soft-tissue cover with a vascularized muscle flap. The minimum follow-up was 1 (range 1–8) year. There were four superficial infections, two deep infections and two amputations. There were no long-term problems with union and no patient required an ankle fusion. Patients were assessed using the SF-36 questionnaire. There were significant differences from the US norm in physical function score (p<0.01), role physical score (p<0.05) and physical component score (p<0.01). Physical component score of 38.5 was significantly better (p<0.01) when compared with amputees from severe lower-extremity trauma. Our protocol for management resulted in a good functional outcome with low infection and amputation rates.

Full Text

The Full Text of this article is available as a PDF (217.7 KB).

References

  • 1.BabisClin Orthop 1997341999269161 [Google Scholar]
  • 2.Bone Orthop Clin North Am. 1987;18:95. [PubMed] [Google Scholar]
  • 3.BoneClin Orthop 19932921018519096 [Google Scholar]
  • 4.BourneClin Orthop 1989240422917444 [Google Scholar]
  • 5.BourneJ Trauma 1983235916876212 [Google Scholar]
  • 6.Dagum AB, Best AK, Schemitsch EH et al (1999) Salvage after severe lower-extremity trauma: Are the outcomes worth the means? Plast and Reconstr Surg 103:1212–1219 [DOI] [PubMed]
  • 7.Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM (2000) Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg [Br] 82:959–966 [DOI] [PubMed]
  • 8.Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg [Am] 58:453–458 [PubMed]
  • 9.GustiloJ Trauma 1984247426471139 [Google Scholar]
  • 10.Kellam J Trauma. 1979;19:593. doi: 10.1097/00005373-197908000-00007. [DOI] [PubMed] [Google Scholar]
  • 11.McHorney Med Care. 1993;31:247. doi: 10.1097/00005650-199303000-00006. [DOI] [PubMed] [Google Scholar]
  • 12.McHorney Med Care. 1994;32:40. doi: 10.1097/00005650-199401000-00004. [DOI] [PubMed] [Google Scholar]
  • 13.Muller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, Berlin Heidelberg New York, pp 171–179
  • 14.Ovadia DN, Beals RK (1986) Fractures of the tibial plafond. J Bone Joint Surg [Am] 68:543–551 [PubMed]
  • 15.Patterson MJ, Cole JD (1999) Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 13:85–91 [DOI] [PubMed]
  • 16.Pugh J Trauma. 1999;47:937. doi: 10.1097/00005373-199911000-00022. [DOI] [PubMed] [Google Scholar]
  • 17.Ruedi Injury. 1969;1:92. [Google Scholar]
  • 18.Ruedi TP, Allgower M (1979) The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop. 138:105–110 [PubMed]
  • 19.Sands A, Grujic L, Byck DC, Agel J, Benirschke S, Swiontkowski MF (1998) Clinical and functional outcomes of internal fixation of displaced pilon fractures. Clin Orthop. 347:131–137 [PubMed]
  • 20.Scheck SM (1965) Treatment of comminuted distal tibial fractures by surgery. J Bone Joint Surg [Am] 47:1537–1543 [PubMed]
  • 21.Sirkin J Orth Trauma. 1999;13:78. doi: 10.1097/00005131-199902000-00002. [DOI] [PubMed] [Google Scholar]
  • 22.Teeny Clin Orthop. 1993;292:108. [PubMed] [Google Scholar]
  • 23.Tornetta P 3rd, Weiner L, Bergman M et al (1993) Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma. 7:489–496 [DOI] [PubMed]
  • 24.Ware Med Care. 1992;30:473. [PubMed] [Google Scholar]
  • 25.Ware JE, Snow KK, Kosinski M, Gandek B. (1993) SF-36 health survey. Manual and interpretation guide. QualityMetric, Lincoln, RI, USA
  • 26.WatsonClin Orthop 20003757810853156 [Google Scholar]
  • 27.Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, Schwartz HS (1996) Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg [Am] 78:1646–1657 [DOI] [PubMed]

Articles from International Orthopaedics are provided here courtesy of Springer-Verlag

RESOURCES