Complications associated with the posterolateral approach for pilon fractures.
OBJECTIVE
To review the complication rates of open reduction and internal fixation (ORIF) of tibial pilon fractures using the posterolateral approach.


METHODS
Retrospective review.


METHODS
Two level I trauma centers.


METHODS
Nineteen consecutive pilon fractures at an average of 13 (range, 13-45) months follow-up. Average age 46 (range, 21-72) years. Four of 19 were open fractures.


METHODS
Because of the high incidence of wound complications associated with the anterior approach for pilon fractures, patients were treated with initial temporary external fixation followed by delayed ORIF through the posterolateral approach to the distal tibia. The hypothesis was that the abundant soft-tissue coverage of the posterior distal tibia would decrease the rate of wound complications.


METHODS
The incidence of wound complications, nonunion, and early posttraumatic arthritis. This was a chart and radiograph retrospective review.


RESULTS
The mean time to definitive treatment was 13 (range 2-30) days. Nine of 19 patients (47%) developed complications. There were 6 patients with wound problems, 2 patients with aseptic nonunions, 2 patients with infected nonunions, 3 tibiotalar fusions, and 1 patient with a 3-mm step off. In total, there were 14 major complications in 9 patients. Ten of 19 patients did not have any complication.


CONCLUSIONS
The posterolateral approach does not eliminate the complications common to other approaches, but does offer a potential alternative when soft tissue concerns prevent other approaches. We do not recommend the posterolateral approach for the routine treatment of tibial pilon fractures.
Bhattacharyya
Timothy
T
Partners Orthopaedic Trauma Service, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, MA 02114, USA.
Crichlow
Renn
R
Gobezie
Ruben
R
Kim
Edward
E
Vrahas
Mark S
MS
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D017102:Fracture Healing; D005597:Fractures, Open / Q000601:surgery; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors