Open reduction and internal fixation of tibial pilon fractures using a lateral approach.
OBJECTIVE
To assess the wound complications and reductions achieved in a cohort of patients with pilon fractures who were treated using a novel lateral approach.


METHODS
Retrospective review.


METHODS
Two level 1 trauma centers affiliated with academic institutions.


METHODS
All 44 fractures (in 43 patients) treated by the senior authors with open reduction and internal fixation (ORIF) using the lateral approach as the primary approach were included.


METHODS
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. Eighteen fractures were open injuries (10 type 3). Fracture reductions were scored using the criteria of Teeny and Wiss.


METHODS
Quality of articular reduction and soft-tissue healing.


RESULTS
An anatomic or good fracture reduction was achieved in 41 fractures (93%), and a fair reduction was obtained in 3 fractures. Two patients were successfully treated for deep infection (4.5%), and 2 patients developed a wound dehiscence (4.5%). There were no amputations. Twelve patients underwent secondary surgeries (27%). Five of these were for symptomatic screw removal (related to the fibular hardware in all cases), and the sixth was for planned removal of a syndesmotic-type screw (13.6%). Four were for nonunion, representing 9% of all cases. The remaining secondary surgeries (2 cases) were performed for infection. Overall, 13.6% of patients underwent a secondary surgical procedure to address nonunion or infection.


CONCLUSIONS
When applied in a staged fashion, the lateral surgical approach for pilon fractures provides excellent protection of the soft-tissue envelopes by creating thick flaps while allowing excellent visualization for reconstruction of the anterior and lateral distal tibia.
Grose
Andrew
A
SUNY Upstate Medical University, Syracuse, New York, USA. docgrose@gmail.com
Gardner
Michael J
MJ
Hettrich
Carolyn
C
Fishman
Felicity
F
Lorich
Dean G
DG
Asprinio
David E
DE
Helfet
David L
DL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005596:Fractures, Closed / Q000601:surgery*; D005597:Fractures, Open / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000601:surgery*; D014193:Trauma Centers; D016896:Treatment Outcome