Treatment protocol for open AO/OTA type C3 pilon fractures with segmental bone loss.
OBJECTIVE
To evaluate the results in patients with open AO/OTA type C3 pilon fractures with segmental bone loss who were treated with a standard treatment protocol.


METHODS
Retrospective case series.


METHODS
Level I trauma center.


METHODS
Of 117 acute open type C pilon fractures treated during the study period, 10 patients with AO/OTA type C3 fractures and segmental metaphyseal bone loss were amenable to treatment with a standard protocol.


METHODS
All patients were treated with immediate debridement and external fixation (stage 1). After a delay of 1-3 weeks, patients with a healthy-appearing soft tissue envelope and no sign of infection underwent open reduction, plate fixation, and antibiotic bead placement (stage 2). Several months later, planned bone grafting was performed (stage 3).


METHODS
The complication rate, additional procedures, and time to bony union were determined.


RESULTS
The treatment protocol was able to be completed in all 10 patients. No cases of acute infection or wound necrosis after plate fixation and antibiotic bead placement occurred. Two cases of late infection occurred after delayed bone grafting, one of which was successfully treated and the other resulted in amputation. Nine of the 10 patients healed at an average of 24 weeks.


CONCLUSIONS
Limb salvage in the most severe open pilon fractures is difficult. In patients with benign soft tissues at several weeks after temporary external fixation, open reduction, antibiotic bead placement, and a delayed bone grafting procedure are associated with a low complication rate and predictable fracture healing.
Gardner
Michael J
MJ
Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA 98105, USA. michaelgardnermd@gmail.com
Mehta
Samir
S
Barei
David P
DP
Nork
Sean E
SE
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002574:Cervical Vertebrae / Q000601:surgery*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005597:Fractures, Open; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents