title: Outcome of 28 open pilon fractures with injury severity-based fixation.
abstract: BACKGROUND
  Open pilon fracture management and treatment poses a significant challenge to orthopedic surgeons. The purpose of this study was to determine patient outcomes for open pilon fractures based on wound complication and infection rates, as well as subjective outcome instruments.
  
  
  METHODS
  This was a retrospective consecutive case series of 28 fractures with Orthopaedic Trauma Association (OTA)-type 43-B and 43-C open pilon fractures. Mean length of follow-up was 36 months and minimum of 1 year. Ten fractures were Gustilo and Anderson grade IIIB, and the remaining fractures were grades I-IIIA. Patients were initially treated with spanning external fixation and staged wound debridement followed by osteosynthesis of the articular surface. Metaphyseal fixation was by either plate fixation or Ilizarov frame. The primary outcome was the incidence of deep tissue infection requiring surgery. Secondary outcomes included the incidence of other complications (nonunion, malunion, amputation) and functional outcomes (Short Musculoskeletal Functional Assessment Questionnaire and AAOS Foot and Ankle Questionnaire).
  
  
  RESULTS
  Four patients developed deep tissue infections, three in the internal fixation group and one in the Ilizarov group, and all were treated successfully with staged debridement. There were two delayed unions required bone grafting, and infection-free union was ultimately achieved in all fractures. Two patients underwent arthrodesis secondary to post-traumatic arthritis, while no patients experienced malunions or amputations.
  
  
  CONCLUSIONS
  The use of staged wound debridement in conjunction with either plate fixation or Ilizarov frame achieves low rates of wound infection and stable fixation after anatomic joint reconstruction for OTA-type 43-B and 43-C open pilon fractures.
authors.affiliation: Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th St., PH1130, New York, NY, 10032, USA, jd2814@columbia.edu.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Danoff
authors.forename: Comron
authors.initials: C
authors.lastname: Saifi
authors.forename: David C
authors.initials: DC
authors.lastname: Goodspeed
authors.forename: J Spence
authors.initials: JS
authors.lastname: Reid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000150:complications / Q000601:surgery; D001168:Arthritis / Q000209:etiology / Q000601:surgery; D001174:Arthrodesis; D001860:Bone Plates / Q000009:adverse effects; D016025:Bone Transplantation; D003646:Debridement; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery; D006801:Humans; D018889:Ilizarov Technique / Q000009:adverse effects / Q000295:instrumentation; D057072:Intra-Articular Fractures / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D016474:Weight-Bearing; D014946:Wound Infection / Q000209:etiology* / Q000601:surgery; D055815:Young Adult