title: Type C tibial pilon fractures: short- and long-term outcome following operative intervention.
abstract: OBJECTIVE
  The aim of this study was to report the outcome following primary fixation or a staged protocol for type C fractures of the tibial plafond.
  
  
  METHODS
  We studied all patients who sustained a complex intra-articular fracture (AO type C) of the distal tibia over an 11-year period. The primary short-term outcome was infection. The primary long-term outcome was the Foot and Ankle Outcome Score (FAOS).
  
  
  RESULTS
  There were 102 type C pilon fractures in 99 patients, whose mean age was 42 years (16 to 86) and 77 were male. Primary open reduction internal fixation (ORIF) was performed in 73 patients (71.6%), whilst 20 (19.6%) underwent primary external fixation with delayed ORIF. There were 18 wound infections (17.6%). A total of nine (8.8%) were deep and nine were superficial. Infection was associated with comorbidities (p = 0.008), open fractures (p = 0.008) and primary external fixation with delayed ORIF (p = 0.023). At a mean of six years (0.3 to 13; n = 53) after the injury, the mean FAOS was 76.2 (0 to 100) and 72% of patients were satisfied.
  
  
  CONCLUSIONS
  This is currently the largest series reporting the outcome following fixation of complex AO type C tibial pilon fractures. Despite the severity of these injuries, we have demonstrated that a satisfactory outcome can be achieved in the appropriate patients using primary ORIF. Cite this article: Bone Joint J 2016;98-B:1106-11.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Duckworth
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Jefferies
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
authors.forename: T O
authors.initials: TO
authors.lastname: White
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Fracture; Open reduction internal fixation; Outcome; Pilon; Tibia