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Early internal fixation and soft tissue cover of severe open tibial pilon fractures

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Abstract

We studied 32 consecutive patients with open distal tibial pilon fractures. All patients had radical debridement with immediate skeletal stabilisation and early soft-tissue cover with a vascularized muscle flap. The minimum follow-up was 1 (range 1–8) year. There were four superficial infections, two deep infections and two amputations. There were no long-term problems with union and no patient required an ankle fusion. Patients were assessed using the SF-36 questionnaire. There were significant differences from the US norm in physical function score (p<0.01), role physical score (p<0.05) and physical component score (p<0.01). Physical component score of 38.5 was significantly better (p<0.01) when compared with amputees from severe lower-extremity trauma. Our protocol for management resulted in a good functional outcome with low infection and amputation rates.

Résumé

Nous avons étudié 32 malades consécutifs avec une fracture ouverte du pilon tibial. Tous les malades avaient un débridement radical avec stabilisation squelettique immédiate et couverture tissulaire précoce avec un lambeau musculaire vascularisé. Le minimum de suivi était une année (1à 8 années). Il y avait 4 infections superficielles, 2 infections profondes et 2 amputations. Il n'y avait pas de problèmes de consolidation à long terme et aucune arthrodèse de cheville ne fut nécessaire. Les malades ont été étudiés à partir du questionnaire SF-36. Il y avait des différences significatives selon la norme américaine du score de la fonction physique (p<0.01), le rôle du score physique (p<0.05) et le score de la composante physique (p<0.01). Le score composant physique de 38.5 était considérablement meilleur (p<0.01) comparé aux amputés pour traumatisme distal sévére. Notre protocole de gestion de ces fractures a conduit à un bon résultat fonctionnel avec un taux d'infection et d'amputation très bas.

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References

  1. Babis GC, Vayanos ED, Papaioannou N, Pantazopoulos T (1997) Results of surgical treatment of tibial plafond fractures. Clin Orthop 341:99–105

    PubMed  Google Scholar 

  2. Bone LB (1987) Fractures of the tibial plafond. The pilon fracture. Orthop Clin North Am 18:95–104

    CAS  PubMed  Google Scholar 

  3. Bone L, Stegemann P, McNamara K, Seibel R (1993) External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop 292:101–107

    PubMed  Google Scholar 

  4. Bourne RB (1989) Pilon fractures of the distal tibia. Clin Orthop 240:42–46

    PubMed  Google Scholar 

  5. Bourne RB, Rorabeck CH, Macnab J (1983) Intra-articular fractures of the distal tibia: the pilon fracture. J Trauma 23:591–596

    CAS  PubMed  Google Scholar 

  6. Dagum AB, Best AK, Schemitsch EH et al (1999) Salvage after severe lower-extremity trauma: Are the outcomes worth the means? Plast and Reconstr Surg 103:1212–1219

    Google Scholar 

  7. Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM (2000) Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg [Br] 82:959–966

    Google Scholar 

  8. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg [Am] 58:453–458

    Google Scholar 

  9. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma 24:742–746

    CAS  PubMed  Google Scholar 

  10. Kellam JF, Waddell JP (1979) Fractures of the distal metaphysis with intra-articular extension: The distal tibial explosion fracture. J Trauma 19:593–601

    CAS  PubMed  Google Scholar 

  11. McHorney CA, Ware JE, Lu JFR, Sherbourne CD (1993) The MOS 36-item short form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247

    PubMed  Google Scholar 

  12. McHorney CA, Ware JE, Lu JFR, Sherbourne CD (1994) The MOS 36-item short form health survey (SF-36): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Care 32:40

    CAS  PubMed  Google Scholar 

  13. Muller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, Berlin Heidelberg New York, pp 171–179

  14. Ovadia DN, Beals RK (1986) Fractures of the tibial plafond. J Bone Joint Surg [Am] 68:543–551

    Google Scholar 

  15. Patterson MJ, Cole JD (1999) Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 13:85–91

    Google Scholar 

  16. Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD (1999) Tibial pilon fractures: a comparison of treatment methods. J Trauma 47:937–941

    CAS  PubMed  Google Scholar 

  17. Ruedi TP, Allgower M (1969) Fractures of the lower end of the tibia into the ankle joint. Injury 1:92–97

    Google Scholar 

  18. Ruedi TP, Allgower M (1979) The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop. 138:105–110

    Google Scholar 

  19. Sands A, Grujic L, Byck DC, Agel J, Benirschke S, Swiontkowski MF (1998) Clinical and functional outcomes of internal fixation of displaced pilon fractures. Clin Orthop. 347:131–137

    Google Scholar 

  20. Scheck SM (1965) Treatment of comminuted distal tibial fractures by surgery. J Bone Joint Surg [Am] 47:1537–1543

    Google Scholar 

  21. Sirkin M, Sanders R, DiPasquale T, Herscovici D (1999) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orth Trauma 13:78–84

    Article  CAS  Google Scholar 

  22. Teeny SM, Wiss DA (1993) Open reduction and internal fixation of tibial plafond fractures. Clin Orthop 292:108–117

    PubMed  Google Scholar 

  23. Tornetta P 3rd, Weiner L, Bergman M et al (1993) Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma. 7:489–496

    Google Scholar 

  24. Ware JE, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30:473

    PubMed  Google Scholar 

  25. Ware JE, Snow KK, Kosinski M, Gandek B. (1993) SF-36 health survey. Manual and interpretation guide. QualityMetric, Lincoln, RI, USA

  26. Watson JT, Moed BR, Karges DE, Cramer KE (2000) Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop 375:78–90

    PubMed  Google Scholar 

  27. Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, Schwartz HS (1996) Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg [Am] 78:1646–1657

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma, St. James University Hospital, Leeds, LS9 7TF, UK

    J. Conroy, M. Agarwal, P. V. Giannoudis & S. J. E. Matthews

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  1. J. Conroy
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  2. M. Agarwal
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  3. P. V. Giannoudis
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  4. S. J. E. Matthews
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Correspondence to P. V. Giannoudis.

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Conroy, J., Agarwal, M., Giannoudis, P.V. et al. Early internal fixation and soft tissue cover of severe open tibial pilon fractures. International Orthopaedics (SICOT) 27, 343–347 (2003). https://doi.org/10.1007/s00264-003-0486-1

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  • DOI: https://doi.org/10.1007/s00264-003-0486-1

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