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High-energy tibial pilon fractures: an instructional review

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Abstract

High-energy tibial pilon fractures continue to represent a significant challenge to the treating orthopaedic surgeon. Pre-operative evaluation includes a careful clinical assessment of the associated soft tissue injury, which frequently dictates surgical management. Staged surgical reconstruction remains the standard treatment protocol at most trauma centres. This includes application of a temporary spanning external fixator for approximately one to four weeks, followed by open reduction and internal fixation once the surrounding soft tissues are amendable. Despite careful soft tissue management protocols, the risk of wound complications continues to be relatively high compared to other orthopaedic trauma procedures. The functional long-term outcomes of these injuries remain limited, and recent data has emphasised that the majority of patients do not regain their pre-operative work status. In addition, the health-related quality of life scores fare poorly when compared to other orthopaedic and non-orthopaedic patient populations, and many patients develop post-traumatic arthritis within the tibiotalar joint. It has been shown that the quality of fracture reduction may significantly correlate with the long-term functional outcomes. While the orthopaedic community has come a long way with regard to safe management of high-energy tibial pilon fractures, the clinical outcomes continue to remain limited. In particular, the persistently high rates of wound complications and the limited functional long-term outcomes leave significant room for improvement. Future investigators may focus on further innovations to minimise the risk of wound complications. The surgical team may emphasise the quality of fracture reduction as an important treatment goal.

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Authors and Affiliations

  1. Department of Orthopaedics, UT Health San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA

    Boris A. Zelle, Khang H. Dang & Samuel S. Ornell

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  1. Boris A. Zelle
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  2. Khang H. Dang
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  3. Samuel S. Ornell
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Correspondence to Boris A. Zelle.

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Conflict of interest

BAZ has received research grants from DePuySynthes, Inc., KCI Inc., and the Orthopaedic Trauma Association. BAZ has received speaker honoraria from AO Trauma North America. BAZ has received an educational grant from Smith & Nephew Inc. KHD and SSO declare that they have no conflict of interest.

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Zelle, B.A., Dang, K.H. & Ornell, S.S. High-energy tibial pilon fractures: an instructional review. International Orthopaedics (SICOT) 43, 1939–1950 (2019). https://doi.org/10.1007/s00264-019-04344-8

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