Considerable morbidity follows the diagnosis of deep infection, with 14% of patients ultimately treated with amputation. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Several methods of treatment have been proposed for these fractures, including nonoperative treatment, open reduction internal fixation, limited open reduction with external fixation, and closed reduction with external fixation.4,17,29 Ayeni1 reported that 50% of his patients experienced poor objective results with nonoperative treatment involving splints or casts. Send an enquiry and get response fast - Updated Nov 2020 See Table 2 for detailed distribution of identified pathogens in this study population. KEY FACTS • The tibial pilon fracture is a rare, yet devastating injury. Patients with closed pilon tibial fractures reached significantly higher values in the AOFAS hindfoot score than those with open ones. Deep infections caused by other pathogens required a total of 1.9 (SD = 1.1) debridement procedures vs. 3.4 (SD = 1.6) debridements in the MSSA group. Linear regression allows for the visualization of a fair negative relationship between these 2 variables, see Fig. Treatment / Management There are few relative contraindications to operative fixation of pilon fractures. Pilon Fractures • Complex injuries • Bone and Soft Tissue Injury – Delicate skin, little underlying soft tissue, obstructions to surgical approach • High Risk for complications & poor outcomes No injury Injury, note soft tissue Pilon Fractures: Early Treatment • Ruedi, AllgowerCORR 1979 – Early treatment He is now 3 weeks from injury and skin swelling has subsided significantly. Patients who were successfully salvaged required an average of 3.5 (±2.3) total procedures following diagnosis of infection, 2.5 (±1.5) debridements and 1.1 (±1.2) reconstructive procedures (see Fig.  |   |  The nature of the pilon fracture has caused evolution of treatment methods and its historically high rate of complication and poor outcome continue to direct choice of treatment. View doctor profiles, clinic contact information and photos. The treatment of tibial pilon fractures has challenged orthopaedic surgeons for decades. Panchbhavi VK. Due to the limited sample size of our population it is not possible to include this variable as part of our logistic regression model and therefore adjust. This information will provide surgeons and patients with a framework to develop an individualized treatment plan and allow for an informed decision making process when presented with a diagnosis of deep infection in the setting of pilon fracture. Outcome following open reduction and internal fixation of open pilon fractures. View doctor profiles, clinic contact information and photos. PURPOSE OF THE STUDY The aim of the present study was to evaluate the postoperative outcome of patients with pilon tibial fractures with a minimum follow-up of 24 months, treated according to a staged treatment algorithm. Patients who were successfully salvaged required an average of 3.5 (±2.3) procedures following diagnosis of infection, 2.5 (±1.5) debridements and 1.1 (±1.2) reconstructive procedures. Total ankle range of motion was 41° ± 10° for B-type fractures (range 20°-55°) and 35° ± 17° (range 0°-60°) for C-type fractures respectively (p > 0.05). USA.gov. A search of Current Procedural Terminology (CPT) codes for pilon fractures (27827, 27826 and 27828) was performed using the above criteria. Reconstructive procedures include both soft tissue and bony procedures. This also highlights the importance of the data regarding treatment, as it likely impacts a higher percentage of patients than would otherwise be predicted, if referencing previous reports that included far fewer patients. 16% (4/25) of those obtaining salvage required at least one soft tissue coverage procedure vs. 66.7% (4/6) of those that did not obtain salvage, p = .04. MSSA: Methicillin Sensitive S. aureus. The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension. The strengths of this study include the large number of patients identified, accounting for debridements and reconstructive procedures after a diagnosis of deep infection, 95% follow-up, with only 3 patients with insufficient data, and the optimal statistical models used to analyze these variables. Key words:pilon, distal tibia fracture, outcome, algorithm. Debridements should include removal of implants when feasible, and priority should be given to soft tissue management, incorporating free flaps as necessary for bony coverage. Table 4 shows differences in outcomes between the two groups. Some pilon fractures do not need surgical treatment. Variables contributing to poor results and complications. The mechanism and degree of injury involved dictate the fracture pattern and the treatment approach to pilon fractures. All patients fifteen years or older treated definitively with ORIF of pilon fractures at our institution between January 1, 2006 and December 31, 2011 were identified from an institutional billing database. MRSA: Methicillin Resistant S. aureus. Cesar S. Molina, Daniel J. Stinner, [...], and Jason M. Evans. Sirkin M., Sanders R., DiPasquale T., Herscovici D., Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. Reed L.K., Mormino M.A. [Fractures of the tibial pilon. A pilon fracture is a type of distal tibial fracture involving the tibial plafond. Further prospective multicenter studies evaluating functional outcomes, pain level and overall patient satisfaction are required in order to determine whether salvage is the best option for this specific patient population. Pilon refers to the actions of a pestle crushing into a mortar. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. pilon fracture or tibial plafond fracture if it involves the articular surface. Ruedi T.P., Allgower M. The operative treatment of intra-articular fractures of the lower end of the tibia. CONCLUSIONS The present study confirms the fact that meticulous planning, respect of the soft-tissues and choice of the optimal timepoint for the definitive osteosynthesis and overall treatment according to standardized protocols can optimize the outcome of this severe injury. Received 2014 Dec 6; Accepted 2015 Jan 27. Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. Comminuted fractures (AO/OTA: 43A3, 43B3, 43C2 and 43C3) compose 78.9% (168/213) of this subset. Vacuum-assisted wound closure therapy and using a staged protocol (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role. However, methods for minimizing the associated surgical trauma and achieve effective fixation still require to be established. Of the fifty-two patients undergoing attempted salvage, only 25% (13/52) had healed at the time of deep infection diagnosis. There often are large separations between fractured fragments and instability in the tibia and fibula at the ankle joint. 20-25% are open . In this infected cohort, the initial treatment used a staged protocol including external fixation and delayed open reduction internal fixation in 82.5% (47/57). Pilon Fracture What is a Tibial Pilon fracture? These are typically lower-energy injuries to the tibia and fibula at the ankle joint. Only two of the eleven patients were diagnosed with a pilon fracture (AO/OTA: 43), both of which healed. However, the initial severity of the fracture in terms of initial absorbed energy, bony comminution and softtissue trauma still affects the outcome. Further analysis was performed to evaluate the association between the need for soft tissue coverage and the success of attempted salvage. Pilon fractures are complex injuries to the ankle region with disrupt the main weight bearing region of the shinbone (tibial) part of the ankle. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. 26(2):273-85. . Fig. Functional outcome after blade plate reconstruction of distal tibia metaphyseal nonunions: a study of 11 cases. A deep infection rate of 16.1% was identified, with a total of 57 deep infections in 355 operatively treated pilon fractures (142/355 (40%) open vs. 213/355 60% closed). What is the most appropriate definitive treatment? The authors agree with traditional recommendations of smoking cessation and nutritional optimization. Vittinghoff E., McCulloch C.E. Epub 2019 Feb 2. The fracture of the tibial plafond or pilon fracture is an uncommon but difficult fracture to manage. First described by Destot 35 in 1911, ankle fractures that involve the weight-bearing articular surface, or floor, of the distal tibia are known as pilon fractures. Implant retention, removal, and utilization of local antibiotics were entirely at the discretion of the treating surgeon, all of whom are experienced in managing post-traumatic infections and non-unions. already built in. Silluzio N, De Santis V, Marzetti E, Piccioli A, Rosa MA, Maccauro G. Injury. All clinics verified by ministry of health Malaysia. The number of procedures following the diagnosis of deep infection was not found to be associated with age, BMI, diagnosis of hypertension, open vs. closed injuries, AO classification, diagnosis of diabetes mellitus, and tobacco use (Table 3). We performed both univariate analysis and the penalized multivariable proportional odds model and both indicated that there is not enough evidence to identify an association between risk factors and the outcome. In this infected cohort, the initial treatment used a staged protocol including external fixation and delayed open reduction internal fixation in 82.5% (47/57). The average total number of operative procedures in the successful salvage population was 3.8 (SD = 1.0) with an average of 2.3 (SD = 0.7) debridements and 1.4 (SD = 0.9) reconstructive procedures. Overall, the patients scored 82.1 ± 20 points (range 30-100) in AOFAS hindfoot score, which represents a good clinical outcome. doi: 10.1016/j.injury.2015.10.067. CPME (Credits: 0.5) Epub 2015 Nov 14. A pilon fracture is a particularly severe break of the shin bone where it forms the ankle joint (see X-rays). Whether or not your doctor recommends surgery often depends on how out of place (displaced) the fractured pieces of bone are. Tested Concept The mean follow-up time was 44.5 ± 16 months (range 24-82). Seven patients required one soft tissue coverage procedure and the remaining patient required an additional procedure during initial treatment. Infection was polymicrobial in 23.1% (12/52). Boraiah S., Kemp T.J., Erwteman A., Lucas P.A., Asprinio D.E. Marsh J.L., Slongo T.F., Agel J. Fracture and dislocation classification compendium – 2007: Orthopaedic Trauma Association classification, database and outcomes committee. Additionally, we did not separate the number of reconstructive procedures needed for soft tissue or bony healing. Prehospital care is administered if not previously instituted. See Table 1 for clinical and operative characteristics of this retrospective cohort. The bone of the lower part of the ankle joint (talus) is driven into the top of the ankle joint, causing a fracture to the weight bearing portion of t… MATERIAL AND METHODS In total, 27 patients (mean age 43.6 ± 13 years, range 18-69) with a pilon tibial fracture and a minimum follow-up of 24 months were included in the study. No large series have been extensively studied in order to characterize the clinical pathway towards limb salvage in patients who have developed post-operative infections following definitive fixation of tibia pilon fractures. Rifampin was routinely employed as multimodal drug therapy when implants were retained. Most pilon fractures have multiple breaks. The purpose of this study is to report the rate of successful salvage and describe typical treatment course for patients with infected pilon fractures. Check prices and reviews of quality Pilon Fracture Treatment clinics in Penang, rated 5 over 5 from 5 verified reviews by our community medical support network. Teeny S.M., Wiss D.A. A sub-analysis of open fractures showed a salvage rate of 93.8% (15/16) in type I and II Gustilo-Anderson fractures vs. 66.7% (10/15) in type III fractures, p = .06. DISCUSSION Within the last decades, the therapeutic algorithm of pilon fractures underwent a paradigm shift; a two-stage protocol has prevailed today. Ovadia D.N., Beals R.K. Fractures of the tibial plafond. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Attempted salvage was performed in fifty-two of the fifty-four patients with the remaining two patients undergoing immediate amputation following diagnosis of deep infection. 1998 Apr;84(2):180-8. Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL. We performed a modified 2-stage treatment of type C1 pilon fracture with distal fibular and posterior malleolar fractures. Bonin, 11 in 1950, described the same fracture as a “plafond” fracture because the fracture disrupted the roof of the ankle joint. Orthop Clin North Am. COVID-19 is an emerging, rapidly evolving situation. The ePub format uses eBook readers, which have several "ease of reading" features 2013 Oct;44(10):1270-4. doi: 10.1016/j.injury.2013.06.016. The ePub format is best viewed in the iBooks reader. Clipboard, Search History, and several other advanced features are temporarily unavailable. The majority of the time, pilon fractures are severe enough with displaced fracture fragments involving the ankle joint that they require surgical intervention. Injury. Nonsurgical Treatment Open reduction and internal fixation of tibial plafond fractures. Pilon Fractures Philip Wolinsky . All patients can be offered salvage with reasonable expectations of success, but should anticipate and plan for three to four additional procedures and a protracted course. If the infection was diagnosed following healing, which occurred in only 25% of our cohort, the debridement for treatment typically included removal of implants. Differences in outcomes by time from definitive fixation to diagnosis of infection. This investigation was performed after gathering a Six-year retrospective database from a single academic trauma center including patients with pilon fractures diagnosed with post-operative deep infection. Cierny G., 3rd, Mader J.T., Penninck J.J. A clinical staging system for adult osteomyelitis. 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