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The injury characteristics of open pilon fractures predictive of complications

Published:January 13, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.019

      Highlights

      • Open pilon fractures are severe, limb-threatening injuries and are at risk for wound complications requiring return trips to the operating room.
      • The OTA open fracture classification is an additional tool to assist in stratifying and assessing the severity of an open pilon injury.
      • In our cohort, a patient was at risk for an early amputation if they presented with segmental bone loss (OTA-OFC bone loss grade 3).
      • Major wound complications occurred with: fall > 3 m, multifragmentary articular surface, segmental fibula fracture, or OTA-OFC contamination grade 3.

      Abstract

      Objective

      Determine predictive injury factors for wound complications in open pilon fractures (OTA/AO 43B and 43C).

      Design

      Retrospective Case Series.

      Setting

      Level I Trauma Center.

      Patients/participants

      A total of 61 open pilon fractures in 60 patients were evaluated after meeting inclusion and exclusion criteria.

      Intervention

      The majority of injuries underwent a staged protocol with immediate antibiotics, debridement, irrigation and external fixation. Following soft tissue stabilization, internal fixation was performed and wound closure achieved in a coordinated fashion depending on the type of closure required.

      Main outcome measurements

      Early amputation rate, 90-day major (wound dehiscence or deep infection requiring operative intervention) and minor (superficial infection) wound complications.

      Results

      Four patients incurred early amputations, 11 had major wound complications and 5 had minor wound complications. An early amputation was more likely if they presented with an OTA Open Fracture Classification (OTA-OFC) Bone Loss Grade 3. A major wound complication was more likely if they presented with a fall from > 3 m, a multifragmentary articular surface, a segmental fibula fracture, or an OTA-OFC Contamination Grade 3. A multifragmentary articular surface was also predictive of developing any wound complication.

      Conclusions

      Open pilon fractures are severe, limb-threatening injuries and are at risk for wound complications. Patients presenting with these injuries and a predictive factor should be counseled regarding the possibility of early limb loss or experiencing a wound complication that will require additional treatment.

      Level of evidence

      Level III

      Keywords

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