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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Article info
Publication history
Published online: January 13, 2022
Accepted:
January 11,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
