Definitive management of open pilon fractures with fine wire fixation. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Lim, Jiang An; Thahir, Azeem; Zhou, Andrew Kailin; Girish, Milind; Krkovic, Matija
• Is Part Of: Injury. Volume 51:Issue 11(2020)
• Page Start: 2717
• Page End: 2722
• Publication Date: 2020-11
• Subjects: Open pilon fractures -- Outcomes -- AOFAS -- Fine wire fixation; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.08.029
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Definitive management of open pilon fractures can be achieved using Fine Wire Fixation alongside BOAST guidelines. Staged treatment algorithm with patient tailored conversion from spanning external fixator to fine wire frame achieves low rates of complication. Statistically significant longer time for both partial and full weight bearing in G/A Type III fractures compared to Type I and Type II fractures. Statistically significant longer time for FWF application in G/A type III fractures compared to Type I and Type II fractures. Abstract: Introduction: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines alongside a treatment protocol which consisted of early wound debridement and spanning external fixation, delayed soft tissue coverage with a flap when necessary and delayed definitive fixation with the use of a Fine Wire Fixator. Material and methods: We conducted a retrospective analysis of open pilon fractures treated between 2014 and 2019. All patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot and Ankle Score (AOFAS) at 12 months post injury. Results: There were 20 patients including 16 males and 4 females. The mean age was 50.45 years. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 hours. The mean time from primary surgery to definitive fixation was 24.5 days. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 10.4 (Range: 2-18) months. The mean AOFAS score was 74.2 (Range: 28-97). A Taylor Spatial Frame was used on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement. There was 1 case of deep infection and 9 cases of superficial infection. There were also 4 cases of delayed union which required bone grafting from their femur using a RIA (Reamer Irrigation Aspirator). Conclusion: Our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with systemic and local antibiotics, external fixators and patient tailored conversion from spanning external fixator to fine wire frame achieves low rates of wound infection and complications for patients with open pilon fractures.