Descriptive statistics were calculated as the median with interquartile range (IQR) for continuous variables. already built in. pilon fracture or tibial plafond fracture if it involves the articular surface. These include a rate of successful salvage in patients diagnosed with deep infection of 88.5% (46/52). Adam Bernatsky, DPM discusses the history of pilon fracture treatment. Generating an ePub file may take a long time, please be patient. Successful salvage can be reliably anticipated in over 80% of patients, but typically requires more than 3 additional procedures. In addition, defining successful treatment is difficult due to a range of endpoints, including healed fracture, arthrodesis, or amputation, making true comparison difficult. Clinical and radiographic outcomes in patients operated for complex open tibial pilon fractures. A major disadvantage to closed treatment in a cast is difficulty in assessing soft tissue healing. It is usually caused by high-energy impact such as a fall from a height. Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open pilon fractures. The mechanism and degree of injury involved dictate the fracture pattern and the treatment approach to pilon fractures. You may notice problems with Pilon Fractures Philip Wolinsky . Dr Bernatsky also reviews the pilon classification system as well as analyzes pilon fracture management. Etienne Destot introduced the term tibial pilon in 1991 where pilon is a French word for pharmacist’s pestle that has a similar shape to the area of distal tibia metaphysis extending 5cm from ankle joint 2. These are most commonly encountered following high energy mechanisms, such as motor vehicle collisions and falls from height.1, 2, 3. Of the thirty-one open fractures, salvage was obtained in 80.6% (25/31) of patients. The total number of procedures, including procedures for debriding and of reconstructive nature, was also higher in this group, 5.1 (SD = 2.5) vs. 2.7 (SD = 1.7), p = .013. See Table 2 for detailed distribution of identified pathogens in this study population. Minimally invasive stabilization of pilon fractures. If the infection was diagnosed following healing, which occurred in only 25% of our cohort, the debridement for treatment typically included removal of implants. All patients were managed via a multidisciplinary team including infectious disease specialists. Additionally, we did not separate the number of reconstructive procedures needed for soft tissue or bony healing. Six patients went on to amputation after attempted salvage, with a mean of 5.3 (±2.3) total procedure post-infection procedures, 2.3 (±1.4) debridements and 3 (±1.3) reconstructions. Patient clinical characteristics vs. number of operative procedures required for successful salvage. Panchbhavi VK. Treatment with plaster casting does not maintain redu… COVID-19 is an emerging, rapidly evolving situation. The mean follow-up time was 44.5 ± 16 months (range 24-82). All enrolled patients were invited for a clinical and radiological follow-up examination (ROM, AOFAS hindfoot score, Kellgren score). Barei and colleagues reported that the presence of a fibular fracture provides clues about the mechanism of injury and fracture pattern [30] . 2005. The incidence of deep infection in a closed pilon fracture was 11.2% (24/213). In the ankle, if you land heavily on your ankle the bones in the ankle can impact forcefully together and the tibial bone or shin bone can break near the ankle. An additional limitation is that we did not include an injury severity scale as part of the logistic regression analysis. The authors report that the statistical analysis for this work was supported in part by the Vanderbilt CTSA grant UL1 TR000445 from NCRR/NIH. 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. 26(2):273-85. . The thin soft tissue envelope surrounding the ankle is susceptible to disruption with violent injury, resulting in open fracture wounds that commonly require secondary coverage procedures.4, 5 Even when not associated with open wounds, the closed soft tissue injury is often severe enough to alter surgical treatment in a variety of ways. Rev Chir Orthop Reparatrice Appar Mot. Most pilon fractures have multiple breaks. Rifampin was routinely employed as multimodal drug therapy when implants were retained. Gram positive bacteria were identified in 25 cases, and gram negative identified in 11. Despite the best treatment, patients sustaining high-energy pilon fractures generally do not return to their previous state of general health or function. 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. The rate of deep infection in closed comminuted fractures was 14.3% (24/168) versus a 0% (0/45) rate of deep infection in non-comminuted closed injuries ( p = .007 ). HHS As described above, and for the purpose of this study, we defined successful salvage as clinical and radiographic evidence of bony union without ongoing signs of infection at last available follow up. 1-10% of LE fx’s . The ePub format is best viewed in the iBooks reader. (ORIGINAL ARTICLE) by "Journal of Evolution of Medical and Dental Sciences"; Health, general Bone transplantation Bone-grafting Fractures Care and treatment Fractures (Injuries) Internal … 1995 Apr. 2 shows the number of operative procedures required for successful salvage when accounting for different patient clinical characteristics. Horan T.C., Gaynes R.P., Martone W.J., Jarvis W.R., Emori T.G. Received 2014 Dec 6; Accepted 2015 Jan 27. NIH Background Distal tibia fracture with intra-articular extension . University of California at Davis Medical Center . A sub-analysis was performed to evaluate the correlation between the number of soft tissue coverage procedures as part of the initial treatment and the number of procedures required for definitive treatment of deep infection. Fracture of the plafond occurs when the talus is driven into the tibia from axial compression. Zalavras C.G., Patzakis M.J., Thordarson D.B., Shah S., Sherman R., Holtom P. Infected fractures of the distal tibial metaphysis and plafond: achievement of limb salvage with free muscle flaps, bone grafting, and ankle fusion. View doctor profiles, clinic contact information and photos. After recovery from pilon fractures, many patients continue to have debilitating pain and ankle stiffness. Free Online Library: Treatment of closed tibial pilon fractures with open reduction, internal fixation and bone grafting. doi: 10.1016/j.injury.2015.10.067. 2017 Aug;120(8):640-647. doi: 10.1007/s00113-017-0383-5. 4 (4):240-8. Bourne R.B., Rorabeck C.H., Macnab J. Intra-articular fractures of the distal tibia: the pilon fracture. Of the fifty-two patients undergoing attempted salvage, only 25% (13/52) had healed at the time of deep infection diagnosis. Unfallchirurg. Michelson J., Moskovitz P., Labropoulos P. The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon. 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. 20-25% are open . 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). However, the initial severity of the fracture in terms of initial absorbed energy, bony comminution and softtissue trauma still affects the outcome. 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. Can be treated nonsurgically it usually happens typically lower-energy injuries to treat difficulty in soft! 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