Anterolateral approach to the distal tibia for fixation of pilon fractures: Rate of wound complications in the early postoperative period

Michael S Khazzam, Gregory J. Della Rocca, Allison M. Wade, Yvonne M. Murtha, Brett D. Crist

Research output: Contribution to journalArticle

Abstract

Background Pilon fractures continue to be a treatment challenge. The purpose of this study was to examine our rate of early (up to 6 weeks) complications associated with using the anterolateral approach to the distal tibia. Methods Thirty-six patients treated between September, 2005, and July, 2007, at a level I trauma center were reviewed. Patients were treated by two fellowship-trained orthopaedic trauma surgeons. Patients followed the standard staged protocol used for pilon fractures with early external fixation after injury and delayed definitive operative fixation through an anterolateral approach. Patients were examined clinically at 2-3 weeks and then 6 weeks for complications associated with the surgical approach. Results All fractures were AO/OTA type C fractures (72% C3, 19% C2, and 8% C1). Nine of the 36 patients (24.7%) had wound complications related to the anterolateral incision. Six patients (16.7%) had minor complications, and three (8%) had major complications. The three major complications were deep wound infections; the six minor complications were treated successfully with oral antibiotics and local wound care. Conclusions Open reduction and internal fixation of pilon fractures using an anterolateral approach provided an extensile approach to the distal tibia and ankle with a relatively low incidence of major early wound complications in a series of patients with highly complex pilon fractures.

Original languageEnglish (US)
Pages (from-to)111-115
Number of pages5
JournalCurrent Orthopaedic Practice
Volume23
Issue number2
DOIs
StatePublished - Mar 2012

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Fracture Fixation
Tibia
Postoperative Period
Wounds and Injuries
Internal Fracture Fixation
Trauma Centers
Wound Infection
Ankle
Anti-Bacterial Agents
Incidence

Keywords

  • Anterolateral approach
  • Distal tibia
  • Pilon fractures
  • Wound complications

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Anterolateral approach to the distal tibia for fixation of pilon fractures : Rate of wound complications in the early postoperative period. / Khazzam, Michael S; Della Rocca, Gregory J.; Wade, Allison M.; Murtha, Yvonne M.; Crist, Brett D.

In: Current Orthopaedic Practice, Vol. 23, No. 2, 03.2012, p. 111-115.

Research output: Contribution to journalArticle

Khazzam, Michael S ; Della Rocca, Gregory J. ; Wade, Allison M. ; Murtha, Yvonne M. ; Crist, Brett D. / Anterolateral approach to the distal tibia for fixation of pilon fractures : Rate of wound complications in the early postoperative period. In: Current Orthopaedic Practice. 2012 ; Vol. 23, No. 2. pp. 111-115.
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abstract = "Background Pilon fractures continue to be a treatment challenge. The purpose of this study was to examine our rate of early (up to 6 weeks) complications associated with using the anterolateral approach to the distal tibia. Methods Thirty-six patients treated between September, 2005, and July, 2007, at a level I trauma center were reviewed. Patients were treated by two fellowship-trained orthopaedic trauma surgeons. Patients followed the standard staged protocol used for pilon fractures with early external fixation after injury and delayed definitive operative fixation through an anterolateral approach. Patients were examined clinically at 2-3 weeks and then 6 weeks for complications associated with the surgical approach. Results All fractures were AO/OTA type C fractures (72{\%} C3, 19{\%} C2, and 8{\%} C1). Nine of the 36 patients (24.7{\%}) had wound complications related to the anterolateral incision. Six patients (16.7{\%}) had minor complications, and three (8{\%}) had major complications. The three major complications were deep wound infections; the six minor complications were treated successfully with oral antibiotics and local wound care. Conclusions Open reduction and internal fixation of pilon fractures using an anterolateral approach provided an extensile approach to the distal tibia and ankle with a relatively low incidence of major early wound complications in a series of patients with highly complex pilon fractures.",
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AB - Background Pilon fractures continue to be a treatment challenge. The purpose of this study was to examine our rate of early (up to 6 weeks) complications associated with using the anterolateral approach to the distal tibia. Methods Thirty-six patients treated between September, 2005, and July, 2007, at a level I trauma center were reviewed. Patients were treated by two fellowship-trained orthopaedic trauma surgeons. Patients followed the standard staged protocol used for pilon fractures with early external fixation after injury and delayed definitive operative fixation through an anterolateral approach. Patients were examined clinically at 2-3 weeks and then 6 weeks for complications associated with the surgical approach. Results All fractures were AO/OTA type C fractures (72% C3, 19% C2, and 8% C1). Nine of the 36 patients (24.7%) had wound complications related to the anterolateral incision. Six patients (16.7%) had minor complications, and three (8%) had major complications. The three major complications were deep wound infections; the six minor complications were treated successfully with oral antibiotics and local wound care. Conclusions Open reduction and internal fixation of pilon fractures using an anterolateral approach provided an extensile approach to the distal tibia and ankle with a relatively low incidence of major early wound complications in a series of patients with highly complex pilon fractures.

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