External frame fixation aided stable reduction of pilon fractures

LAS VEGAS — Fragments of pilon fractures could be adequately reduced without exposing the soft tissues of the ankle to additional trauma when investigators at Ashford and St. Peters NHS Foundation Trust used Ilizarov external frames for indirect reduction, fixation and stabilization of fractures, according to a presentation given here.

Ashwin Unnithan, MBBS, MSc, FRCS (Ortho), and colleagues studied 97 consecutive patients with a pilon fracture seen at the Trust, which is a regional referral center for patients who need Ilizarov frame fixation. All the patients were treated with frame fixation. They had 54 months mean follow-up. The mean time to union for the fractures was 6 months.

During his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting, Unnithan said this study was among the larger series of pilon fractures treated with external fixation frames.

“What did we learn from this and what is the take home message? What we have found is patients referred to us, after Ilizarov distraction, do better, but I have not got statistical evidence to show that. An anatomic ankle reconstruction is what you should aim for,” Unnithan said. “And the most important thing, as all of us know, is treat the patient, not the X-ray.”

Forty patients achieved an anatomical reconstruction based on the Teeny and Wiss criteria. The investigators evaluated various factors, including imaging, to determine the extent of surgical complications in these cases and assess clinical outcomes retrospectively.

Based on their review, more than twice as many men presented with these fractures than women. The distraction frames were applied an average of 9 days post-injury.

Thirty-five patients of 97 patients developed a pin site infection which was determined to be deep in three patients, superficial in 30 patients, and both superficial and deep in two patients. The patients with superficial infections were treated with oral antibiotics, and those with deep infections received intravenous antibiotics, according to the findings.

Other complications included some cases of deep vein thrombosis, one pulmonary embolism and four patients who later required ankle fusions. – by Susan M. Rapp

Reference:

Unnithan A, et al. Paper #132. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.

Disclosure: Unnithan reports no relevant financial disclosures.