Open Pilon Fracture Postoperative Outcomes with Definitive Surgical Management Options: A Systematic Review and Meta-analysis.

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Abstract

9. Unfallchirurg. 2017 Aug;120(8):648-651. doi: 10.1007/s00113-017-0377-3. [Operative access for treatment of pilon fractures]. [Article in German] Klaue K(1). Author information: (1)Reparto di Chirurgia Ortopedica, Clinica Luganese, 6900, Lugano, Schweiz. k.klaue@bluewin.ch. BACKGROUND: Under optimal conditions, fractures of the tibial pilon can be definitively managed operatively within 6 h after the trauma. Under suboptimal conditions, preoperative antiphlogistic treatment, possibly after approximate correction and external fixation of the alignment, is a reasonable option. Osteosynthesis implies reconstruction of good joint congruency in anatomical orientation. The soft tissue coverage of the distal lower leg is relatively poorly constructed and there is a high risk of devascularization, necrosis and ensuing infection. THERAPY: Several local accesses with complete visual control of the joint surface enable a strain-free soft tissue handling and thus reduction of the incidence of complications. Besides a specific access to the fibula fracture, two anterior and two posterior accesses are proposed based on normal vascularization. These accesses can be simultaneously combined. Using a bone distractor facilitates control of the joint surface. CONCLUSION: Open reduction and stabilization of pilon fractures enables rapid restoration of joint mobility. After having analyzed the fracture and setting the priorities, the treatment strategy should include a well-thought out selection of possible accesses. DOI: 10.1007/s00113-017-0377-3