The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two stage Approach

Abstract

Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is an<br />important factor in choosing treatment options. Two major methods of treatment are considered as one-stage open<br />reduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter is<br />most accepted in literature. In the current study, we compared the results of these two methods.<br />Methods: In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21<br />patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection<br />(superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, pain<br />intensity, and patients' satisfaction with AOFAS score, were compared between the two groups.<br />Results: There was no significant difference between the two groups in measured variables except hospital stay<br />which was significantly longer for the two-stage group.<br />Conclusion: Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type C<br />and Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.<br />Level of evidence: II