Two-staged delayed open reduction and internal fixation of severe pilon fractures

Objective: To evaluate the use of a two-staged technique for the treatment of C3 pilon fractures. Design: Retrospective. Setting: Level 1 trauma center. Patients/Participants: Twenty-one consecutive patients with twenty-two C3 pilon fractures. Patients with C1 or C2 fractures and patients with open growth plates were excluded. Intervention: All patients underwent immediate fibular fixation and placement of a medial spanning external fixator. After, on average, twenty-four days, patients underwent removal of the external fixator and formal open reduction and internal fixation of the pilon fractures. Main Outcome Measurements: At average follow-up of twenty-two months, all patients were evaluated by using subjective, objective, and radiographic measurements as described by Burwell and Charnley (J Bone Joint Surg 1965;47B:634-659). Range of motion and postoperative complications were also recorded. Results: Twenty-one of the twenty-two fractures healed within an average of 3.2 months. Average range of motion was 7 degrees of dorsiflexion, 33 degrees of plantar flexion, 17 degrees of eversion, and 11 degrees of inversion. Subjective and objective measurements showed 77 percent good results, 14 percent fair results, and 9 percent poor results. Radiographic reduction showed 73 per cent anatomic and 27 percent fair reductions. There were no infections or soft tissue complications. The arthrodesis rate was 9 percent. Conclusions: A two-staged approach offers acceptable results for the treatment of severe pilon fractures. These results compare favorably with those of primary open reduction and of internal fixation and external fixation techniques. The major advantages include limited soft tissue complications and improved articular reconstruction.