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Ortho-Plastic Approach in Management of Open Pilon Fractures

CATEGORY: Trauma; Ankle INTRODUCTION/PURPOSE: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to det...

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Autores principales: Lim, Jiang An, Thahir, Azeem, Krkovic, Matija
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696333/
http://dx.doi.org/10.1177/2473011420S00331
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author Lim, Jiang An
Thahir, Azeem
Krkovic, Matija
author_facet Lim, Jiang An
Thahir, Azeem
Krkovic, Matija
author_sort Lim, Jiang An
collection PubMed
description CATEGORY: Trauma; Ankle INTRODUCTION/PURPOSE: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines including relatively aggressive bone debridement. METHODS: A retrospective analysis of open pilon fractures treated between 2014 and 2019 was conducted. Injuries were graded according to the Gustillo-Anderson classification and all patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot & Ankle Score (AOFAS) at 6 months after definitive surgery. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 (Range: 3-24) hours. Definitive fixation was performed when the wound was healed, with the mean time from primary surgery to definitive surgery being 24.5 (Range: 7-60) days. RESULTS: There was a total of 20 patients. The mean age was 50.5 (Range: 16-88) years. Follow-up was for an average of 25.1 (Range: 9-36) months. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 9.3 (Range: 4-18) months. The mean AOFAS score was 64.4 (Range: 15-90). Definitive treatment via Taylor Spatial Frame was performed on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement, while 3 patients had Stimulan beads with antibiotics. There were no cases of deep infection, however a superficial wound infection was found in 9 patients (45%). CONCLUSION: Results of our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with antibiotics, external fixators and patient tailored timing of definitive surgery achieves low rates of wound infection and complications for patients with open pilon fractures. We suggest treating these fractures with the availability of Orthoplastic care and with an MDT approach.
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spelling pubmed-86963332022-01-28 Ortho-Plastic Approach in Management of Open Pilon Fractures Lim, Jiang An Thahir, Azeem Krkovic, Matija Foot Ankle Orthop Article CATEGORY: Trauma; Ankle INTRODUCTION/PURPOSE: The BOAST (British Orthopaedic Association Standards for Trauma) guidelines do advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines including relatively aggressive bone debridement. METHODS: A retrospective analysis of open pilon fractures treated between 2014 and 2019 was conducted. Injuries were graded according to the Gustillo-Anderson classification and all patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot & Ankle Score (AOFAS) at 6 months after definitive surgery. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 (Range: 3-24) hours. Definitive fixation was performed when the wound was healed, with the mean time from primary surgery to definitive surgery being 24.5 (Range: 7-60) days. RESULTS: There was a total of 20 patients. The mean age was 50.5 (Range: 16-88) years. Follow-up was for an average of 25.1 (Range: 9-36) months. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 9.3 (Range: 4-18) months. The mean AOFAS score was 64.4 (Range: 15-90). Definitive treatment via Taylor Spatial Frame was performed on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement, while 3 patients had Stimulan beads with antibiotics. There were no cases of deep infection, however a superficial wound infection was found in 9 patients (45%). CONCLUSION: Results of our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with antibiotics, external fixators and patient tailored timing of definitive surgery achieves low rates of wound infection and complications for patients with open pilon fractures. We suggest treating these fractures with the availability of Orthoplastic care and with an MDT approach. SAGE Publications 2020-11-06 /pmc/articles/PMC8696333/ http://dx.doi.org/10.1177/2473011420S00331 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Lim, Jiang An
Thahir, Azeem
Krkovic, Matija
Ortho-Plastic Approach in Management of Open Pilon Fractures
title Ortho-Plastic Approach in Management of Open Pilon Fractures
title_full Ortho-Plastic Approach in Management of Open Pilon Fractures
title_fullStr Ortho-Plastic Approach in Management of Open Pilon Fractures
title_full_unstemmed Ortho-Plastic Approach in Management of Open Pilon Fractures
title_short Ortho-Plastic Approach in Management of Open Pilon Fractures
title_sort ortho-plastic approach in management of open pilon fractures
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696333/
http://dx.doi.org/10.1177/2473011420S00331
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