The injury characteristics of open pilon fractures predictive of complications

Objective: Determine predictive injury factors for wound complications in open pilon fractures (OTA/AO 43B and 43C).

Design: Retrospective Case Series.

Setting: Level I Trauma Center.

Patients/participants: A total of 61 open pilon fractures in 60 patients were evaluated after meeting inclusion and exclusion criteria.

Intervention: The majority of injuries underwent a staged protocol with immediate antibiotics, debridement, irrigation and external fixation. Following soft tissue stabilization, internal fixation was performed and wound closure achieved in a coordinated fashion depending on the type of closure required.

Main outcome measurements: Early amputation rate, 90-day major (wound dehiscence or deep infection requiring operative intervention) and minor (superficial infection) wound complications.

Results: Four patients incurred early amputations, 11 had major wound complications and 5 had minor wound complications. An early amputation was more likely if they presented with an OTA Open Fracture Classification (OTA-OFC) Bone Loss Grade 3. A major wound complication was more likely if they presented with a fall from > 3 m, a multifragmentary articular surface, a segmental fibula fracture, or an OTA-OFC Contamination Grade 3. A multifragmentary articular surface was also predictive of developing any wound complication.

Conclusions: Open pilon fractures are severe, limb-threatening injuries and are at risk for wound complications. Patients presenting with these injuries and a predictive factor should be counseled regarding the possibility of early limb loss or experiencing a wound complication that will require additional treatment.

Level of evidence: Level III.