Pilon fractures - Treatment protocol based on severity of soft tissue injury

One hundred seven pilon fractures in 107 patients were treated according to a staged prospective protocol. All pilon fractures were stabilized immedia tely by the application of calcaneal traction. Open fractures or fractures in patients with multiple injuries were stabilized with traveling traction that was applied in the operating room. A distraction computed tomography s can was obtained before definitive treatment. Treatment groups were based o n the degree of soft tissue compromise. Forty-one patients with Tscherne Gr ade 0 or Grade I injuries underwent open reduction and internal fixation (o pen plating) using contemporary techniques and low-profile implants. Sixty- four patients with Tscherne Grade II and Grade III closed injuries and all patients with open fractures underwent definitive treatment with limited op en reduction and stabilization using small wire circular external fixators. Clinical and radiographic evaluations were performed at an average 4.9 yea rs after injury. For all fracture types (AO classification), 81% of the pat ients who were treated with external fixation and 75% of the patients who w ere treated with open plating had good or excellent results. For severe fra cture patterns (Type C), patients in both groups had significantly poorer r esults than patients with Types A and B fractures. The patients in the open plating group had a significantly higher rate of nonunion, malunion, and s evere wound complications compared with the patients who received external fixation for Type C fracture patterns. Because of the increased incidence o f bony and soft tissue complications when treating open or closed Type C fr actures, use of limited exposures and stabilization with small wire circula r external fixators is recommended.