Management of Open versus Closed Pilon Fractures: Comparison of Outcomes and Complications

Description

In this medical presentation, Victor Lu, a fifth-year medical student from the University of Cambridge, discusses the treatment outcomes of open and closed pilon fractures using a consistent treatment algorithm. He highlights the challenges of managing these high-impact injuries and the importance of surgical techniques, namely open reduction and internal fixation (ORIF) and external fixation with a fine wire frame.



Lu elaborates on the complexity of ORIF due to potential complications, such as severe soft tissue compromise and deep infections, and points out that external fixation may minimize surgical trauma and better preserve blood supply. He presents data from a study involving 91 closed fractures and 50 open fractures, identifying key demographics and treatment results, including follow-up outcomes and complications.



The presentation includes statistical insights, such as AOFAS scores demonstrating a general upward trend in recovery, and outlines rates of non-union and infection. Lu discusses specific cases of complications like deep infections, neurological deficits, and instances requiring more aggressive treatment approaches, such as bone grafting. Furthermore, he emphasizes the efficacy of a two-staged approach combining external fixation followed by definitive fixation for optimal recovery.



The discussion transitions to a Q&A segment where audience members, including Jitendra Mangwani and Robert Clayton, inquire about the implications of infection rates comparative to different fixation methods, the classification of soft tissue damage, and the criteria for selecting surgical interventions based on fracture patterns.



Overall, the presentation underscores the nuanced decision-making required in the management of pilon fractures and the ongoing need for clinical assessment and adaptation of surgical strategies.

DOI: 10.1302/3114-221393

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