A Robust Treatment Algorithm for Pilon Fractures: Our Management and Outcomes

Description

The transcript presents a detailed overview of Victor Lu’s presentation on the outcomes of managing open and closed pilon fractures using a treatment algorithm. Victor, a fifth-year medical student at the University of Cambridge, introduces the context of pilon fractures, which represent a portion of distal tibial fractures. He describes two primary management methods: Open Reduction Internal Fixation (ORIF) and external fixation with fine wire frames.



Victor reiterates the importance of a staged approach to treatment, especially in high-energy fractures, as it allows soft tissue swelling to subside before definitive management. He outlines the treatment algorithm, which guides the choice between fine wire frame application for severely comminuted closed fractures and ORIF for less complex cases.



He shares demographic data from the study, detailing 91 closed and 50 open fractures, with the majority resulting from falls. Key outcomes include AOFAS scores reflecting significant functional recovery and union rates amongst the cohorts, indicating a trend towards improved scores over time post-treatment.



However, complications were noted, particularly infections related to the pin sites, specifically in cases treated with fine wire frames. He notes the identification of factors leading to complications such as mechanical failure and the occurrence of osteomyelitis. Victor also addresses psychosocial elements, discussing patient experiences during recovery after surgical interventions, which further emphasizes patient-centric approaches in trauma care.



In concluding, he highlights the efficacy of combining fine wire frames with minimally invasive procedures and reinforces that a two-staged approach enhances outcomes while maintaining a low complication rate. The presentation ends with an acknowledgment of no financial disclosures or conflicts of interest.

DOI: 10.1302/3114-221524

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