OTA 2006 Posters

OTA 2006 Posters

Scientific Poster #34 Foot and Ankle

Tibial Pilon Fractures: Open Reduction and Internal Fixation versus External Fixation. A Meta-Analysis
Barnaby Todd Dedmond, MD¹ (n); William Barfield, PhD² (n);
Langdon A. Hartsock, MD² (a-Synthes); Rafath Baig, MD² (n);
Kyle E. Watford, MD³ (n);
¹Wake Forest University, Winston-Salem, North Carolina, USA;
²Medical University of South Carolina, Charleston, South Carolina, USA;
³Palmetto Health Richland, Columbia, South Carolina, USA

Purpose/Hypothesis: We hypothesized that open reduction and internal fixation (ORIF) of tibial pilon fractures would result in a decreased arthrodesis rate, but have a greater incidence of deep infection compared to external fixation.

Methods: An English language literature review since the landmark study of Ruedi and Allgower in 1969 was performed. Criteria for inclusion in the meta-analysis included classification by the Ruedi and Allgower or AO/Orthopaedic Trauma Association (OTA) classification, treatment by external fixation or ORIF, and reporting of deep infection and arthrodesis rates. 26 studies involving 876 pilon fractures444 treated with external fixation and 432 treated with ORIFmet the inclusion criteria and were included in the meta-analysis. Data were analyzed by the chi square method.

Results: When all patients were considered, the incidence of deep infection was similar in the external fixation and ORIF groups (5.0% vs. 7.4%, Not Significant). The highest deep infection rate, 12%, was found in the Ruedi and Allgower Type 3 or AO/OTA 43C fractures which underwent ORIF. This compares to a 4% rate in patients with similar fractures who underwent external fixation as definitive treatment (P = 0.01). Interestingly, in the high-velocity Ruedi and Allgower Type 3 and AO/OTA 43C fractures, the rate of arthrodesis in the patients treated with ORIF was greater than those treated with external fixation (11.5% vs. 5.3%, P = 0.025). The addition of limited internal fixation to external fixation did not affect the development of posttraumatic degenerative joint disease as the arthrodesis rate was similar for patients undergoing external fixation with limited ORIF compared to those with external fixation alone (4.4% vs. 3.6%, Not Significant).

Conclusions: External fixation is the treatment of choice for high-velocity tibial pilon fractures with lower rates of deep infection and similar rates of late arthrodesis compared to ORIF. The addition of limited internal fixation does not improve the arthrodesis rate.

Significance: Despite the early success of Ruedi and Allgower in the open treatment of tibial pilon fractures, several subsequent studies suggested less than optimal results with open treatment of these injuries, leading to greater utilization of external fixation. Recently, however, many orthopaedic surgeons have once again been moving toward ORIF of pilon fractures. The results of this meta-analysis suggest that external fixation may be the treatment of choice, especially in the high-velocity injury.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.