The Outcomes of Pilon Fracture Treatment: Primary Open Reduction and Internal Fixation Versus Two stage Approach

Background: Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is animportant factor in choosing treatment options. Two major methods of treatment are considered as one-stage openreduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter ismost accepted in literature. In the current study, we compared the results of these two methods.Methods: In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection(superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, painintensity, and patients’ satisfaction with AOFAS score, were compared between the two groups.Results: There was no significant difference between the two groups in measured variables except hospital staywhich was significantly longer for the two-stage group.Conclusion: Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type Cand Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.Level of evidence: II

Keywords:

External fixation , Infection , Open reduction internal fixation , Pilon fracture , Two-stage surgery