FUNCTIONAL OUTCOME AFTER SEVERE OPEN PILON FRACTURES: RESULTS AFTER EARLY INTERNAL FIXATION AND SOFT TISSUE COVER

Abstract

32 consecutive patients who suffered open [Gustilo grade IIIB] distal tibial [AO type 43B and C] ‘Pilon’ fractures were prospectively studied in order to assess long-term functional outcome. All patients had radical debridement with immediate [within 24hrs] skeletal stabilisation and early soft tissue cover with a vascularized muscle flap as per our hospital’s protocol for management of severe open tibial fractures. The minimum follow-up was one year [range 1–8 years]. The superficial infection rate was 13% [4/32], deep infection rate was 6% [2/32] and the amputation rate as 6% [2/32]. There were no long-term problems with union and none of the patients required an ankle fusion. Patients were assessed using the SF-36 questionnaire. There were sig-nificant differences from the US norm in physical function score [p< 0.01], role physical score (p< 0.05) and physical component score (p< 0.01). Physical component score of 38.5 was significantly better (p< 0.01) when compared with amputees from severe lower extremity trauma. Our protocol for management of severe open pilon fractures resulted in a good functional outcome with low infection and amputation rates.