Abstract
Pilon fractures are associated to significant soft tissue injury, as well as soft tissue complications. The soft tissue on the medial side of the distal tibia is often involved, likely due to a lack of muscle investment. Medial approaches and medial plate application may well add to the soft tissue trauma. The objective of this study was to examine the relationship between medial plating and soft tissue complications in our center.
This is a retrospective study based on a prospective database. Pilon cases treated with plate and screw fixation were identified between 2011 and 2014. Injury characteristics, patient demographics, and soft tissue complications were collected from chart review. Soft tissue complications recorded included any wound or skin problem, as well as patient complaints of hardware irritation leading to hardware removal. Logistic regression was employed. Independent variables for the model included medial plating, the presence of open fracture, smoking status and diagnosis of diabetes. Two models were created, one with the dependent variable as presence of any soft tissue complication, and the second model with the dependent variable as presence of a wound complication, which required surgical intervention.
The study included 91 patients, 89 of whom had full data with an average follow up of 11.6 months (1–33 months). The incidence of soft tissue complications, including hardware irritation, was 26% (n=23), and 13% (n=12) required surgical treatment. Smoking status was the only predictor of soft tissue complications with an odds ratio of 3.6 (95%CI 1.2, 10.4; p=0.02), while controlling for other independent variables. The model explained 12% of the variation in soft tissue complications (Cox and Snell 0.119, p=0.028). In the second model, presence of a medial plate predicted soft tissue complications requiring surgical intervention with an odds ratio of 8.8 (95%CI 1.1, 73.7; p=0.045), while controlling for the other independent variables. The model explained 10% of the variation in soft tissue complications requiring surgical intervention (Cox and Snell 0.095, p=0.035).
The use of a medial plate does not appear to correlate to general soft tissue complications in pilon fractures. Smoking status increased the odds of a soft tissue complication more than three fold. The use of medial plating did increase the odds of soft tissue complications that required surgical treatment almost nine fold. It appears medial plating is not related to soft tissue complications, however treating soft tissue compilations in the presence of a medial plate may require more invasive methods.
