Pilon fractures are complex intra-articular fractures of the tibial plafond associated with significant short and long morbidity. Minimising surgical complications is essential. Clinical and radiological outcomes in 49 patients with AO type 43B and 43C fractures were evaluated retrospectively. Definitive management depended on patient factors, soft tissue injury and fracture pattern.Background:
Methods:
There is little evidence from the literature regarding the timing of hip fracture surgery for patients who are on the antiplatelet agent clopidogrel bisulphate (Plavix) (1). We report the results of a retrospective case control study of 40 patients comparing the timing of surgery for patients taking clopidogrel against a control group of those not taking an antiplatelet agent. Time to surgery, length of stay, transfusion requirements, wound problems and other post operative complications were examined. Within the study group of patients taking clopidogrel, we also compared those who underwent surgery within four days of stopping the clopidogrel and after four days. The transfusion requirements were greater in those patients on clopidogrel prior to admission. Wound healing and post operative complications were similar between the two groups. Total length of hospital stay and post operative length of stay were longer in the clopidogrel group. There was an increase in transfusion requirements and post operative length of stay in patients on clopidogrel undergoing early surgery (within 4 days) compared to the group where surgery was delayed. We conclude that, in this small study, transfusion requirements and length of stay were greater in patients on clopidogrel. Transfusion requirements and post operative length of stay were also greater if surgery was performed within four days of omitting clopidogrel. Further studies are required to determine optimal timing of surgery following discontinuation of clopidogrel.
