Fusion Versus Fixation in Complex Comminuted C3-type Tibial Pilon Fractures: a Systematic Review

Overview

Journal Patient Saf Surg

Publisher Biomed Central

Date 2021 Oct 19

PMID 34663412

Citations 4

Authors

Yash P Chaudhry

Efstratios Papadelis

Hunter Hayes

Philip F Stahel

Erik A Hasenboehler

Affiliations

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Abstract

Background: Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed [1] treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and [2] primary ankle arthrodesis as a management option for these types of complex injuries.

Methods: A systematic literature search was performed on PubMed from 1990 to 2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures. The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: "tibial pilon"/"pilon fracture"/"plafond fracture"/"distal tibial"/"43-C3"/"ankle fracture"/"ankle fusion"/"primary ankle arthrodesis"/"pilon fracture staged"/"pilon external fixation" and "pilon open reduction internal fixation." Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a "PICO" approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications.

Results: The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group.

Conclusions: At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

Citing Articles

An Examination of Personalized Approaches in the Management of Ankle Fractures: A Thorough Evaluation of Soft Tissue Factors, Treatment Methods, and Patient Adherence.

Cursaru A, Popa M, Lupu A, Iordache S, Costache M, Cretu B Cureus. 2023; 15(9):e45507.

PMID: 37868385 PMC: 10585051. DOI: 10.7759/cureus.45507.

Pilon fractures: Consensus and controversy.

Flores M, Ciminero M, Kottmeier S, Botros D, Zelle B, Shearer D OTA Int. 2023; 6(3 Suppl):e236.

PMID: 37533444 PMC: 10392439. DOI: 10.1097/OI9.0000000000000236.

Evaluation of effects of small-incision approach treatment on proximal tibia fracture by deep learning algorithm-based magnetic resonance imaging.

Li X, Yu H, Li F, He Y, Xu L, Xiao J Open Life Sci. 2023; 18(1):20220624.

PMID: 37426618 PMC: 10329276. DOI: 10.1515/biol-2022-0624.

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures.

Gao Y, Zhu H, Guo Y, Yu X J Pers Med. 2023; 13(3).

PMID: 36983732 PMC: 10051139. DOI: 10.3390/jpm13030551.

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