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Anterolateral approach to the distal tibia for fixation of pilon fractures: rate of wound complications in the early postoperative period

Khazzam, Michaela; Della Rocca, Gregory J.b; Wade, Allison M.c; Murtha, Yvonne M.d; Crist, Brett D.b

doi: 10.1097/BCO.0b013e318244dd9d

Background Pilon fractures continue to be a treatment challenge. The purpose of this study was to examine our rate of early (up to 6 weeks) complications associated with using the anterolateral approach to the distal tibia.

Methods Thirty-six patients treated between September, 2005, and July, 2007, at a level I trauma center were reviewed. Patients were treated by two fellowship-trained orthopaedic trauma surgeons. Patients followed the standard staged protocol used for pilon fractures with early external fixation after injury and delayed definitive operative fixation through an anterolateral approach. Patients were examined clinically at 2–3 weeks and then 6 weeks for complications associated with the surgical approach.

Results All fractures were AO/OTA type C fractures (72% C3, 19% C2, and 8% C1). Nine of the 36 patients (24.7%) had wound complications related to the anterolateral incision. Six patients (16.7%) had minor complications, and three (8%) had major complications. The three major complications were deep wound infections; the six minor complications were treated successfully with oral antibiotics and local wound care.

Conclusions Open reduction and internal fixation of pilon fractures using an anterolateral approach provided an extensile approach to the distal tibia and ankle with a relatively low incidence of major early wound complications in a series of patients with highly complex pilon fractures.

aUniversity of Texas Southwestern Medical Center, Dallas, TX.

bDepartment of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO

cVero Orthopedics and Vero Neurology, Vero Beach, FL

dAdvanced Orthopaedic Associates, Wichita, KS

Financial disclosure: The authors report no financial conflicts of interest. Dr. Crist is a consultant for KCI. He has received grants and/or travel funds from KCI, Medtronic, Pfizer, Synthes, Stryker, Smith & Nephew, Novalign, Wound Care Technologies. He owns stock in Amedica. Dr. Della Roca has received grants from Stryker, Synthes, Smith & Nephew, Medtronic, KCI, and Wound Care Technologies. He owns stock in Amedica.

Correspondence to Brett D. Crist, MD, Department of Orthopaedic Surgery, University of Missouri-Columbia, One Hospital Dr. Columbia, MO 65212 Tel: +573 882 6562; fax: +573 884 0438; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.