Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures
Background: The treatment for highly comminuted pilon fractures remains controversial. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). Methods: Patients who underwent p...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2018-08-01
|
| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011418780437 |
| _version_ | 1819104204214501376 |
|---|---|
| author | Colin H. Beckwitt BS Spencer J. Monaco DPM Gary S. Gruen MD |
| author_facet | Colin H. Beckwitt BS Spencer J. Monaco DPM Gary S. Gruen MD |
| author_sort | Colin H. Beckwitt BS |
| collection | DOAJ |
| description | Background: The treatment for highly comminuted pilon fractures remains controversial. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). Methods: Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology ( CPT ) code. Inclusion criteria for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon fracture. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon. Outcome assessment was determined by the Foot and Ankle Outcome Score (FAOS) and Short Form 36-item health survey (SF-36), time to radiographic union or fusion, and wound-healing complications at a minimum of 2 years after their surgery. Results: Nineteen ORIF and 16 fusion patients completed the study’s outcome assessments. A higher rate of nonunion was observed in patients treated by primary ORIF than primary fusion (5/19 vs 1/16). Posttraumatic arthritis was observed in 11 of 19 primary ORIF patients. Primary fusion patients exhibited increased symptoms, pain, and physical role limits but were equivalent to primary ORIF patients on all other functional metrics examined. Conclusions: Primary ankle arthrodesis achieves a lower rate of nonunion and comparable functional outcomes to ORIF in patients with severely comminuted pilon fractures. The higher rate of nonunion observed in the primary ORIF group suggests that primary fusion should be considered an effective procedure for severe injuries to decrease the need for further operative intervention. Level of Evidence: Therapeutic Level III, retrospective cohort. |
| first_indexed | 2024-12-22T02:02:38Z |
| format | Article |
| id | doaj.art-e12473fa1ab44627b2a557dbb0d183b1 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-22T02:02:38Z |
| publishDate | 2018-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-e12473fa1ab44627b2a557dbb0d183b12022-12-21T18:42:36ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142018-08-01310.1177/2473011418780437Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon FracturesColin H. Beckwitt BS0Spencer J. Monaco DPM1Gary S. Gruen MD2 Department of Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA Premier Orthopaedics, Kennett Square, PA, USA Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USABackground: The treatment for highly comminuted pilon fractures remains controversial. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). Methods: Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology ( CPT ) code. Inclusion criteria for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon fracture. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon. Outcome assessment was determined by the Foot and Ankle Outcome Score (FAOS) and Short Form 36-item health survey (SF-36), time to radiographic union or fusion, and wound-healing complications at a minimum of 2 years after their surgery. Results: Nineteen ORIF and 16 fusion patients completed the study’s outcome assessments. A higher rate of nonunion was observed in patients treated by primary ORIF than primary fusion (5/19 vs 1/16). Posttraumatic arthritis was observed in 11 of 19 primary ORIF patients. Primary fusion patients exhibited increased symptoms, pain, and physical role limits but were equivalent to primary ORIF patients on all other functional metrics examined. Conclusions: Primary ankle arthrodesis achieves a lower rate of nonunion and comparable functional outcomes to ORIF in patients with severely comminuted pilon fractures. The higher rate of nonunion observed in the primary ORIF group suggests that primary fusion should be considered an effective procedure for severe injuries to decrease the need for further operative intervention. Level of Evidence: Therapeutic Level III, retrospective cohort.https://doi.org/10.1177/2473011418780437 |
| spellingShingle | Colin H. Beckwitt BS Spencer J. Monaco DPM Gary S. Gruen MD Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures Foot & Ankle Orthopaedics |
| title | Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures |
| title_full | Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures |
| title_fullStr | Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures |
| title_full_unstemmed | Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures |
| title_short | Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures |
| title_sort | primary ankle arthrodesis vs orif for severely comminuted pilon fractures |
| url | https://doi.org/10.1177/2473011418780437 |
| work_keys_str_mv | AT colinhbeckwittbs primaryanklearthrodesisvsorifforseverelycomminutedpilonfractures AT spencerjmonacodpm primaryanklearthrodesisvsorifforseverelycomminutedpilonfractures AT garysgruenmd primaryanklearthrodesisvsorifforseverelycomminutedpilonfractures |