8/15/2023 0 Comments Pilon fracture orif cpt![]() ![]() None of the 43 articles had complete information in all the PICO categories investigated (Table (Table1). The full-length manuscripts of the remaining 43 articles were included for review. The initial MeSH keyword search yielded 72 original articles, 29 of which were eliminated based on the exclusion criteria (Fig. The PICO questions addressed in this study were to evaluate the effectiveness of primary arthrodesis as a treatment option in AO 43-C3 type tibial pilon fractures as an alternative to staged treatment in reducing the rates of postoperative short-term complications and poor long-term outcomes. Temporary ex fix followed by ORIF (vacuum sealing drainage) Temporary ex fix followed by late primary arthrodesisĢ-Staged, ex fix followed by ORIF (closed)ģ-staged (ex fix, ORIF posterior column, ORIF anterior/medial columns) Temporary ex fix followed by primary arthrodesisĢ-Staged, minimally invasive anterior approach The hypothesis of the present study was to review the literature of the past 30 years to assess treatment modalities, complications, and clinical outcomes for AO 43-C3 tibial fractures treated with a staged approach, versus primary arthrodesis to compare the outcomes between these 2 patient populations and to determine if primary arthrodesis can be a definitive treatment option for these fractures. ![]() These complications have the potential to result in long hospital stays, need for additional surgeries (e.g., secondary arthrodesis), prolonged pain control, non-weightbearing periods and absence from work. Although operative techniques and complication rates in pilon fractures have improved, the reported complication rates may lead to the erroneous conclusion that the outcomes for these injuries are substantially better than what is experienced clinically. Regardless of the fixation method used to treat pilon fractures, a substantial percentage of patients develop complications postoperatively, including wound infection, osteomyelitis, nonunion, and post-traumatic osteoarthritis (PTOA). This concept has led to recommendations of a staged procedure especially for high-energy AO 43-C2 and AO 43-C3 injuries initial external fixation (with or without internal fixation of the fibula) to allow soft tissue resting followed by open reduction and internal fixation (ORIF) 10 to 14 days later. Therefore, the goal of treatment is not only to stabilize the fracture and reduce the joint anatomically, but to preserve the soft tissue envelope. Studies have shown that complications and outcomes are closely associated with the degree of injury, especially that of soft tissues. Type AO 43-C3 fractures, which have a high degree of comminution and extensive intra-articular involvement, are the most challenging because of the severe disruption to the articular surface and the associated soft tissue injury. The AO/OTA Classification system is the most comprehensive system for categorizing pilon fractures, organizing them according to the degrees of articular surface involvement and comminution. Several classification systems allow comparison among different series and help guide clinical decision making. ![]() Accounting for less than 10% of all tibial fractures, they can be challenging to manage because of the reconstruction needed of the involved articular surface and adjacent metaphysis and fibula fracture which is observed in up to 85% of cases. axial compression or shearing injuries from motor vehicle accidents or falls from heights. Tibial pilon fractures are complex injuries that typically result from high-energy trauma mechanisms, e.g. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. ![]()
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