An Acute Fixation Protocol for High-Energy Tibial Pilon Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations.

Abstract

To determine if an acute fixation protocol for high-energy tibial pilon fractures increases the rate of wound complications. Retrospective comparative study. Urban level 1 trauma centerPatients/Participants: 147 patients with OTA/AO 43B and 43C high-energy tibial pilon fractures treated with open reduction and internal fixation (ORIF). Acute (<48 hours) versus delayed ORIF protocols. Wound complications, reoperations, time to fixation, operative costs, hospital length of stay (LOS). Patients were compared by protocol, regardless of ORIF timing, for an intention-to-treat analysis. 35 and 112 high-energy pilon fractures were treated under the acute and delayed ORIF protocols, respectively. In the acute ORIF protocol group, 82.9% of patients received acute ORIF versus 15.2% of patients in the standard delayed protocol group. The two groups had no observed difference in the rate of wound complications (observed difference (OD) -5.7%, confidence interval (CI) -16.1 to 7.8%; p=0.56) or reoperations (OD -3.9%, CI -14.1 to 9.4%; p=0.76). The acute ORIF protocol group had a shorter LOS (OD -2.0, CI -4.0 to 0.0; p=0.02) and lower operative costs (OD $-2,709.27, CI -3,582.02 to -1601.16; p<0.01). On multivariate analysis, wound complications were associated with open fractures (odds ratio (OR) 3.36, CI 1.06 to 10.69; p=0.04) and an American Society of Anesthesiologists (ASA) score >2 (OR 3.68, CI 1.07 to 12.67; p=0.04). This study suggests that an acute fixation protocol for high-energy pilon fractures decreases time to definitive fixation, lowers operative costs, and shortens hospital LOS without affecting wound complications or reoperations. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.