Retrograde tibiotalocalcaneal nails

Abstract

No consensus exists on the optimal treatment method of type III open pilon fractures. Despite staged management, the outcome remains unsatisfactory. Since 2008, we have been treating open grade III tibial pilon fractures that cannot be reconstructed with a retrograde calcaneotalotibial fusion nail after 2 weeks of ankle bridging external fixation. Patients with severe soft-tissue injury and comorbidities such that the infection risk after a large skin incision is deemed unacceptable or the degree of articular comminution does not allow reconstruction are candidates for the above procedure. These patients undergo staged treatment with external fixation initially and conversion to retrograde tibiotalocalcaneal nailing as a second procedure. We have noted no infections, but removal of a prominent calcaneal screw was required in one patient. A retrograde tibiotalocalcaneal nail allows the soft-tissue envelope to be left intact, thus decreasing the incidence of deep-seated infection. The method decreases pain, reduces the number of operative procedures needed, and aids an early return to activity, making it an option in the treatment of open type III tibial pilon fractures.