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ORIF with standard plating of the tibia and fibula
1%
13/1490
ORIF with locked plating of the tibia and fibula
2%
30/1490
ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect
27/1490
External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect
8%
113/1490
External fixation of the tibia
87%
1301/1490
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External fixation of the tibia is the MOST appropriate initial treatment. Some surgeons prefer to defer the fibular fixation until definitive ORIF of the pilon but the common theme is that pilon fractures are treated with external fixation and staged ORIF. If bone grafting of the tibia is necessary it would be performed during the staged ORIF of the tibia. Sirkin et al reports Level 4 evidence of a staged protocol of immediate (within twenty-four hours) open reduction and internal fixation of the fibula, using a one-third tubular or 3.5-mm DC plate and application of an external fixator spanning the ankle joint. They followed both open and closed pilon fractures that were treated with external fixation until the soft tissue swelling resolved and then underwent ORIF. There was less than an 11% rate of major wound complication or infection in both groups. Their conclusions suggested the historically high rates of wound complication and infection associated with ORIF of pilon fractures are likely due to attempts at immediate fixation through swollen, compromised soft tissues.
4.1
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