Review Question - QID 219480

Several studies have found higher complication rates with FWF compared with ORIF in open tibial plafond fractures with complete articular dissociation from the tibia (43C).

A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. Treatment is generally operative with temporary external fixation followed by delayed open reduction internal fixation once the soft tissues permit.

Lu et al. reviewed differences in outcomes and complications between open and closed pilon fractures, and between patients treated by open reduction internal fixation (ORIF) or fine wire fixator (FWF) for open and closed fracture subgroups. They reported that most ORIF-treated subgroups in either open or closed pilon fractures showed better primary and secondary outcomes than FWF-treated subgroups, yet few were statistically significant. They noted a higher complication rate with FWF. They concluded that overall, their use of a two-staged approach involving temporary external fixation, followed by ORIF or FWF, achieved low complication rates and good functional recovery.

Lim et al. reviewed open pilon fractures. They reported on the clinical outcomes in patients with open pilon fractures treated with early wound debridement and spanning external fixation, delayed soft tissue coverage with a flap when necessary and delayed definitive fixation with a FWF. They concluded that staged wound debridement, including relatively aggressive bone debridement in conjunction with systemic and local antibiotics, external fixators, and patient-tailored conversion from spanning external fixator to fine wire frame, achieves low rates of wound infection and complications for patients with open pilon fractures.

Incorrect Answers:
Answer 1: FWF and ORIF have similar functional outcome scores.
Answer 3: FWF and ORIF have no difference in the rate of malunion compared with ORIF.
Answer 4: FWF does not have a higher union rate than ORIF.
Answer 5: FWF has a longer time to full weight bearing compared with ORIF.