Benny Ewe Boon Yeow*, Simret Singh Randhawa Singh, Keong Joo Lee and Gurmeet Singh Sewa Singh

Foot and Ankle Unit, Orthopaedic Department, Penang General Hospital, Malaysia

*Corresponding Author: Benny Ewe Boon Yeow, Foot and Ankle Unit, Orthopaedic Department, Penang General Hospital, Malaysia.

Received: August 07, 2023; Published: August 24, 2023

Abstract

Background: Selection of appropriate surgical approach plays an important role to allow adequate exposures and visualization of operative site and ensure good surgical outcome. This holds especially true for open reduction and internal fixation of high-energy pilon fractures. This is a retrospective study of twelve patients with the extensile approach to high energy pilon fractures, and the aim is to assess the soft tissue outcome and complications.

Methods: Total of twelve patients with high-energy pilon fracture involving articular and metaphyseal-diaphyseal junction extension, underwent extensile approach during ORIF, from April 2021 to March 2022 were included in this study. Demographic data was obtained including pre- and post-operative radiographs, treatment methods, intraoperative photos, complications. Eleven patients underwent staged surgery, spanning external fixator were applied for soft tissue care prior to the definitive surgery. One patient who presented late to our center avoided the staged surgery. During the definitive surgeries, tibia and fibula were approached via extensile; and lateral respectively and stabilized with locking plates.

Results: With this approach, the surgical field was well exposed for visualization, reduction and fixation. Intra-articular surface, Chaput tubercle and medial malleolus were able to be accessed without difficulties. Early complications such as wound edge necrosis were noted at the junction of the distal lateral corner of the incision in six patients, but resolved with dressing alone. Another two patients had superficial infection over the wound edge necrosis, requiring oral antibiotic and dressing.

Discussions: There are various approaches for pilon fractures, however there is a limitation of accessibility in each approach. Despite the extensive soft tissue release, soft tissue complications are kept to minimum with meticulous handling.

Conclusion: Extensile approach to high-energy pilon fractures allows good visualization and access of fracture site, without significant soft tissue complication.

Keywords: Extensile Approach; Pilon Fracture; Surgical Exposure; Surgical Outcome; Soft Tissue Complication

References

1. Bartlett C. "Fractures of the tibial pilon”. Skeletal trauma (2003).
2. Borrelli Jr Joseph and Louis Catalano. "Open reduction and internal fixation of pilon fractures”. Journal of Orthopaedic Trauma8 (1999): 573-582.
3. Hahn MP and JW Thies. "Pilon tibiale fractures”. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 2 (2004): 211-230
4. Mast J. "Pilon fractures of the distal tibia: a test of surgical judgment”. Major Fractures of the Pilon, the Talus, and the Calcaneus: Current Concepts of Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg (1993): 7-27.
5. Patterson, Michael J and J Dean Cole. "Two-staged delayed open reduction and internal fixation of severe pilon fractures”. Journal of Orthopaedic Trauma2 (1999): 85-91.
6. Sirkin Michael., et al. "A staged protocol for soft tissue management in the treatment of complex pilon fractures”. Journal of Orthopaedic Trauma2 (1999): 78-84.
7. Rüedi Thomas P., et al. “AO principles of fracture management”. Stuttgart: Thieme (2000).
8. Tornetta III Paul., et al. “Pilon fractures: treatment with combined internal and external fixation”. Journal of Orthopaedic Trauma6 (1993): 489-496.v
9. Assal Mathieu., et al. “The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing”. Journal of Orthopaedic Trauma3 (2007): 198-206.

Citation

Citation: Benny Ewe Boon Yeow., et al. “Extensile Approach: The Workhorse to High Energy Pilon Fractures - A Case Series". Acta Scientific Orthopaedics 6.9 (2023): 71-75.

Copyright

Copyright: © 2023 Benny Ewe Boon Yeow., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.