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

Abstract

Objectives: To determine whether an acute fixation protocol for high-energy tibial pilon fractures increases the rate of wound complications. Design: Retrospective comparative study. Setting: Urban level 1 trauma center. Patients/Participants: One hundred forty-seven patients with OTA/AO 43B and 43C high-energy tibial pilon fractures treated with open reduction and internal fixation (ORIF). Intervention: Acute (<48 hours) versus delayed ORIF protocols. Main Outcome Measurement: Wound complications, reoperations, time to fixation, operative costs, and hospital length of stay (LOS). Patients were compared by protocol, regardless of ORIF timing, for an intention-to-treat analysis. Results: Thirty-five 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 2 groups had no observed difference (OD) in the rate of wound complications (OD −5.7%, confidence interval (95% CI) −16.1% to 7.8%; P = 0.56) or reoperations (OD −3.9%, 95% CI, −14.1% to 9.4%; P = 0.76). The acute ORIF protocol group had a shorter LOS (OD −2.0, 95% CI, −4.0 to 0.0; P = 0.02) and lower operative costs (OD $−2709.27, 95% CI, −3582.02 to −1601.16; P < 0.01). On multivariate analysis, wound complications were associated with open fractures (odds ratio 3.36, 95% CI, 1.06–10.69; P = 0.04) and an American Society of Anesthesiologists score >2 (odds ratio 3.68, 95% CI, 1.07–12.67; P = 0.04). Conclusion: 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. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.