• Jacob A Heiner, Katherine A Banner, Victor J Wu, Timothy S Achor, Joshua L Gary, John W Munz, Andrew M Choo, James F Kellam, and Stephen J Warner.
• From the Department of Orthopedic Surgery, McGovern Medical School at UTHealth, Houston, TX, United States.
• Injury. 2022 Apr 1; 53 (4): 1510-1516.

ObjectiveDetermine predictive injury factors for wound complications in open pilon fractures (OTA/AO 43B and 43C).DesignRetrospective Case Series.SettingLevel I Trauma Center.Patients/ParticipantsA total of 61 open pilon fractures in 60 patients were evaluated after meeting inclusion and exclusion criteria.InterventionThe majority of injuries underwent a staged protocol with immediate antibiotics, debridement, irrigation and external fixation. Following soft tissue stabilization, internal fixation was performed and wound closure achieved in a coordinated fashion depending on the type of closure required.Main Outcome MeasurementsEarly amputation rate, 90-day major (wound dehiscence or deep infection requiring operative intervention) and minor (superficial infection) wound complications.ResultsFour patients incurred early amputations, 11 had major wound complications and 5 had minor wound complications. An early amputation was more likely if they presented with an OTA Open Fracture Classification (OTA-OFC) Bone Loss Grade 3. A major wound complication was more likely if they presented with a fall from > 3 m, a multifragmentary articular surface, a segmental fibula fracture, or an OTA-OFC Contamination Grade 3. A multifragmentary articular surface was also predictive of developing any wound complication.ConclusionsOpen pilon fractures are severe, limb-threatening injuries and are at risk for wound complications. Patients presenting with these injuries and a predictive factor should be counseled regarding the possibility of early limb loss or experiencing a wound complication that will require additional treatment.Level Of EvidenceLevel III.Copyright © 2022. Published by Elsevier Ltd.

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