• Michael J Gardner, Samir Mehta, David P Barei, and Sean E Nork.
• Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA 98105, USA. michaelgardnermd@gmail.com
• J Orthop Trauma. 2008 Aug 1;22(7):451-7.

ObjectivesTo evaluate the results in patients with open AO/OTA type C3 pilon fractures with segmental bone loss who were treated with a standard treatment protocol.DesignRetrospective case series.SettingLevel I trauma center.Patients/ParticipantsOf 117 acute open type C pilon fractures treated during the study period, 10 patients with AO/OTA type C3 fractures and segmental metaphyseal bone loss were amenable to treatment with a standard protocol.InterventionAll patients were treated with immediate debridement and external fixation (stage 1). After a delay of 1-3 weeks, patients with a healthy-appearing soft tissue envelope and no sign of infection underwent open reduction, plate fixation, and antibiotic bead placement (stage 2). Several months later, planned bone grafting was performed (stage 3).Main Outcome MeasurementsThe complication rate, additional procedures, and time to bony union were determined.ResultsThe treatment protocol was able to be completed in all 10 patients. No cases of acute infection or wound necrosis after plate fixation and antibiotic bead placement occurred. Two cases of late infection occurred after delayed bone grafting, one of which was successfully treated and the other resulted in amputation. Nine of the 10 patients healed at an average of 24 weeks.ConclusionsLimb salvage in the most severe open pilon fractures is difficult. In patients with benign soft tissues at several weeks after temporary external fixation, open reduction, antibiotic bead placement, and a delayed bone grafting procedure are associated with a low complication rate and predictable fracture healing.

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