CME OnDemand: 2022 AOFAS Annual Meeting-What are the Major Risk Factors for Nonunion in Pilon Fractures?

Pdf Summary

The study aimed to identify risk factors associated with nonunion in patients who underwent operative fixation for pilon fractures. A retrospective review was conducted on 279 patients who met the inclusion criteria, and 48 of them developed nonunion at the 6-month follow-up, resulting in a nonunion rate of 17.2%.<br /><br />The findings showed that patients with nonunion had lower rates of medial column fixation and higher rates of surgical site infection compared to those without nonunion. Open fractures, the need for soft tissue coverage or bone grafting, and surgical site infection were associated with higher rates of nonunion. Additionally, patients undergoing induced membrane bone grafting had a higher nonunion rate.<br /><br />Although not statistically significant, nonunion rates were also higher in fractures classified as AO/OTA 43C and fractures treated with plates overlapping the site of external fixation. There were no significant differences in demographics, mechanism of injury, Gustilo-Anderson classification, associated lower extremity injuries, surgical approach, or type of fixation between the nonunion and union groups.<br /><br />The study highlights the challenges in managing pilon fractures due to the combination of bone and soft tissue injuries. While staged management with external fixation followed by open reduction and internal fixation can help mitigate soft tissue complications, nonunion rates remain high in this patient population. The identified risk factors can help guide treatment decisions and interventions aimed at reducing the risk of nonunion in pilon fractures.

Asset Subtitle

Anthony L. Wilson, BS, Brandon Boyd, Kyle Cichos, Sudarsan Murali, MBA, Alexander K. Mihas, David A. Patch, MD, Gerald McGwin, Michael D. Johnson, MD, Clay A. Spitler, MD

Keywords

risk factors

nonunion

operative fixation

pilon fractures

retrospective review

inclusion criteria

surgical site infection

open fractures

soft tissue coverage

bone grafting