Objectives: To identify characteristics that contribute to surgical complexity in pilon fractures and to develop a machine learning (ML) Pilon Surgical Difficulty Score (PSDS) based on these factors.
Design: Retrospective cohort study.
Setting: Academic Level I trauma center.
Patient Selection Criteria: Pilon fractures (OTA/AO Type 43) in adult patients treated with open reduction internal fixation.
Outcomes Measures And Comparisons: Various patient, injury, and radiological characteristics were assessed. Surgical difficulty was measured using 2 outcomes: (1) operative time and (2) perceived difficulty. Perceived difficulty was determined using the opinion of 16 fellowship-trained orthopaedic traumatologists on a 10-point scale. Significant predictors of difficulty were determined using univariate analyses. ML models were used to develop a PSDS for both operative time and surgical difficulty.
Results: One hundred operatively fixed pilon fractures were included. Predictors of operative time were age, OTA/AO classification, articular comminution, articular impaction, bone loss, delay to surgery, poor quality reduction, number of approaches, and number of articular fragments. Predictors of perceived difficulty included OTA/AO classification and delay to surgery. Operative time PSDS had a mean absolute error of 64 minutes and a 60-minute buffer accuracy of 59%. Perceived difficulty PSDS had a mean absolute error of 1.7 points and a 2-point buffer accuracy of 63%.
Conclusion: ML was used to generate accurate PSDSs for operative time and difficulty for pilon fractures. Future work should aim to clinically validate these PSDSs, so they may improve patient outcomes.
Objective: To explore weight-bearing stability of Pilon fracture fixed by external fixator.
Methods: Six ankle bone models (right side) and 4 pairs (8 ankle cadaver specimens) were selected. Pilon fracture model was prepared by using the preset osteotomy line based on Ruedi Allgower Pilon fracture type.
Introduction: There is a lack of consensus regarding indications for fibula fixation in pilon fractures. Reduction of the fibula fracture can assist with restoring lateral column length and reduction of the tibial plafond during pilon ORIF. However, there are theoretical concerns with wound complications and soft tissue insult.
Introduction: Pilon fractures are potentially limb-threating injuries. Staged soft tissue damage control is described, but actual practices are unknown. We report a national trainee collaborative evaluating how tibial Pilon fractures are acutely managed.
Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Background: Temporary ankle-spanning circular fixation aims to provide osseous stability while (1) allowing access to and recovery of the traumatized soft-tissue envelope and (2) facilitating safe, comfortable, and clinically relevant cross-sectional imaging for surgical planning. It is most commonly utilized in a "span-scan-plan" treatment strategy in cases of peri-articular fractures around the ankle. Conventional monolateral fixators are prone to morbidity at the half-pin sites in the foot and variation in construct stability.
