Does Surgical Approach Influence the Risk of Postoperative Infection After Surgical Treatment of Tibial Pilon Fractures?

Objectives: To determine whether a particular surgical approach or combination of approaches is a risk factor for infection. Design: Retrospective review. Setting: Two Level-1 trauma centers. Patients/Participants: Five hundred ninety pilon fractures in 581 patients (66% male) with a median age of 45 years were identified. Intervention: Open reduction internal fixation of pilon fractures. Main Outcome Measures: Postoperative deep surgical site infection and risk factors for postoperative deep infection. Results: The most common primary surgical approach was medial (54%), followed by anterolateral (25%), anteromedial (11%), posterolateral (8%), and posteromedial (2%). A dual approach to the distal tibia was used in 18% of the cases. The overall deep infection rate was 19%. There was no association between primary surgical approach and development of infection (P = 0.19-0.78). Independent risk factors for infection were smoking (hazard ratio, 2.1; P < 0.001) and need for soft tissue coverage (hazard ratio, 6.9; P < 0.001). Conclusions: Surgical approach does not appear to be a significant risk factor for postoperative infection after open reduction internal fixation of distal tibial pilon fractures. When treating tibial plafond fractures, surgeons should select the approach they feel best addresses the specific fracture pattern.