Ballistic Tibial Plafond Fractures: Outcomes of Operative vs Nonoperative Treatment

INTRODUCTION: There is limited literature on ballistic intraarticular tibial plafond fractures. Although treatment recommendations for open pilon fractures exist, there are no such clinical protocols for ballistic pilon-type fractures. We aim to review our experience and observed outcomes of fracture care of ballistic pilon-type fractures and compare operative vs nonoperative treatment. METHODS: We report on a consecutive series of patients over a 10-year period that presented to a single level I trauma center for an OTA 43C ballistic tibial plafond fracture. Patients treated operatively were compared to those treated nonoperatively. Outcome measures were infection and nonunion rates. Chi-square and Fischer’s exact tests were utilized to determine differences between groups. RESULTS: A total of 30 patients were identified. Distal fibular fracture was present in 73% (22 of 30) of cases. Operative fixation was performed in 15 patients and the remaining 15 patients were treated definitively with external fixation (n = 12) or immobilization in a cast (n = 3). The mean follow-up was 10.0 months (±12.8). Operatively treated patients had nonsignificant lower rates of deep infection (13.3% vs 20.0%, p = 1.00), superficial infection (26.7% vs 46.7%, p = 0.26), and nonunion (6.7% vs 26.7%, p = 0.33). CONCLUSION: This is the first series to describe outcomes of ballistic pilon-type fractures. The infection and nonunion rate in our series is high and reflective of historic rates of open OTA 43C pilons. There was no difference in deep infection rates between ORIF vs treatment with external fixation. Our data may help inform treating surgeons and patients of expected complications rates for this type of injury.