Open AccessSecondary below-knee amputation following open reduction and internal fixation of a closed pilon fracture
Author(s) -
Dong Wei,
Yangbo Xu,
Feifan Xiang,
Junwu Ye
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000024791
Subject(s) - medicine , pilon fracture , surgery , internal fixation , ankle , amputation , reduction (mathematics) , orthopedic surgery , external fixation , external fixator , geometry , mathematics
Rationale: Despite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons. Patient concerns: A 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications. Diagnoses: According to the X-ray and CT scans, the patient was diagnosed with pilon fracture (type AO-43-C2) and lateral malleolus fracture of the right limb. Interventions: The patient was initially treated with calcaneal traction upon admission to a primary hospital. Five days after the injury, the patient underwent open reduction and internal fixation (ORIF) of the fracture and vacuum sealing drainage (VSD) for wound closure. Outcomes: The patient presented to our hospital on the 9th day after the first ORIF operation because of critical ischemia of the affected foot and distal lower leg. Blood circulation did not improve after a series of salvage treatments, and below-knee amputation was ultimately performed. Lessons: This is a rare case of complete ischemic necrosis following ORIF surgery of a closed pilon fracture due to iatrogenic damage. Standardized treatment that strictly follows the guidelines, instructions, or expert consensus should be promoted in this kind of complicated pilon fracture.