{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T03:06:51Z","timestamp":1791688011447,"version":"4.3.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Summary:<\/jats:title>\n          <jats:p>A subset of C2\/C3 pilon fractures, open pilon injuries, metaphyseal bone comminution, and those involving substantial soft tissue or vascular injury may be nonreconstructable. Such injuries are at risk of progress to nonunion and failing open reduction internal fixation (ORIF). The risk of infection, malunion, and nonunion is relatively high with such injury patterns. In such cases, tibiotalar arthrodesis is performed after ORIF fails as a salvage procedure. Overall, the literature agrees that all pilon fractures will develop posttraumatic osteoarthritis, and these patients are ultimately treated with an arthrodesis or in narrow population with total ankle arthroplasty. Given these combined findings, it follows that patients identified as high risk of failing ORIF could benefit from the use of primary arthrodesis. The proposed technique provides a reliable approach designed to achieve ankle fusion. It provides a means to achieve reliable union rates and spares the subtalar joint. In addition, it avoids the anterior soft tissue envelope, and hardware irritation is tempered as the final implants are covered by a muscular layer. Last, patients who are at higher risk of failing ORIF are selected and spared, having to undergo trial ORIF, time to nonunion, work absence, and rehab.<\/jats:p>","DOI":"10.1097\/bot.0000000000000911","type":"journal-article","created":{"date-parts":[[2017,7,11]],"date-time":"2017-07-11T15:31:25Z","timestamp":1499787085000},"page":"S30-S33","source":"Crossref","is-referenced-by-count":19,"title":["Primary Posterior Blade Plate Tibiotalar Arthrodesis: A Salvage Procedure for Complex Nonreconstructable Pilon Fractures"],"prefix":"10.1097","volume":"31","author":[{"given":"Ermias","family":"Abebe","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana J.","family":"Farrell","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute (CTSI), University of Pittsburgh, Pittsburgh, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Zelle","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Division of Orthopaedic Traumatology, UT Health Science Center at San Antonio, San Antonio, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Gruen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20231017","doi-asserted-by":"crossref","first-page":"3823","DOI":"10.1007\/s11999-014-3683-x","article-title":"Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture","volume":"472","author":"Beaman","year":"2014","journal-title":"Clin Orthop Relat Res."},{"key":"R2-20231017","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/BOT.0b013e3181abbc31","article-title":"Pin site care during circular external fixation using two different protocols","volume":"23","author":"Cavusoglu","year":"2009","journal-title":"J Orthop Trauma."},{"key":"R3-20231017","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.3113\/FAI.2009.1042","article-title":"Early complications following the operative treatment of pilon fractures with and without diabetes","volume":"30","author":"Kline","year":"2009","journal-title":"Foot Ankle Int."},{"key":"R4-20231017","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.injury.2007.07.024","article-title":"An update on the management of high-energy pilon fractures","volume":"39","author":"Tarkin","year":"2008","journal-title":"Injury"},{"key":"R5-20231017","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s11751-015-0231-5","article-title":"Management of high-energy tibial pilon fractures","volume":"10","author":"Jacob","year":"2015","journal-title":"Strategies Trauma Limb Reconstr."},{"key":"R6-20231017","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1053\/j.jfas.2012.04.015","article-title":"Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss","volume":"51","author":"Ochman","year":"2012","journal-title":"J Foot Ankle Surg."},{"key":"R7-20231017","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.2106\/00004623-200408000-00035","article-title":"Outcomes after treatment of high-energy tibial plafond fractures","volume":"86-A","author":"Hutson","year":"2004","journal-title":"J Bone Joint Surg Am."},{"key":"R8-20231017","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.injury.2016.05.026","article-title":"Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: is dual plate fixation necessary?","volume":"47","author":"Penny","year":"2016","journal-title":"Injury"},{"key":"R9-20231017","doi-asserted-by":"crossref","first-page":"e378","DOI":"10.3928\/01477447-20161202-04","article-title":"Primary ankle arthrodesis for severely comminuted tibial pilon fractures","volume":"40","author":"Al-Ashhab","year":"2017","journal-title":"Orthopedics"},{"key":"R10-20231017","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/00005131-200103000-00002","article-title":"Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques","volume":"15","author":"Blauth","year":"2001","journal-title":"J Orthop Trauma."},{"key":"R11-20231017","doi-asserted-by":"crossref","first-page":"e543","DOI":"10.3928\/01477447-20140528-54","article-title":"Operative versus nonoperative treatment for complex proximal humeral fractures: a meta-analysis of randomized controlled trials","volume":"37","author":"Jia","year":"2014","journal-title":"Orthopedics"},{"key":"R12-20231017","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1097\/BOT.0b013e3181d04bc0","article-title":"The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study","volume":"24","author":"White","year":"2010","journal-title":"J Orthop Trauma."},{"key":"R13-20231017","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00402-006-0225-3","article-title":"Long-term results of pilon fractures","volume":"127","author":"Chen","year":"2007","journal-title":"Arch Orthop Trauma Surg."},{"key":"R14-20231017","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.2106\/00004623-200310000-00005","article-title":"Outcomes after treatment of high-energy tibial plafond fractures","volume":"85-A","author":"Pollak","year":"2003","journal-title":"J Bone Joint Surg Am."},{"key":"R15-20231017","first-page":"331","article-title":"Fractures of the tibial plafond","volume":"56","author":"Marsh","year":"2007","journal-title":"Instr Course Lect."},{"key":"R16-20231017","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/BOT.0b013e3181c8ad52","article-title":"The sequential recovery of health status after tibial plafond fractures","volume":"24","author":"Marsh","year":"2010","journal-title":"J Orthop Trauma."},{"key":"R17-20231017","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/00003086-199307000-00013","article-title":"Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications","volume":"292","author":"Teeny","year":"1993","journal-title":"Clin Orthop Relat Res."},{"key":"R18-20231017","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1016\/j.injury.2016.04.009","article-title":"Functional outcome and general health status after treatment of AO type 43 distal tibial fractures","volume":"47","author":"van den Berg","year":"2016","journal-title":"Injury"},{"key":"R19-20231017","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/00003086-199802000-00016","article-title":"Clinical and functional outcomes of internal fixation of displaced pilon fractures","volume":"347","author":"Sands","year":"1998","journal-title":"Clin Orthop Relat Res."},{"key":"R20-20231017","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1016\/j.injury.2015.06.025","article-title":"Prognostic factors of health-related quality of life in patients after tibial plafond fracture. A pilot study","volume":"46","author":"Cutillas-Ybarra","year":"2015","journal-title":"Injury"},{"key":"R21-20231017","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.injury.2016.11.012","article-title":"Patient reported health related quality of life early outcomes at 12 months after surgically managed tibial plafond fracture","volume":"48","author":"Bonato","year":"2017","journal-title":"Injury"},{"key":"R22-20231017","first-page":"15","article-title":"Arthrodesis of the ankle and subtalar joints","volume":"268","author":"Gruen","year":"1991","journal-title":"Clin Orthop Relat Res."},{"key":"R23-20231017","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1053\/j.oto.2006.02.004","article-title":"Posterior blade plate fusion: a salvage procedure in severe posttraumatic osteoarthritis of the tibiotalar joint","volume":"16","author":"Zelle","year":"2006","journal-title":"Oper Tech Orthopaedics."},{"key":"R24-20231017","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.2106\/JBJS.M.00544","article-title":"Primary arthrodesis of the tibiotalar joint in severely comminuted high-energy pilon fractures","volume":"96","author":"Zelle","year":"2014","journal-title":"J Bone Joint Surg Am."},{"key":"R25-20231017","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/BOT.0b013e31815cf6e9","article-title":"Vascular abnormalities as assessed with CT angiography in high-energy tibial plafond fractures","volume":"22","author":"LeBus","year":"2008","journal-title":"J Orthop Trauma."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00005131-201708003-00016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T15:02:19Z","timestamp":1697554939000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00005131-201708003-00016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000000911","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2017,8]]}}}