Is It Safe to Prep the External Fixator in Situ during Second-Stage Pilon Surgical Treatment?

Objective: To evaluate the infection rate of our protocol of prepping the external fixator in situ during definitive second-stage pilon fracture open reduction internal fixation. Design: Retrospective clinical investigation. Setting: Academic Level 1 Trauma Center. Patients/Participants: Out of 229 patients with distal tibia fractures presenting to our institution from 1999 to 2014, 100 were treated in a 2-stage fashion utilizing this protocol. Intervention: Prepping the external fixator into the surgical field during the second-stage/definitive open reduction internal fixation procedure. Main Outcome Measurement: The rates of deep and superficial infections after definitive fixation. Results: The deep infection rate was 13%, and the superficial infection rate was 11%. Conclusions: Infection rates using this protocol are comparable to previously reported infection rates for two-stage surgical treatment of pilon fractures. This protocol provides the treating surgeon information about an alternative method to streamline definitive fixation.