Die septische Pseudarthrose des Pilon tibiale: Lösung eines unlösbaren Problems

Abstract

Septic non-union of a tibial pilon or plafond fracture is a serious complication. Only a consistent procedure with multiple interventions and a long process promises a sustainable success. In the following, a current and practicable therapeutical concept of a septic non-union of the tibial pilon is presented, which is carried out in an established manner in our clinic and which, if carried out consistently, many of these complex patients can be healed with a good clinical result. The key points of the concept are radical bone and soft-tissue resection followed by local and systemic anti-infective therapy, and reconstruction of bone and soft tissue loss. Depending on the degree of bone loss, the authors describe local defect filling, if necessary, in combination with osteosynthetic treatment or primary arthrodesis. In the case of long-distance bone loss, there is the possibility of bone segment transport. Therefore, different techniques are presented, followed by docking-procedure or secondary arthrodesis depending on the condition of the joint.