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

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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.


Retrospective clinical investigation.


Academic Level 1 Trauma Center.


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.


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.


The deep infection rate was 13%, and the superficial infection rate was 11%.


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.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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