• OBJECTIVE
    • To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures.
  • DESIGN
    • Retrospective chart review.
  • SETTING
    • Level 1 academic trauma center.
  • PATIENTS
    • Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020.
  • INTERVENTION
    • External fixation and/or open reduction and internal fixation.
  • MAIN OUTCOME MEASUREMENTS
    • Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results.
  • RESULTS
    • Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus ( P = 0.0001), open fractures ( P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) ( P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results ( P = 0.006). History of diabetes was also positively associated with adverse results ( P = 0.019).
  • CONCLUSIONS
    • History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results.
  • LEVEL OF EVIDENCE
    • Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.