Debridement, Antibiotics and Implant Retention (DAIR) for a Complex, Infected Pilon Fracture, with Ankle Contracture

Management of infected fractures requires debridement, antibiotics, stable fixation, and good soft tissue cover. These can be difficult to achieve in periarticular fractures. Retention of implants in established infection is controversial (Morgenstern et al., Bone Joint J 103-B(2):213–221, 2021) due to concern about infection recurrence. The use of local antimicrobials delivered in bioabsorbable ceramic carriers can eradicate infection and promote bone healing (McNally et al., Bone Joint J 98-B:1289–1296, 2016; Ferguson et al., J Bone Joint Infect 4(2):76–84, 2019). Infected ankle fractures often produce loss of joint motion or equinus contractures. Treatment must also address the joint position and function (Rozbruch, HSSJ 1(1):68–88, 2005).