Abstract:Objective To explore the surgical strategies and clinical outcomes of Pilon fractures caused by different injury mechanisms. Methods From February 2009 to July 2015, 64 patients with Pilon fractures were retrospectively analyzed in this study. These patients were divided into five groups (varus, valgus, back stretch, plantar flexion and vertical compression) according to the injury mechanisms and the imaging findings of anatomic features.There were 18 patients in varus, valgus group 15 patients, back stretch group 12 patients, 10 patients of plantar flexion group, vertical compression group 9 patients. Sixty-four patients were treated with internal fixation. By adopting the corresponding approaches on the injury mechanism, there were used posterormedial approach 6 patients, middle approach 9 patients, anterolateral approach 12 patients, posterolateral approach 18 patients, anteromedial approach 19 patients; the buttress plate was placed on the compression fracture of distal tibia. Six months after surgery, the reduction quality of the joint surface was evaluated by Burwell-Charnleys radiological evaluation system. Twelve months after surgery, the function of ankle joint was assessed by utilizing American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system, and the total effect was evaluated by improved Baird-Jackson score system. Results Sixty-four cases were followed up for 15-48 months(average 31 months). The average healing time ranged from 13.0 to 18.0 weeks [mean (15.54±0.2) weeks ]. Mean AOFAS score was 85.82. Radiological evaluation of curative effect: excellent in 52 patients, good in 12 patients. The postoperative reductions were as follows: 9 anatomic, 8 good, and 1 fair in varus group; 6 anatomic, 7 good, and 2 fair in valgus group; 7anatomic, 4 good, and 1 fair in back stretch group; 5 anatomic, 3 good, and 2 fair in plantar flexion group; 2 anatomic, 4 good, and 3 fair in vertical compression group. Postoperative follow-up of ankle function, AOFAS score and radiological evaluation of curative effect were 87.52±0.2, excellent 15 patients, good 3 patients in varus group; 86.41±0.1, excellent 12 patients, good 3 patients in valgus group; 85.34±0.4, excellent 10 patients, good 2 patients in back stretch group; 85.25±0.1, excellent 8 patients, good 2 patients in plantar flexion group; 84.63±0.3, excellent 7 patients, good 2 patients in vertical compression group. In group varus, 1 patient developed superficial wound infection and 1 patient epidermal necrosis; In group valgus, 3 patients developed superficial wound infection, 1 patient deep wound infection; In group back stretch 1 patient developed superficial wound infection; In group plantar flexion 1 patient developed traumatic arthritis; In group vertical compression 1 patient deep wound infection, 2 patients delayed union of bone, 2 patients developed traumatic arthritis. Conclusions Different injury mechanisms will result in different types of Pilon fractures. Different strategies should be used according to the characteristics of fracture with the buttress plates being placed on compression fracture of distal tibia to achieve better clinical outcomes.
王朝亮,黄素芳,王仲秋,孙雪生,蔺楚,李强,王英振. 不同受伤机制Pilon骨折的临床特点和手术策略[J]. 中华解剖与临床杂志, 2017, 22(3): 217-224.
Wang Chaoliang, Huang Sufang, Wang Zhongqiu, Sun Xuesheng, Lin Chu, Li Qiang, Wang Yingzhen. Surgical strategies and clinical outcomes of Pilon fractures caused by different injury mechanism. Chinese Journal of Anatomy and Clinics, 2017, 22(3): 217-224.
Viberg B, Kleven S, Hamborg-Petersen E, et al.Complications and functional outcome after fixation of distal tibia fractures with locking plate-a multicentre study[J].Injury, 2016, 47(7): 1514-1518.DOI:10.1016/j.injury.2016.04.025
[2]
Duckworth AD, Jefferies JG, Clement ND, et al.Type C tibial pilon fractures: short- and long-term outcome following operative intervention[J].Bone Joint J, 2016, 98-B(8): 1106-1111.DOI:10.1302/0301-620X.98B8.36400
[3]
Vetter SY, Euler F, von Recum J, et al.Impact of intraoperative cone beam computed tomography on reduction quality and implant position in treatment of tibial plafond fractures[J].Foot Ankle Int, 2016, 37(9): 977-982.DOI:10.1177/1071100716650532
[4]
Ballal A, Rai HR, Shetty SM, et al.A prospective study on functional outcome of internal fixation of tibial pilon fractures with locking plate using minimally invasive plate osteosynthesis technique[J].J Clin Diagn Res, 2016, 10(1): RC01-4.DOI:10.7860/JCDR/2016/15284.7013
[5]
Siegel J, Tornetta P 3rd.Fracture pattern assessment of tibial pilon fractures[J].Tech Foot Ankle Surg, 2016, 15(4): 162-168.DOI:10.1097/btf.0000000000000137
[6]
Topliss CJ, Jackson M, Atkins RM.Anatomy of pilon fractures of the distal tibia[J].J Bone Joint Surg Br, 2005, 87(5): 692-697.DOI:10.1302/0301-620X.87B5.15982
dHeurle A, Kazemi N, Connelly C, et al.Prospective randomized comparison of locked plates versus nonlocked plates for the treatment of high-energy pilon fractures[J].J Orthop Trauma, 2015, 29(9): 420-423.DOI:10.1097/BOT.0000000000000386
[9]
Wang Z, Qu W, Liu T, et al.A two-stage protocol with vacuum sealing drainage for the treatment of type C pilon fractures[J].J Foot Ankle Surg, 2016, 55(5): 1117-1120.DOI:10.1053/j.jfas.2016.01.047
Bülbül M, Kuyucu E, Say F, et al.Hybrid external fixation via a minimally invasive method for tibial pilon fractures-technical note[J].Ann Med Surg(Lond), 2015, 4(4): 341-345.DOI:10.1016/j.amsu.2015.09.006
[13]
Chan R, Taylor BC, Gentile J.Optimal management of high-energy Pilon fractures[J].Orthopedics, 2015, 38(8): e708-e714.DOI:10.3928/01477447-20150804-59
[14]
Stapleton JJ, Zgonis T.Surgical treatment of tibial plafond fractures[J].Clin Podiatr Med Surg, 2014, 31(4): 547-564.DOI:10.1016/j.cpm.2014.06.002
Mehta S, Gardner MJ, Barei DP, et al.Reduction strategies through the anterolateral exposure for fixation of type B and C pilon fractures[J].J Orthop Trauma, 2011, 25(2): 116-122.DOI:10.1097/BOT.0b013e3181cf00f3
[19]
Gauthé R, Desseaux A, Rony L, et al.Ankle fractures in the elderly: treatment and results in 477 patients[J].Orthop Traumatol Surg Res, 2016, 102(4 Suppl): S241-S244.DOI:10.1016/j.otsr.2016.03.001
[20]
Henry M.Volar, dorsal, and lateral locking plate fixation for pilon fractures[J].Tech Hand Up Extrem Surg, 2017, 21(1): 22-27.DOI:10.1097/BTH.0000000000000148
[21]
Lomax A, Singh A, N Jane M, et al.Complications and early results after operative fixation of 68 pilon fractures of the distal tibia[J].Scott Med J, 2015, 60(2): 79-84.DOI:10.1177/0036933015569159