POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENJuwen ¹ , WANGYongqing ¹ ,  KONGLingwei ² , LIBaogui ¹ , ZHAOZhihui ¹

1. Department of Orthopaedics, the Fourth Central Clinical College, Tianjin Medical University, Tianjin, 300140, P. R. China;
2. Department ofHand Surgery, the Third Clinical College, Hebei Medical University;

Corresponding author：

KONGLingwei, Email: klw380@sohu.com

Keywords：

Posterior Pilon fracture; Ankle; Internal fixation; Elderly patient

DOI：

10.7507/1002-1892.20160222

Video：

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Objective To explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. Methods Between August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. Results The operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. Conclusion A combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.

Citation： CHENJuwen, WANGYongqing, KONGLingwei, LIBaogui, ZHAOZhihui. POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1089-1093. doi: 10.7507/1002-1892.20160222 Copy

1.	陈志伟, 陈丹, 阳海清, 等.双切口联合入路360°内固定治疗高能量闭合性Pilon骨折.中国修复重建外科杂志, 2015, 29(10):1226-1229.
2.	肖睿, 唐强, 蔡程, 等.有限内固定结合外固定支架治疗Pilon骨折.中国修复重建外科杂志, 2005, 19(8):603-606.
3.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
4.	张英泽.老年髋部骨折--中国骨科医师面临的机遇和挑战.中华创伤杂志, 2014, 30(3):193-195.
5.	马信龙.认识、重视骨质疏松症, 提高骨质疏松性骨折的诊疗水平.中华骨科杂志, 2014, 34(1):1-5.
6.	Chen DW, Li B, Aubeeluck A, et al. Open reduction and internal fixation of posterior Pilon fractures with buttress plate. Acta Ortop Bras, 2014, 22(1):48-53.
7.	Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
8.	魏世隽, 蔡贤华, 刘曦明, 等.后内侧入路低切迹多向锁定接骨板内固定治疗累及内踝的胫骨后Pilon骨折.中国修复重建外科杂志, 2014, 28(5):558-561.
9.	赵宏谋, 梁晓军, 李毅, 等.胫骨远端内外翻畸形对胫距关节接触的影响.中国修复重建外科杂志, 2016, 30(7):826-829.
10.	魏世隽, 蔡贤华, 刘曦明, 等.有限切开复位结合锁定加压接骨板内固定治疗胫骨Pilon骨折.中华创伤杂志, 2013, 29(1):49-52.
11.	Tang X, Tang PF, Wang MY, et al. Pilon fractures:a new classification and therapeutic strategies. Chin Med J (Engl), 2012, 125(14):2487-2492.
12.	俞光荣, 陈大伟, 赵宏谋, 等.支撑钢板固定后侧Pilon骨折的疗效分析.中华创伤杂志, 2013, 29(3):243-248.
13.	Klammer G, Kadakia AR, Joos DA, et al. Posterior Pilon fractures:a retrospective case series and proposed classification system. Foot Ankle Int, 2013, 34(2):189-199.
14.	魏世隽, 蔡贤华, 黄继锋, 等.内外翻不同损伤机制导致胫骨Pilon骨折的手术策略.中华骨科杂志, 2014, 34(3):298-305.
15.	陈雁西, 俞关荣.踝关节骨折的治疗策略与数字化临床路径.中华骨科杂志, 2011, 31(3):275-284.
16.	王小平, 韦展图, 黄俭, 等.虚拟三维重建术前规划技术在Pilon骨折的应用研究.中国修复重建外科杂志, 2016, 30(1):44-49.
17.	东靖明, 田旭, 马宝通.经踝关节后外侧入路治疗三踝骨折.中华创伤杂志, 2013, 29(6):536-540.
18.	李延炜, 洪海森, 刘晖, 等. TightRope治疗下胫腓联合分离的近期疗效.中国修复重建外科杂志, 2016, 30(8):971-974.
19.	刘建永.腓骨侧单隧道解剖重建与改良Brostrom法缝合修复治疗慢性踝关节外侧不稳定的对比研究.中国修复重建外科杂志, 2015, 29(10):1214-1220.

1. 陈志伟, 陈丹, 阳海清, 等.双切口联合入路360°内固定治疗高能量闭合性Pilon骨折.中国修复重建外科杂志, 2015, 29(10):1226-1229.
2. 肖睿, 唐强, 蔡程, 等.有限内固定结合外固定支架治疗Pilon骨折.中国修复重建外科杂志, 2005, 19(8):603-606.
3. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
4. 张英泽.老年髋部骨折--中国骨科医师面临的机遇和挑战.中华创伤杂志, 2014, 30(3):193-195.
5. 马信龙.认识、重视骨质疏松症, 提高骨质疏松性骨折的诊疗水平.中华骨科杂志, 2014, 34(1):1-5.
6. Chen DW, Li B, Aubeeluck A, et al. Open reduction and internal fixation of posterior Pilon fractures with buttress plate. Acta Ortop Bras, 2014, 22(1):48-53.
7. Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
8. 魏世隽, 蔡贤华, 刘曦明, 等.后内侧入路低切迹多向锁定接骨板内固定治疗累及内踝的胫骨后Pilon骨折.中国修复重建外科杂志, 2014, 28(5):558-561.
9. 赵宏谋, 梁晓军, 李毅, 等.胫骨远端内外翻畸形对胫距关节接触的影响.中国修复重建外科杂志, 2016, 30(7):826-829.
10. 魏世隽, 蔡贤华, 刘曦明, 等.有限切开复位结合锁定加压接骨板内固定治疗胫骨Pilon骨折.中华创伤杂志, 2013, 29(1):49-52.
11. Tang X, Tang PF, Wang MY, et al. Pilon fractures:a new classification and therapeutic strategies. Chin Med J (Engl), 2012, 125(14):2487-2492.
12. 俞光荣, 陈大伟, 赵宏谋, 等.支撑钢板固定后侧Pilon骨折的疗效分析.中华创伤杂志, 2013, 29(3):243-248.
13. Klammer G, Kadakia AR, Joos DA, et al. Posterior Pilon fractures:a retrospective case series and proposed classification system. Foot Ankle Int, 2013, 34(2):189-199.
14. 魏世隽, 蔡贤华, 黄继锋, 等.内外翻不同损伤机制导致胫骨Pilon骨折的手术策略.中华骨科杂志, 2014, 34(3):298-305.
15. 陈雁西, 俞关荣.踝关节骨折的治疗策略与数字化临床路径.中华骨科杂志, 2011, 31(3):275-284.
16. 王小平, 韦展图, 黄俭, 等.虚拟三维重建术前规划技术在Pilon骨折的应用研究.中国修复重建外科杂志, 2016, 30(1):44-49.
17. 东靖明, 田旭, 马宝通.经踝关节后外侧入路治疗三踝骨折.中华创伤杂志, 2013, 29(6):536-540.
18. 李延炜, 洪海森, 刘晖, 等. TightRope治疗下胫腓联合分离的近期疗效.中国修复重建外科杂志, 2016, 30(8):971-974.
19. 刘建永.腓骨侧单隧道解剖重建与改良Brostrom法缝合修复治疗慢性踝关节外侧不稳定的对比研究.中国修复重建外科杂志, 2015, 29(10):1214-1220.

Chinese Journal of Reparative and Reconstructive Surgery

POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS

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