IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGMingxin ,  LIUDechang , WANGKun , MENGDeqiang , DINGYue

Department of Orthopaedics, Jinshan Hospital, Fudan University, Shanghai, 201508, P. R. China;

Corresponding author：

LIUDechang, Email: Ldchang2003@sina.cn

Keywords：

Pilon fracture; Fibula fracture; Internal fixation; Improved double operative approaches

DOI：

10.7507/1002-1892.20160307

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the clinical effect of surgical treatment of Pilon fractures accompanied with fibula fractures with the improved double operative approaches. Methods Between January 2012 and June 2015, 19 patients with closed Pilon fractures accompanied with fibula fractures (Rüedi-Allgöwer type Ⅲ) underwent open reduction and internal fixation with improved anterior-median incision and posterior-lateral incision. There were 13 males and 6 females, aged 35 years on average (range, 23-68 years). Injury was caused by traffic accident in 11 cases, falling from height in 7 cases, and crash injury of heavy object in 1 case. According to AO/OTA classification, there were 4 cases of type C2, and 15 cases of type C3. According to Tscherne-Gotzen classification of soft tissue defect, 6 cases were rated as grade 1 and 13 cases as grade 2. The interval of injury and operation was 6-18 days (mean, 10.3 days). After operation, reduction of Pilon fracture was evaluated by the Burwell-Charnley radiological evaluation criteria, and the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The operation time was 1.8-4.6 hours (mean, 2.4 hours); the intraoperative blood loss was 200-500 mL (mean, 310 mL). All the 19 patients were followed up for 13.7 months on average (range, 12-18 months). The fracture healing time was 3.6 months on average (range, 2.5-8.0 months). Postoperative complications included anterior-median incision necrosis in 2 cases, traumatic arthritis in 2 cases, and ankle instability in 1 case. According to Burwell-Charnley radiological evaluation criteria, anatomical reduction was obtained in 15 cases and satisfactory reduction in 4 cases. According to AOFAS score, the excellent and good rate was 84.2% (excellent in 11 cases, good in 5 cases, and fair in 3 cases). Conclusion The improved anterior-median incision combined with posterior-lateral incision is a safe and effective method to treat complex Pilon fractures accompanied with fibula fractures, which has the advantages of simple operation, adequate exposure and minimal invasion.

Citation： WANGMingxin, LIUDechang, WANGKun, MENGDeqiang, DINGYue. IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(12): 1483-1487. doi: 10.7507/1002-1892.20160307 Copy

1.	郁耀平, 陈大伟, 俞光荣. Pilon骨折中腓骨固定的研究.中国矫形外科杂志, 2013, 21(20):2072-2075.
2.	刘家明, 高鹏, 沈建雄.复杂Pilon骨折的治疗策略.中华外科杂志, 2011, 49(7):654-656.
3.	Mandi MD, Belin PR, Banks J, et al. Pilon fracture. Clin Podiatr Med Surg, 2012, 29(2):243-278.
4.	Barei DP, Nork SE, Bellabarba C, et al. Is the absence of an ipsilateral fibular fracture predictive of increased radiographic tibial Pilon fracture severity. J Orthop Trauma, 2006, 20(1):6-10.
5.	Lee YS, Chen SW, Chen SH, et al. Stabilisation of the fractured fibula plays an important role in the treatment of Pilon fractures:a retrospective comparison of fibular fixation methods. Int Orthop, 2009, 33(3):695-699.
6.	Rüedi T, Allgöwer M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res, 1979, (138):105-110.
7.	Tscherne H, Gotzen L. Fractures with soft tissue injurie. Berlin:Springer-Verlag, 1984:1-58.
8.	Burwell HN, Charley AD. The treatment of displaced fractures of the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4):634-660.
9.	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.
10.	Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg, 2007, 127(1):55-60.
11.	杨正明, 潘志军, 李杭, 等.胫骨Pilon骨折的外科治疗策略.中华创伤杂志, 2010, 26(9):835-839.
12.	Assal M, Ray A, Stern R. The extensile approach for the operative treatment of high-energy Pilon fractures:surgical technique and soft-tissue healing. J Orthop Trauma, 2007, 21(3):198-206.
13.	陈子贤, 姜南春, 曹渊武, 等.采用前内侧扩大入路治疗复杂闭合性Pilon骨折的疗效分析.中国临床医学, 2015, 22(2):176-180.
14.	杨立辉, 柳伟, 孔晓川, 等.经前正中切口结合L型解剖锁定板治疗Rüedi-AllgöwerⅡ、Ⅲ型pilon骨折.中华创伤骨科杂志, 2014, 16(6):490-494.
15.	程宇, 杨惠林, 王根林, 等.经前正中有限切口治疗Ruedi-Allgower Ⅱ、Ⅲ型pilon骨折.中华创伤骨科杂志, 2012, 14(9):755-758.
16.	张健, 王满宜, 龚晓峰, 等.后外侧入路治疗后方Pilon骨折.中华关节外科杂志(电子版), 2011, 5(4):433-439.
17.	陈立, 马昕, 王旭, 等.后pilon骨折.国际骨科学杂志, 2014, 35(3):151-152.
18.	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.

1. 郁耀平, 陈大伟, 俞光荣. Pilon骨折中腓骨固定的研究.中国矫形外科杂志, 2013, 21(20):2072-2075.
2. 刘家明, 高鹏, 沈建雄.复杂Pilon骨折的治疗策略.中华外科杂志, 2011, 49(7):654-656.
3. Mandi MD, Belin PR, Banks J, et al. Pilon fracture. Clin Podiatr Med Surg, 2012, 29(2):243-278.
4. Barei DP, Nork SE, Bellabarba C, et al. Is the absence of an ipsilateral fibular fracture predictive of increased radiographic tibial Pilon fracture severity. J Orthop Trauma, 2006, 20(1):6-10.
5. Lee YS, Chen SW, Chen SH, et al. Stabilisation of the fractured fibula plays an important role in the treatment of Pilon fractures:a retrospective comparison of fibular fixation methods. Int Orthop, 2009, 33(3):695-699.
6. Rüedi T, Allgöwer M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res, 1979, (138):105-110.
7. Tscherne H, Gotzen L. Fractures with soft tissue injurie. Berlin:Springer-Verlag, 1984:1-58.
8. Burwell HN, Charley AD. The treatment of displaced fractures of the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4):634-660.
9. 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.
10. Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg, 2007, 127(1):55-60.
11. 杨正明, 潘志军, 李杭, 等.胫骨Pilon骨折的外科治疗策略.中华创伤杂志, 2010, 26(9):835-839.
12. Assal M, Ray A, Stern R. The extensile approach for the operative treatment of high-energy Pilon fractures:surgical technique and soft-tissue healing. J Orthop Trauma, 2007, 21(3):198-206.
13. 陈子贤, 姜南春, 曹渊武, 等.采用前内侧扩大入路治疗复杂闭合性Pilon骨折的疗效分析.中国临床医学, 2015, 22(2):176-180.
14. 杨立辉, 柳伟, 孔晓川, 等.经前正中切口结合L型解剖锁定板治疗Rüedi-AllgöwerⅡ、Ⅲ型pilon骨折.中华创伤骨科杂志, 2014, 16(6):490-494.
15. 程宇, 杨惠林, 王根林, 等.经前正中有限切口治疗Ruedi-Allgower Ⅱ、Ⅲ型pilon骨折.中华创伤骨科杂志, 2012, 14(9):755-758.
16. 张健, 王满宜, 龚晓峰, 等.后外侧入路治疗后方Pilon骨折.中华关节外科杂志(电子版), 2011, 5(4):433-439.
17. 陈立, 马昕, 王旭, 等.后pilon骨折.国际骨科学杂志, 2014, 35(3):151-152.
18. 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.

Chinese Journal of Reparative and Reconstructive Surgery

IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content