Effectiveness of new Pilon plate in treatment of type C Pilon fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YU Jinwei ¹ ,  CHEN Haojie ¹ , ZHANG Yanru ² , CHEN Xu ¹ , CHAI Le ¹ , BAI Wei ¹ , WANG Bin ¹ , SHI Zhiyuan ¹ , SUN Guangtao ³

1. Department of Orthopaedics, the Second People’s Hospital of Jiaozuo, Jiaozuo Henan, 454000, P. R. China;
2. Institute of Orthopaedics, Henan Polytechnic University, Jiaozuo Henan, 454000, P. R. China;
3. Department of Orthopaedics, People’s Hospital of Boai County, Boai Henan, 454400, P. R. China;

Corresponding author：

YU Jinwei, Email: hnwcgk@163.com; CHEN Haojie, Email: 1192664573@qq.com

Keywords：

Pilon fracture; new Pilon plate; ankle joint; internal fixation

DOI：

10.7507/1002-1892.202208013

Video：

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Objective By comparing with traditional L-shaped plate, to explore the effectiveness of new Pilon plate in the treatment of type C Pilon fracture.Methods A clinical data of 57 patients with type C Pilon fractures who met the selection criteria between May 2018 and January 2020 was analyzed retrospectively. Thirty-two patients were treated with new Pilon plate (trial group) and 25 patients with traditional L-shaped plate (control group). There was no significant difference in gender, age, cause of injury, fracture side and type, the interval between injury and operation between the two groups (P>0.05). The operation time and complications of the two groups were recorded. X-ray films were taken after operation to assess the quality of fracture reduction according to the Burwell-Charnley classification and fracture healing. Ankle function was evaluated according to Johner-Wruhs scoring standard and American Orthopaedic Foot and Ankle Society (AOFAS) score.Results The operations of the two groups were completed successfully, and the operation time of the trial group was significantly shorter than that of the control group (t=–3.025, P=0.005). After operation, the incision necrosis occurred in 2 cases of the control group, and the incisions of other patients in both groups healed by first intention. All patients were followed up 8-16 months, with an average of 10.1 months. There was no significant difference in follow-up time between the two groups (t=0.433, P=0.667). X-ray films showed that the ankle reduction of the trial group was rated as excellent in 28 cases and good in 4 cases, with an excellent and good rate of 100%, while in the control group, the ankle reduction was rated as excellent in 15 cases, good in 5 cases, and fair in 5 cases, with an excellent and good rate of 80.0%. There was a significant difference in the excellent and good rate of fracture reduction between the two groups (Z=–2.565, P=0.010). The fracture healed in both groups, and the healing time was (16.59±3.78) weeks in the trial group and (17.80±3.81) weeks in the control group, and there was no significant difference between the two groups (t=–1.191, P=0.239). At last follow-up, according to Johner-Wruhs scoring standard, the ankle joint function in the trial group was evaluated as excellent in 25 cases and good in 7 cases, with an excellent and good rate of 100%; the AOFAS score was 90.9±4.5. In the control group, 16 cases were excellent, 5 cases were good, and 4 cases were fair, and the excellent and good rate was 84.0%; the AOFAS score was 85.2±10.0. The ankle function scores of the trial group was superior to that of the control group (P<0.05). During follow-up, except for 1 case of ankle traumatic arthritis in the control group, there was no complication such as ankle malunion, plate loosening and fracture, or fracture reduction loss in both groups.Conclusion Compared with the traditional L-shaped plate, the new Pilon plate in the treatment of type C Pilon fracture has the advantages of high reduction quality, reliable fixation, less irritation to soft tissue, high fracture healing rate, and satisfactory functional recovery of ankle joint.

Citation： YU Jinwei, CHEN Haojie, ZHANG Yanru, CHEN Xu, CHAI Le, BAI Wei, WANG Bin, SHI Zhiyuan, SUN Guangtao. Effectiveness of new Pilon plate in treatment of type C Pilon fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 31-36. doi: 10.7507/1002-1892.202208013 Copy

1.	Flett L, Adamson J, Barron E, et al. A multicentre, randomized, parallel group, superiority study to compare the clinical effectiveness and cost-effectiveness of external frame versus internal locking plate for complete articular pilon fracture fixation in adults. Bone Jt Open, 2021, 2(3): 150-163.
2.	Aneja A, Luo TD, Liu B, et al. Anterolateral distal tibia locking plate osteosynthesis and their ability to capture OTAC3 pilon fragments. Injury, 2018, 49(2): 409-413.
3.	Bartoníček J, Rammelt S, Kostlivý K, et al. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg, 2015, 135(4): 505-516.
4.	Nwankwo EC, Labaran LA, Athas V, et al. Pathogenesis of posttraumatic osteoarthritis of the ankle. Orthop Clin North Am, 2019, 50(4): 529-537.
5.	Bear J, Rollick N, Helfet D. Evolution in management of tibial Pilon fractures. Curr Rev Musculoskelet Med, 2018, 11(4): 537-545.
6.	Biz C, Angelini A, Zamperetti M, et al. Medium-long-term radiographic and clinical outcomes after surgical treatment of intra-articular tibial Pilon fractures by three different techniques. Biomed Res Int, 2018, 2018: 6054021. doi: 10.1155/2018/6054021.
7.	陈宇, 张晖, 刘熹, 等. 改良分期分部策略治疗C3型Pilon骨折. 中国修复重建外科杂志, 2019, 33(11): 1358-1362.
8.	Assal M, Ray A, Stern R. Strategies for surgical approaches in open reduction internal fixation of pilon fractures. J Orthop Trauma, 2015, 29(2): 69-79.
9.	Carter TH, Duckworth AD, Oliver WM, et al. Open reduction and internal fixation of distal tibial Pilon fractures. JBJS Essent Surg Tech, 2019, 9(3): e29. doi: 10.2106/JBJS.ST.18.00093.
10.	Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4): 634-660.
11.	Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
12.	杨春林, 成瑞萍, 李小美, 等. 微创切口联合胫骨远端内侧板在Ⅰ、Ⅱ型Pilon骨折中的应用. 创伤外科杂志, 2022, 24(5): 364-365.
13.	李勇奇, 罗瑞, 杨云峰. 后踝骨折及后pilon骨折分型的研究进展. 中华骨与关节外科杂志, 2022, 15(3): 234-240.
14.	唐润, 杨杰, 李毅, 等. 改良内侧入路治疗内侧柱压缩性Pilon骨折. 中国骨伤, 2022, 35(3): 248-252.
15.	Hak DJ. Anterolateral approach for tibial pilon fractures. Orthopedics, 2012, 35(2): 131-133.
16.	周树立, 刘志勋, 罗天放. 前外侧入路L型锁定钢板治疗粉碎性Pilon骨折的疗效及安全性分析. 国际医药卫生导报, 2018, 24(5): 674-676.
17.	徐强. 微创经皮钢板内固定技术治疗Pilon骨折的研究进展. 中医正骨, 2021, 33(12): 38-41,45.
18.	Penny P, Swords M, Heisler J, et al. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary? Injury, 2016, 47(8): 1761-1769.

1. Flett L, Adamson J, Barron E, et al. A multicentre, randomized, parallel group, superiority study to compare the clinical effectiveness and cost-effectiveness of external frame versus internal locking plate for complete articular pilon fracture fixation in adults. Bone Jt Open, 2021, 2(3): 150-163.
2. Aneja A, Luo TD, Liu B, et al. Anterolateral distal tibia locking plate osteosynthesis and their ability to capture OTAC3 pilon fragments. Injury, 2018, 49(2): 409-413.
3. Bartoníček J, Rammelt S, Kostlivý K, et al. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg, 2015, 135(4): 505-516.
4. Nwankwo EC, Labaran LA, Athas V, et al. Pathogenesis of posttraumatic osteoarthritis of the ankle. Orthop Clin North Am, 2019, 50(4): 529-537.
5. Bear J, Rollick N, Helfet D. Evolution in management of tibial Pilon fractures. Curr Rev Musculoskelet Med, 2018, 11(4): 537-545.
6. Biz C, Angelini A, Zamperetti M, et al. Medium-long-term radiographic and clinical outcomes after surgical treatment of intra-articular tibial Pilon fractures by three different techniques. Biomed Res Int, 2018, 2018: 6054021. doi: 10.1155/2018/6054021.
7. 陈宇, 张晖, 刘熹, 等. 改良分期分部策略治疗C3型Pilon骨折. 中国修复重建外科杂志, 2019, 33(11): 1358-1362.
8. Assal M, Ray A, Stern R. Strategies for surgical approaches in open reduction internal fixation of pilon fractures. J Orthop Trauma, 2015, 29(2): 69-79.
9. Carter TH, Duckworth AD, Oliver WM, et al. Open reduction and internal fixation of distal tibial Pilon fractures. JBJS Essent Surg Tech, 2019, 9(3): e29. doi: 10.2106/JBJS.ST.18.00093.
10. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4): 634-660.
11. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
12. 杨春林, 成瑞萍, 李小美, 等. 微创切口联合胫骨远端内侧板在Ⅰ、Ⅱ型Pilon骨折中的应用. 创伤外科杂志, 2022, 24(5): 364-365.
13. 李勇奇, 罗瑞, 杨云峰. 后踝骨折及后pilon骨折分型的研究进展. 中华骨与关节外科杂志, 2022, 15(3): 234-240.
14. 唐润, 杨杰, 李毅, 等. 改良内侧入路治疗内侧柱压缩性Pilon骨折. 中国骨伤, 2022, 35(3): 248-252.
15. Hak DJ. Anterolateral approach for tibial pilon fractures. Orthopedics, 2012, 35(2): 131-133.
16. 周树立, 刘志勋, 罗天放. 前外侧入路L型锁定钢板治疗粉碎性Pilon骨折的疗效及安全性分析. 国际医药卫生导报, 2018, 24(5): 674-676.
17. 徐强. 微创经皮钢板内固定技术治疗Pilon骨折的研究进展. 中医正骨, 2021, 33(12): 38-41,45.
18. Penny P, Swords M, Heisler J, et al. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary? Injury, 2016, 47(8): 1761-1769.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of new Pilon plate in treatment of type C Pilon fracture

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