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Title: [IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES].
Author: Wang M, Liu D, Wang K, Meng D, Ding Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2016 Dec 08; 30(12):1483-1487. PubMed ID: 29786338.
Abstract:
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). CONCLUSIONS: 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. 目的: 探讨改良前正中入路联合后外侧入路治疗合并腓骨骨折的Pilon骨折疗效。. 方法: 2012年1月-2015年6月，采用改良前正中入路联合后外侧入路行切开复位内固定术治疗合并腓骨骨折的Rüedi-AllgöwerⅢ型Pilon骨折19例。男13例，女6例；年龄23～68岁，平均35岁。致伤原因：交通事故伤11例，高处坠落伤7例，重物压砸伤1例。根据AO/OTA分型，C2型4例，C3型15例。根据软组织损伤Tscherne-Gotzen分级，1级6例，2级13例。受伤至手术时间6～18 d，平均10.3 d。术后采用Burwell-Charnley影像学评价标准评价Pilon骨折复位情况，采用美国矫形足踝协会（AOFAS）踝-后足评分系统评价踝关节功能。. 结果: 手术时间1.8～4.6 h，平均2.4 h；术中出血量200～500 mL，平均310 mL。19例均获随访，随访时间12～18个月，平均13.7个月。骨折愈合时间2.5～8.0个月，平均3.6个月。术后前正中切口边缘部分坏死2例，并发创伤性关节炎2例，踝关节不稳定1例。术后12个月，根据Burwell-Charnley影像学评价标准，解剖复位15例，复位一般4例。根据AOFAS评分，优11例，良5例，可3例，优良率为84.2%。. 结论: 改良前正中入路联合后外侧入路操作简便、显露充分、创伤较小，是治疗合并腓骨骨折的Pilon骨折的一种安全有效方法。.

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