360° INTERNAL FIXATION BY DOUBLE APPROACHES FOR HIGH-ENERGY CLOSED Pilon FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CHENZhiwei , CHENDan , YANGHaiqing , WUWente , DAIZhu

Department of Orthopedics, First Affiliated Hospital, University of South China, Hengyang Hunan, 421001, P. R. China;

Corresponding?author：

CHENZhiwei, Email: czw9915@sina.com

Keywords：

Double approaches; 360° internal fixation; High-energy injury; Pilon fracture

DOI：

10.7507/1002-1892.20150266

Video：

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Objective To observe the effectiveness of 360° internal fixation by anteromedial and posterior-lateral approaches for high-energy closed Pilon fractures. Methods Between February 2013 and February 2015, 18 cases of high-energy closed Pilon fractures were treated. There were 11 males and 7 females with an average age of 40.5 years (range, 20-65 years). The causes were falling injury in 10 cases and traffic accident injury in 8 cases. All fractures were RüediAllgower type Ⅲ Pilon fracture combined with ipsilateral fibula fracture. The average interval from injury to operation was 8 days (range, 5-13 days). Reduction of fracture was performed by anteromedial and posterior-lateral approaches and the fracture fragments were fixed by 360° internal fixation. The effectiveness was assessed by ankle X-ray film and Mazur score at last follow-up. Results Two cases had skin necrosis and received flap surgery, the other cases obtained primary healing of incision. All the cases were followed up 11.2 months on average (range, 3-27 months). X-ray film showed that all fractures healed at 3-4 months after operation (mean, 3.6 months). No deep infection or plate exposure occurred. According to Mazur score, the results were excellent in 8 cases, good in 7 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 83.3%. Conclusion The effectiveness of the 360° internal fixation for treatment of high-energy closed Pilon fractures has the advantages of reliable fixation, early functional exercise, and good functional recovery of the ankle joint.

Citation： CHENZhiwei, CHENDan, YANGHaiqing, WUWente, DAIZhu. 360° INTERNAL FIXATION BY DOUBLE APPROACHES FOR HIGH-ENERGY CLOSED Pilon FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1226-1229. doi: 10.7507/1002-1892.20150266 Copy

1.	Marsh JL, Saltzman CL. Axial-loading injuries:tibial plafond fractures//Bucholz RW, Heckman JD, Court-Brown CM, et al. Fractures in Adults. 6th eds. Philadelphia, PA:JB Lippincott, 2006: 2203-2234.
2.	盧世璧, 王巖, 周勇剛, 等. 坎貝爾骨科手術學. 11版. 北京:人民軍醫出版社, 2009:2436.
3.	Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg (Am), 1979, 61(7): 964-975.
4.	Bourne RB. Pilon fractures of the distal tibia. Clin Orthop Relat Res, 1989, (240):42-46.
5.	顧立強. Pilon骨折的分類與功能評價. 中華創傷骨科志, 2004, 6(8):894-898.
6.	Zhang L, Bail H, Mittlmeier T, et al. Immediate microcirculatory derangements in skeletal muscle and periosteum after closed tibial fracture. Trauma, 2003, 54(5):979-985.
7.	Leonard M, Magill P, Khayyat G. Minimally invasive treatment of high velocity intra-articular fractures of the distal tibia. Int Orthop, 2009, 33(4):1149-1153.
8.	黃洪, 儲輝, 俞航, 等. 影響脛骨Pilon骨折療效的相關因素分析. 中國矯形外科雜志, 2012, 20(6):490-494.
9.	Varela CD, VaughanTK, Carr JB, et al. Fracture blisters:clinical and Pathological Aspects. J Orthop Trauma, 1993, 7(5):417-427.
10.	蔣東明, 王培民. 三葉型鋼板內固定治療新鮮Pilon骨折(附21例報告). 骨與關節損傷雜志, 2002, 17(5):392-393.
11.	任繼鑫, 劉智, 李京生, 等. 復雜pilon骨折治療方法的選擇. 中華創傷骨科雜志, 2005, 7(3):221-224.
12.	Leonard M, Magill P, Khayyat G. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia. Int Orthop, 2009, 33(4):1149-1153.
13.	Cole PA, Mehrle RK, Bhandari M, et al. The pilon map:fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. J Orthop Trauma, 2013, 27(7):e152-156.
14.	Korkmaz A, Ciftdemir M, Ozcan M, et al. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury, 2013, 44(10):1270-1274.
15.	俞航, 董啟榕, 儲輝, 等. 多軸鎖定鋼板內固定結合關節鏡技術治療高能量Pilon 骨折. 中國骨與關節損傷雜志, 2015, 30(2):181-183.
16.	Scolaro J, Ahn J. Pilon fractures. Clin Orthop Relat Res, 2011, 469(2): 621-623.
17.	Rüedi T, Allg?wer M. Fractures of the lower end of the tibia into the ankle-joint. Injury, 1969, 1(2):92-99.
18.	霍永鑫, 湯欣, 羅珊, 等. 脛骨Pilon骨折受傷機制的有限元分析. 中華創傷骨科雜志, 2011, 13(3):256-260.
19.	Puha B, Petreu? T, Berea G, et al. Surgical approach in difficult tibial pilon fractures. Chirurgia (Bucur), 2014, 109(1):104-110.
20.	Domingo C, John E. Failed internal fixation about the distal tibia. Tech Orthop, 2003,17(4):479-489.

1. Marsh JL, Saltzman CL. Axial-loading injuries:tibial plafond fractures//Bucholz RW, Heckman JD, Court-Brown CM, et al. Fractures in Adults. 6th eds. Philadelphia, PA:JB Lippincott, 2006: 2203-2234.
2. 盧世璧, 王巖, 周勇剛, 等. 坎貝爾骨科手術學. 11版. 北京:人民軍醫出版社, 2009:2436.
3. Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg (Am), 1979, 61(7): 964-975.
4. Bourne RB. Pilon fractures of the distal tibia. Clin Orthop Relat Res, 1989, (240):42-46.
5. 顧立強. Pilon骨折的分類與功能評價. 中華創傷骨科志, 2004, 6(8):894-898.
6. Zhang L, Bail H, Mittlmeier T, et al. Immediate microcirculatory derangements in skeletal muscle and periosteum after closed tibial fracture. Trauma, 2003, 54(5):979-985.
7. Leonard M, Magill P, Khayyat G. Minimally invasive treatment of high velocity intra-articular fractures of the distal tibia. Int Orthop, 2009, 33(4):1149-1153.
8. 黃洪, 儲輝, 俞航, 等. 影響脛骨Pilon骨折療效的相關因素分析. 中國矯形外科雜志, 2012, 20(6):490-494.
9. Varela CD, VaughanTK, Carr JB, et al. Fracture blisters:clinical and Pathological Aspects. J Orthop Trauma, 1993, 7(5):417-427.
10. 蔣東明, 王培民. 三葉型鋼板內固定治療新鮮Pilon骨折(附21例報告). 骨與關節損傷雜志, 2002, 17(5):392-393.
11. 任繼鑫, 劉智, 李京生, 等. 復雜pilon骨折治療方法的選擇. 中華創傷骨科雜志, 2005, 7(3):221-224.
12. Leonard M, Magill P, Khayyat G. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia. Int Orthop, 2009, 33(4):1149-1153.
13. Cole PA, Mehrle RK, Bhandari M, et al. The pilon map:fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. J Orthop Trauma, 2013, 27(7):e152-156.
14. Korkmaz A, Ciftdemir M, Ozcan M, et al. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury, 2013, 44(10):1270-1274.
15. 俞航, 董啟榕, 儲輝, 等. 多軸鎖定鋼板內固定結合關節鏡技術治療高能量Pilon 骨折. 中國骨與關節損傷雜志, 2015, 30(2):181-183.
16. Scolaro J, Ahn J. Pilon fractures. Clin Orthop Relat Res, 2011, 469(2): 621-623.
17. Rüedi T, Allg?wer M. Fractures of the lower end of the tibia into the ankle-joint. Injury, 1969, 1(2):92-99.
18. 霍永鑫, 湯欣, 羅珊, 等. 脛骨Pilon骨折受傷機制的有限元分析. 中華創傷骨科雜志, 2011, 13(3):256-260.
19. Puha B, Petreu? T, Berea G, et al. Surgical approach in difficult tibial pilon fractures. Chirurgia (Bucur), 2014, 109(1):104-110.
20. Domingo C, John E. Failed internal fixation about the distal tibia. Tech Orthop, 2003,17(4):479-489.

Chinese Journal of Reparative and Reconstructive Surgery

360° INTERNAL FIXATION BY DOUBLE APPROACHES FOR HIGH-ENERGY CLOSED Pilon FRACTURES

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