Treatment of AO/OTA 43-C3 Pilon Fracture: Be Aware of Posterior Column Malreduction
Treatment of AO/OTA 43-C3 Pilon Fracture: Be Aware of Posterior Column Malreduction
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AO/OTA 43-C3 Pilon 骨折的治疗：注意后柱复位不良
DOI：
10.1155/2019/4265782
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发表时间：
2019-01-01
影响因子：
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通讯作者：
Wang, Lei
中科院分区：
文献类型：
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作者：
Guan, Junjie;Huang, Moran;Wang, Lei
由于骨折复位困难和相关的软组织并发症，pilon骨折的治疗仍然具有挑战性。本研究的目的是评估后柱复位治疗复杂胫骨Pilon骨折（AO/OTA 43-C3）的缺陷和策略。回顾性分析了2013年1月至2016年1月期间治疗的13例AO/OTA分类43-C3型pilon骨折。9例于伤后26小时内（6-56小时）行外固定治疗。待伤口愈合，无感染，软组织肿胀消退后，行确定性切开复位内固定术（ORIF）。在延迟/二期手术中，通过后外侧和前侧入路复位胫骨远端平台的关节面。术前或术后进行X线和CT扫描。采用Burwell-Charnley的影像学标准评价复位质量。常规随访，记录所有并发症。采用美国足踝矫形协会（AOFAS）踝-后足评分评价踝关节功能。在延迟/二期手术中，完全通过后外侧入路进行后柱一期复位。然而，4例患者透视显示后柱复位不良，其中3例通过后外侧和前入路重新调整，第4例直接通过前入路调整。术后CT扫描显示12例关节面台阶小于2 mm，1例大于2 mm但小于5 mm。按Burwell-Charnley复位标准，满意率为92.3%。11例患者定期随访; 2例发生浅表感染，但分别在3周和5周后伤口护理治疗后愈合。所有11例骨折均在平均3.6个月（范围，2.6-5个月）内愈合。踝关节活动度平均背屈19°，跖屈28°。平均AOFAS踝-后足评分为82（范围，61-92）。在我们看来，我们建议关节面复位应通过后外侧和前联合入路进行延迟手术，并灵活固定后柱。如果后柱复位不佳，则可通过前路轻松操作关节面。根据这一策略，AO/OTA C3 pilon骨折的治疗结果令人满意。
Treatment of pilon fractures remains challenging due to the difficulty of fracture reduction and associated soft tissue complications. The aim of this study was to evaluate the pitfalls and strategies of posterior column reduction in the treatment of complex tibial pilon fractures (AO/OTA 43-C3). Thirteen AO/OTA classification 43-C3 type pilon fractures treated between January 2013 and January 2016 were retrospectively analyzed. Nine cases were treated by external fixation within 26 hours (range, 6–56 hours) after injury. The definitive open reduction and internal fixation (ORIF) was performed after the wound was healed without infection and soft tissue swelling had subsided. During the delayed/second-stage operation, the articular surface of the distal tibial plafond was reduced through the posterolateral and anterior approaches. X-ray and CT scans were performed pre- or postoperatively. The reduction quality was evaluated using Burwell–Charnley's radiographic criteria. The follow-up was performed routinely and all complications were recorded. Ankle function was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. During the delayed/second-stage operation, primary reduction of the posterior column was performed entirely through posterolateral approaches. However, poor posterior column reduction was revealed by fluoroscopy in four cases, three of which were readjusted through the posterolateral and anterior approaches, and the fourth was adjusted directly through the anterior approach. Postoperative CT scan revealed that the step-off of the articular surface was less than 2 mm in 12 cases, and in only one case the step-off was greater than 2 mm but less than 5 mm. The satisfactory rate was 92.3% according to Burwell–Charnley's reduction criteria. Eleven patients were followed up regularly; superficial infections occurred in two cases but healed after wound care treatment in 3 and 5 weeks, respectively. All eleven fractures were healed within an average of 3.6 months (range, 2.6–5 months). The average range of ankle motion was 19° of dorsiflexion and 28° of plantar-flexion. The mean AOFAS ankle-hindfoot score was 82 (range, 61–92). In our opinion, we suggest that the reduction of the articular surface should be performed through combined posterolateral and anterior approaches in a delayed operation, with flexible fixation of the posterior column. If the posterior column is poorly reduced, the articular surface can easily be manipulated through anterior approaches. According to this strategy, satisfactory outcomes of AO/OTA C3 pilon fractures would be anticipated.