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.	卢世璧, 王岩, 周勇刚, 等. 坎贝尔骨科手术学. 11版. 北京:人民军医出版社, 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.	顾立强. Pilon骨折的分类与功能评价. 中华创伤骨科志, 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.	黄洪, 储辉, 俞航, 等. 影响胫骨Pilon骨折疗效的相关因素分析. 中国矫形外科杂志, 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.	蒋东明, 王培民. 三叶型钢板内固定治疗新鲜Pilon骨折(附21例报告). 骨与关节损伤杂志, 2002, 17(5):392-393.
11.	任继鑫, 刘智, 李京生, 等. 复杂pilon骨折治疗方法的选择. 中华创伤骨科杂志, 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, 董启榕, 储辉, 等. 多轴锁定钢板内固定结合关节镜技术治疗高能量Pilon 骨折. 中国骨与关节损伤杂志, 2015, 30(2):181-183.
16.	Scolaro J, Ahn J. Pilon fractures. Clin Orthop Relat Res, 2011, 469(2): 621-623.
17.	Rüedi T, Allgöwer M. Fractures of the lower end of the tibia into the ankle-joint. Injury, 1969, 1(2):92-99.
18.	霍永鑫, 汤欣, 罗珊, 等. 胫骨Pilon骨折受伤机制的有限元分析. 中华创伤骨科杂志, 2011, 13(3):256-260.
19.	Puha B, Petreuş 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. 卢世璧, 王岩, 周勇刚, 等. 坎贝尔骨科手术学. 11版. 北京:人民军医出版社, 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. 顾立强. Pilon骨折的分类与功能评价. 中华创伤骨科志, 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. 黄洪, 储辉, 俞航, 等. 影响胫骨Pilon骨折疗效的相关因素分析. 中国矫形外科杂志, 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. 蒋东明, 王培民. 三叶型钢板内固定治疗新鲜Pilon骨折(附21例报告). 骨与关节损伤杂志, 2002, 17(5):392-393.
11. 任继鑫, 刘智, 李京生, 等. 复杂pilon骨折治疗方法的选择. 中华创伤骨科杂志, 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, 董启榕, 储辉, 等. 多轴锁定钢板内固定结合关节镜技术治疗高能量Pilon 骨折. 中国骨与关节损伤杂志, 2015, 30(2):181-183.
16. Scolaro J, Ahn J. Pilon fractures. Clin Orthop Relat Res, 2011, 469(2): 621-623.
17. Rüedi T, Allgöwer M. Fractures of the lower end of the tibia into the ankle-joint. Injury, 1969, 1(2):92-99.
18. 霍永鑫, 汤欣, 罗珊, 等. 胫骨Pilon骨折受伤机制的有限元分析. 中华创伤骨科杂志, 2011, 13(3):256-260.
19. Puha B, Petreuş 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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