Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

Pilon骨折20例手术治疗体会

Objective To study the surgical methods and surgical timing on Pilon fractures.Methods Retrospective analysis in accordance with fractures types and soft tissue damage degrees using different methods of internal fixation surgery for 20 eases of Pilon fractures.Results Clinical observation of all cases averaged 18 mouths,all bone healing,Ruediand-Allgawer Ⅰ type had a good rate of 100%,Ⅱ -type 80%,Ⅲ type 67%.Conclusions According to patient's age,general condition,fracture and articular surface of cartilage,the degree of soft tissue injury of different factors,we should select the appropriate surgical meth-ods and surgical timing for Pilon fractures to obtain a satisfactory outcome.     

重度开放性Pilon骨折的治疗

Objective To discuss the operative methods, timing and outcomes of severe open Pilon fractures. Methods From April 2003 to July 2008, 21 patients with open Pilon fractures were admitted. All the patients were type C fracture according to AO/OTA classification, including 17 cases of type C2 and 4 cases of type C3. According to Gustilo classification, there were 18 cases of type Ⅱ, 2 cases of type ⅢA, 1 case of type ⅢB. The patients were treated in two different ways: one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with transarticular external fixation of the ankle (19 cases),which included 16 cases of Gustilo Ⅱ AO/OTA C2, 2 cases of type Gustilo Ⅱ AO/OTA C3 and 1 case of type Gustilo ⅢA AO/OTA C2. Formal open reconstruction of the articular surface by plating and external fixation was performed when the condition of soft tissue had improved (2 cases), which included 1 cases of type Gustilo ⅢA AO/OTA C3 and 1 cases of type Gustilo Ⅲ B AO/OTA C3. Results All the patients were followed up from 6 to 48 months, with the mean of 24 months. The outcome of reduction was evaluated by the Burwell-Charnley score. Anatomical reduction was found in 6 cases, function reduction was in 14 cases and poor reduction was 1 case. The heal-time ranged from 2.5 to 11 months, with the mean of 4.7 months. The delayed union occurred in 2 cases. The rate of delayed union was 9.5%. Two patients experienced skin superficial necrosis. There were superficial infection in 2 cases and deep infection in 1 case. The infection rate was 14.3%. Eight cases experienced early traumatic arthritis. The incidence of this complication was 38.1%.According to American Orthopedic Foot Ankle Society (AOFAS) scale for ankle joint, the result of the treatment was 66-94, with an average of 85.2. Conclusion It is important to have the optimal timing of surgery and reliable fixation according to fracture classification, the condition of soft tissue and time after injury. It is the key to evaluate the condition of soft tissue and protect the blood supply.     

A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

Objective： The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a com- bined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retro- spective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods： Based on an anatomic study oftibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lat- eral （Tillaux-Chaput） involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were： （1） pre- sence of an anterior/anterolateral type fragment or a poste- rior （Volkmann） type fragment involving 〉25% of the articu- lar surface, （2） a minimum follow-up of 12 months, （3） a fibula fracture associated with a medial colunm fracture of the distal tibia, and （4） soft tissue conditions at the time of opera- tion that did not compromise the choice of surgical access （Tscheme classification for closed fractures： grade 0 and grade 1）. Tibial plafond fractures were classified into two groups： one presenting anterior and the other with poste- rior rim （Volkmann） fragments. Results： Most patients achieved a good clinical re- covery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 os- teoarthritis at the 12 month follow-up. Conclusion： Our two-choice strategy highlights con- cepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture pat- terns and their association should be further investigated.     

胫骨干骨折的手术治疗对策

目的：明确不同固定器械在胫骨干不同骨折类型固定中的特点，以指导临床应用。方法：68例胫骨干骨折，行加压钢板螺钉、交锁髓内钉、单侧外固定架固定后，作临床疗效分析。结果：加压钢板固定组42例，感染5例，骨不连1例，平均愈合时间3．8个月；交锁髓内钉固定组13例，无感染及骨不连，平均愈合时间5．4个月；单侧外固定架组13例，骨不连1例，踝关节背伸受限3例，平均愈合时间4．5个月。结论：胫骨骨折交锁髓内钉固定并发症少，功能恢复好，适用范围广，但要注意及时进行动力加压。加压钢板及外固定架固定应选择各自的最佳适应证，以达到理想的疗效。