Background Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for ...Background Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result. Methods One hundred and ten cases （107 patients） of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved. Results One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley＇s Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system. Conclusion As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.展开更多
Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of...Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications rel展开更多
Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III p...Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019.Before the surgery,the patients were fully relieved of swelling and pain,and a comprehensive examination was carried out.The posteromedial approach exposed the posterior and medial fracture block of the distal tibia.According to the fracture of external malleolus,it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor,and then perform a fracture reduction and internal fixation.Postoperatively,the patients were treated with analgesia,detumescence,anticoagulation and rehabilitation exercise.The American orthopaedic foot and ankle society(AOFAS)score and visual analogue score were recorded at regular follow-up after surgery.A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female(n=20)included in the study,aged 22 to 88 years(average age 54.2 years).The injury mechanisms were falling from a height(n=7),traffic accident(n=6),walking injury(n=2)and heavy injury(n=5).The postoperative follow-up duration was 12—24 months(mean 16.95 months).The AOFAS score of the 20 patients before and after surgery were compared.The preoperative AOFAS score was 38.90±3.91,and the final AOFAS score was 80.55±4.20,(p<0.001).The mean final visual analogue scores at rest,active and weight-bearing walking were 0.30,0.85 and 1.70,respectively.One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures,the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus,achieve good reduction and internal fixation with l展开更多
Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swel...Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.展开更多
BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation.Infection can negatively impact patient o...BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation.Infection can negatively impact patient outcomes.AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.METHODS Among the 137 patients included,67 developed a surgical site infection.Demographic,clinical,and surgical factors were compared between the two groups.A binary logistic regression analysis was used to determine the odds ratio(OR)and corresponding 95% CI for significant risk factors for postoperative infection.RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows:Gram-positive,58.2%(n=39);Gramnegative,38.8%(n=26);and fungal,2.9%(n=2).The following factors were associated with postoperative infection(P<0.05):a Ruedi–Allgower pilon fracture type Ⅲ(OR=2.034;95%CI:1.109–3.738);a type Ⅲ surgical incision(OR=1.840;95%CI:1.177–2.877);wound contamination(OR=2.280;95%CI:1.378–3.772);and diabetes as a comorbidity(OR=3.196;95%CI:1.209–8.450).CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type Ⅲ,surgical incision type Ⅲ,wound contamination,and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.展开更多
文摘Background Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result. Methods One hundred and ten cases （107 patients） of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved. Results One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley＇s Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system. Conclusion As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.
文摘Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications rel
文摘Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019.Before the surgery,the patients were fully relieved of swelling and pain,and a comprehensive examination was carried out.The posteromedial approach exposed the posterior and medial fracture block of the distal tibia.According to the fracture of external malleolus,it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor,and then perform a fracture reduction and internal fixation.Postoperatively,the patients were treated with analgesia,detumescence,anticoagulation and rehabilitation exercise.The American orthopaedic foot and ankle society(AOFAS)score and visual analogue score were recorded at regular follow-up after surgery.A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female(n=20)included in the study,aged 22 to 88 years(average age 54.2 years).The injury mechanisms were falling from a height(n=7),traffic accident(n=6),walking injury(n=2)and heavy injury(n=5).The postoperative follow-up duration was 12—24 months(mean 16.95 months).The AOFAS score of the 20 patients before and after surgery were compared.The preoperative AOFAS score was 38.90±3.91,and the final AOFAS score was 80.55±4.20,(p<0.001).The mean final visual analogue scores at rest,active and weight-bearing walking were 0.30,0.85 and 1.70,respectively.One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures,the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus,achieve good reduction and internal fixation with l
文摘Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompanies the fracture to induce secondary injury to skin tissue. In addition, initiation of postoperative weight-bearing is delayed due to bone fragility and difficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for elderly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe osteoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe osteoporosis. The present case provides evidence that this procdure can be successfully applied to the management of such pilon fractures in elderly patients.
文摘BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation.Infection can negatively impact patient outcomes.AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.METHODS Among the 137 patients included,67 developed a surgical site infection.Demographic,clinical,and surgical factors were compared between the two groups.A binary logistic regression analysis was used to determine the odds ratio(OR)and corresponding 95% CI for significant risk factors for postoperative infection.RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows:Gram-positive,58.2%(n=39);Gramnegative,38.8%(n=26);and fungal,2.9%(n=2).The following factors were associated with postoperative infection(P<0.05):a Ruedi–Allgower pilon fracture type Ⅲ(OR=2.034;95%CI:1.109–3.738);a type Ⅲ surgical incision(OR=1.840;95%CI:1.177–2.877);wound contamination(OR=2.280;95%CI:1.378–3.772);and diabetes as a comorbidity(OR=3.196;95%CI:1.209–8.450).CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type Ⅲ,surgical incision type Ⅲ,wound contamination,and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.
