McFerran M A, Smith S W, Boulas H J, Schwartz H S
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2550.
J Orthop Trauma. 1992;6(2):195-200. doi: 10.1097/00005131-199206000-00011.
A total of 52 tibial plafond (pilon) fractures in 51 patients were retrospectively reviewed from the years 1985-1990 to define the rate of complications encountered during their management. All fractures were managed under faculty supervision at a level I trauma center and its two affiliated institutions. The follow-up period was scrutinized to determine whether or not a complicating event occurred. Major local complications, termed events, were defined as those requiring unplanned surgery due to infection, wound breakdown with subsequent flap coverage, and failure of fixation or fracture healing. Reduction accuracy and final clinical results were not specifically examined. There were 14 (27%) type I, 17 (33%) type II, and 21 (40%) type III Ruedi-Allgower fracture types. The majority (79%) of the fractures were closed and 89% were treated by open reduction and internal fixation. The overall local complication rate was 54%. A total of 21 (40%) pilon fractures (six type I, six type II, and nine type III) had major local complicating events requiring 77 additional operations. Patient follow-up time ranged from 1 week (the occurrence of a major local complication) to 200 weeks (no complication), with a mean of 67 weeks. Kaplan-Meier survivorship (K-M) analysis was utilized to statistically estimate the complication rate in this patient population accounting for the occurrence of censored events. The K-M-determined event rate was 42 +/- 7%. Ten (of 21) pilon fractures had events by 3 weeks, while only two occurred beyond 40 weeks.
对1985年至1990年间51例患者的52处胫骨平台（pilon）骨折进行了回顾性研究，以确定其治疗过程中出现并发症的发生率。所有骨折均在一级创伤中心及其两个附属机构的教员监督下进行处理。对随访期进行了仔细审查，以确定是否发生了并发症事件。主要的局部并发症，即事件，定义为因感染、伤口裂开随后进行皮瓣覆盖、固定失败或骨折不愈合而需要进行计划外手术的情况。未具体检查复位准确性和最终临床结果。有14例（27%）I型、17例（33%）II型和21例（40%）III型Ruedi-Allgower骨折类型。大多数骨折（79%）为闭合性骨折，89%采用切开复位内固定治疗。总体局部并发症发生率为54%。共有21例（40%）pilon骨折（6例I型、6例II型和9例III型）发生了主要局部并发症事件，需要额外进行77次手术。患者随访时间从1周（发生主要局部并发症）到200周（无并发症）不等，平均为67周。采用Kaplan-Meier生存分析（K-M）对该患者群体的并发症发生率进行统计学估计，同时考虑到删失事件的发生情况。K-M确定的事件发生率为42±7%。21例pilon骨折中有10例在3周内发生事件，而只有2例发生在40周以后。
