Othman Mohamed, Strzelczyk Piotr
Katedra i Klinika Ortopedii i Traumatologii Narzadu Ruchu, Akademia Medyczna, Warszawa.
Ortop Traumatol Rehabil. 2003 Dec 30;5(6):787-94.
Material and methods. From 1996 to 2002 30 cases of distal tibia epiphysis fractures (pilon fractures), including 4 cases of open fractures, were treated by conservative technique. According to the Rüedi-Allgöwer AO classification, there were 13 patients with type I fractures, 9 type II and 8 type III fractures. Follow up examinations were performed from 4 moths to 4 years.
Results. Long-term results (mean 3 years) have been assessed in 8 cases as good, 12 as fair and 10 as bad. In 23 cases osteoarthritis of talotibiae joint has been found. In 16 cases there were deviations of bone axis (15 degree of varus). The range of movement of the joint was limited in all patients. In 18 cases there was no dorsiflexion. In one case shortening of the treated leg 2 cm has occured.
Conclusions. The conservative treatment is effective for pilon fractures type I and II. The majority of bad results was found in type III due to the severe destruction of the articular surfaces. In that cases we recommend treatment by external fixation with corrections of deformation.
材料与方法。1996年至2002年期间，采用保守技术治疗了30例胫骨远端骨骺骨折（pilon骨折），其中包括4例开放性骨折。根据Rüedi-Allgöwer AO分类，I型骨折13例，II型骨折9例，III型骨折8例。随访时间为4个月至4年。
结果。8例患者的长期结果（平均3年）评估为良好，12例为中等，10例为差。23例发现距胫关节骨关节炎。16例存在骨轴偏差（内翻15度）。所有患者关节活动范围均受限。18例无背屈。1例患侧下肢短缩2厘米。
结论。保守治疗对I型和II型pilon骨折有效。III型骨折多数预后不良，原因是关节面严重受损。对于此类病例，我们建议采用外固定并矫正畸形进行治疗。
