Stern P J, Roman R J, Kiefhaber T R, McDonough J J
Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Ohio.
J Hand Surg Am. 1991 Sep;16(5):844-50. doi: 10.1016/s0363-5023(10)80147-9.
A pilon fracture is an uncommon intraarticular fracture of the proximal interphalangeal (PIP) joint resulting in comminution, central depression, and splay, sagittally and coronally, of the articular surface of the base of the middle phalanx. This study reviews three treatment methods and results in 20 patients. Injury was produced by an axial load and occurred primarily to the ulnar digits. Clinical and radiographic follow-up averaged 25 months. Treatment was divided into three categories: splint (four patients), skeletal traction through the middle phalanx (seven patients), and open reduction with Kirschner pins (nine patients). Anatomic restoration of PIP articular contour was not achieved, regardless of technique. No patient regained full mobility at either interphalangeal joint. Treatment by immobilization is undesirable. Open reduction should be approached cautiously and may result in significant complications. Skeletal traction is safe and gives results that are radiographically and clinically comparable to those achieved with open reduction.
Pilon骨折是一种不常见的近端指间关节（PIP）关节内骨折，导致中节指骨基底关节面在矢状面和冠状面出现粉碎、中央凹陷和张开。本研究回顾了20例患者的三种治疗方法及结果。损伤由轴向载荷引起，主要发生于尺侧手指。临床和影像学随访平均25个月。治疗分为三类：夹板固定（4例患者）、经中节指骨骨牵引（7例患者）和克氏针切开复位（9例患者）。无论采用何种技术，均未实现PIP关节轮廓的解剖复位。没有患者指间关节恢复完全活动度。固定治疗不可取。切开复位应谨慎进行，可能会导致严重并发症。骨牵引安全，其影像学和临床结果与切开复位相当。
