Department of Orthopaedic Surgery, University of Texas-San Antonio, San Antonio, TX, USA.
J Orthop Trauma. 2010 Aug;24(8):491-4. doi: 10.1097/BOT.0b013e3181eb5c4f.
The purpose of this study was to determine the ability of intramedullary fibular fixation to maintain reduction until healing and to determine the overall complication rate in high-energy pilon fractures associated with fibular fractures.
Retrospective study.
Level I university trauma center.
PATIENTS/PARTICIPANTS: From 2000 to 2007, 972 pilon fractures were treated at our institution, 38 of which were treated with an intramedullary device for the associated fibular fracture. Two patients had acute amputations and two died; 1-year follow-up was obtained in 27 of the remaining patients. Average length of follow-up was 21 months.
A retrospective chart and radiograph review was conducted of all patients for data extraction.
Fibular fixation type and length, fibular healing, and complications.
Average patient age was 36 years (range, 18-59 years). Four of the fibular fractures were segmental. All fractures had at least 50% of the cortex intact to prevent shortening. The average height of the fibular fractures from the distal tip was 6.9 cm (range, 1.3-22.2 cm). In 20 patients, a 3.5-mm fully threaded cortical screw was used for stabilization, and in the remaining seven, a 2.5-mm wire was used. The intramedullary implant extended 8.5 cm above the most proximal fracture line on average (range, 1.6-29.8 cm). Fibular alignment was within 3 degrees of anatomic in all cases after initial fixation. At final follow-up, fibular alignment had not changed more than 1 degrees in any case. No complications related to the fibular incision occurred, and all fibula fractures healed within 3 months.
In axially and rotationally stable fibular fracture patterns associated with pilon fractures, intramedullary fibular stabilization was effective in maintaining fibular alignment. This technique led to reliable fracture healing in appropriately selected fractures and may be particularly advantageous in patients with compromised lateral and posterolateral soft tissues.
本研究旨在确定髓内腓骨固定在愈合前维持复位的能力，并确定与腓骨骨折相关的高能 Pilon 骨折的总体并发症发生率。
回顾性研究。
一级大学创伤中心。
患者/参与者：2000 年至 2007 年，我院共治疗 972 例 Pilon 骨折，其中 38 例合并腓骨骨折采用髓内装置治疗。2 例患者发生急性截肢，2 例死亡；其余 27 例患者获得 1 年随访。平均随访时间为 21 个月。
对所有患者进行回顾性图表和 X 线检查，以提取数据。
腓骨固定类型和长度、腓骨愈合和并发症。
患者平均年龄 36 岁（18-59 岁）。4 例腓骨骨折为节段性骨折。所有骨折至少有 50%的皮质完整以防止缩短。腓骨骨折从远端尖端的平均高度为 6.9cm（1.3-22.2cm）。20 例患者采用 3.5mm 全螺纹皮质螺钉固定，其余 7 例患者采用 2.5mm 钢丝固定。髓内植入物平均比最靠近的骨折线高出 8.5cm（1.6-29.8cm）。初始固定后，所有病例腓骨对线均在解剖学 3 度以内。最终随访时，所有病例腓骨对线均未超过 1 度。无与腓骨切口相关的并发症，所有腓骨骨折均在 3 个月内愈合。
在轴向和旋转稳定的腓骨骨折模式与 Pilon 骨折相关的情况下，髓内腓骨固定可有效维持腓骨对线。这种技术在适当选择的骨折中可导致可靠的骨折愈合，并且在外侧和后外侧软组织受损的患者中可能特别有利。
