Kapoor S K, Kataria H, Patra S R, Boruah T
Lady Hardinge Medical College, New Delhi, India.
J Bone Joint Surg Br. 2010 Aug;92(8):1100-6. doi: 10.1302/0301-620X.92B8.23602.
Open reduction and internal fixation of high-energy pilon fractures are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. A total of 17 consecutive patients with pilon fractures of AO/OTA type 43-B3 (n = 1), type C2 (n = 12) and type C3 (n = 4) were treated by indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov fixator. The calcaneal ring was removed at a mean of 3.7 weeks (3 to 6). A total of 16 patients were available for follow-up at a mean of 29 months (23 to 43). The mean time to healing was 15.8 weeks (13 to 23). Nine patients had pin-track infections but none had deep infection or osteomyelitis. Four patients (25%) had malunion. Fair, good or excellent ankle scores were found in 14 patients. External fixation with a ring fixator achieves stable reduction of the fractured fragments without additional trauma to soft tissues. With minimum complications and good healing results, the Ilizarov apparatus is particularly useful for high-energy pilon fractures.
高能Pilon骨折的切开复位内固定术常伴有严重并发症。人们采用了各种方法来治疗这些损伤，结果各不相同。共有17例连续的AO/OTA 43 - B3型（n = 1）、C2型（n = 12）和C3型（n = 4）Pilon骨折患者，采用经关节囊韧带牵张间接复位，并使用跨踝关节的Ilizarov固定架进行固定。跟骨环平均在3.7周（3至6周）时拆除。共有16例患者可供随访，平均随访时间为29个月（23至43个月）。平均愈合时间为15.8周（13至23周）。9例患者发生针道感染，但无深部感染或骨髓炎。4例患者（25%）发生骨不连。14例患者踝关节评分达到一般、良好或优秀。环形固定架外固定可实现骨折碎片的稳定复位，且不会对软组织造成额外创伤。Ilizarov器械并发症最少，愈合效果良好，尤其适用于高能Pilon骨折。
