Division of Orthopedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada.
J Orthop Trauma. 2010 Dec;24(12):757-63. doi: 10.1097/BOT.0b013e3181d04bc0.
The optimal treatment for pilon fractures remains controversial. We have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries and the purpose of this study was to determine the safety and efficacy of this strategy.
Cohort study.
Level I trauma center.
PATIENTS/PARTICIPANTS: Ninety-five patients with Orthopaedic Trauma Association type 43.C pilon fractures.
Primary ORIF.
Primary: Wound dehiscence or deep infection requiring surgery; secondary: quality of fracture reduction, functional outcomes (SF-36 and Foot and Ankle Outcome Score).
Primary ORIF was performed within 24 hours in 70% of cases and within 48 hours in 88%. Reduction was judged to be anatomic in 90% cases. Six patients developed a deep wound infection or dehiscence that required surgical débridement, four after open fractures (four of 21 [19%]) and two after closed fractures (two of 74 [2.7%]). Complications were associated with local scarring, chronic alcohol abuse, schizophrenia, diabetes, and peripheral neuropathy.
Provided surgery is performed expeditiously by experienced orthopaedic trauma surgeons, most tibial pilon fractures can be stabilized by primary ORIF within a safe and effective operative window with relatively low rates of wound complications, a high quality of reduction, and functional outcomes that compare favorably with the published results for all other reported surgical treatments of these severe injuries.
对于 Pilon 骨折的最佳治疗方法仍存在争议。我们采用早期一期切开复位内固定（ORIF）治疗这些损伤，本研究的目的是确定这种策略的安全性和有效性。
队列研究。
一级创伤中心。
患者/参与者：95 例 Orthopaedic Trauma Association 43.C 型 Pilon 骨折患者。
主要 ORIF。
主要指标：需要手术治疗的伤口裂开或深部感染；次要指标：骨折复位质量、功能结果（SF-36 和足踝结局评分）。
70%的病例在 24 小时内，88%的病例在 48 小时内进行了主要 ORIF。90%的病例复位被认为是解剖学的。6 例发生深部伤口感染或裂开，需要手术清创，其中 4 例为开放性骨折（21 例中的 4 例[19%]），2 例为闭合性骨折（74 例中的 2 例[2.7%]）。并发症与局部瘢痕、慢性酒精滥用、精神分裂症、糖尿病和周围神经病有关。
如果由经验丰富的骨科创伤外科医生迅速进行手术，大多数胫骨 Pilon 骨折可以在安全有效的手术窗口内通过一期 ORIF 稳定，伤口并发症的发生率相对较低，复位质量较高，功能结果与所有其他报道的这些严重损伤的手术治疗结果相当。
