Department of Trauma, Tianjin Hospital, Tianjin, China.
Orthop Surg. 2011 Feb;3(1):45-51. doi: 10.1111/j.1757-7861.2010.00113.x.
To discuss the methods, timing and clinical outcomes of surgical treatment for open pilon fractures.
From April 2003 to July 2008, 28 patients with open pilon fractures were treated. All had type C fractures according to the Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation (AO/ASIF) classification. Three operative methods were applied, the methods being determined by the types of fracture, soft tissue damage and time interval after injury. Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated by the Burwell-Charnley score.
All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1. The healing time was from 2.5 to 11 months (average 4.7 months). Two cases had delayed union. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases, good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis.
It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications.
探讨手术治疗开放性 Pilon 骨折的方法、时机和临床疗效。
自 2003 年 4 月至 2008 年 7 月，治疗 28 例开放性 Pilon 骨折患者。所有患者骨折均按 Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation（AO/ASIF）分型为 C 型。根据骨折类型、软组织损伤及受伤后时间间隔选择 3 种手术方法。7 例行清创内固定钢板治疗，19 例行有限内固定联合外固定治疗，2 例行延期手术。采用 Burwell-Charnley 评分评估临床疗效。
所有患者均获随访，随访时间 648 个月，平均 24 个月。Burwell-Charnley 评分：解剖复位 12 例，功能复位 15 例，不满意复位 1 例。愈合时间 2.511 个月，平均 4.7 个月。2 例延迟愈合。按美国矫形足踝协会（AOFAS）踝与后足评分标准：优 8 例，良 14 例，可 5 例，差 1 例。并发症包括皮肤浅层坏死 4 例，浅表感染 2 例，深部感染 1 例，骨折延迟愈合 2 例，创伤性关节炎 10 例。
根据骨折分型、皮肤及软组织损伤程度和受伤后时间间隔选择合适的手术方式治疗开放性 Pilon 骨折至关重要。彻底清创、合理使用抗感染药物、适当植骨、术后踝关节功能锻炼可减少并发症的发生。
