NYU Hospital for Joint Diseases, Orthopaedic Surgery, 301 E. 17th St. Suite 1402, New York, NY 10001, USA.
Foot Ankle Int. 2011 Oct;32(10):955-61. doi: 10.3113/FAI.2011.0955.
The optimal treatment for high energy pilon fractures is controversial. Good clinical and functional results have been reported with traditional open reduction techniques and minimally invasive techniques utilizing external fixation (EF). The purpose of this study was to critically evaluate clinical, radiographic and functional outcomes following high-energy fractures of the tibial plafond.
Between 2000 and 2006, 62 patients who were diagnosed with 63 Type 43C pilon fractures were treated surgically by a single surgeon and retrospectively reviewed. Twenty-seven patients were treated with a hinged bridging external fixator (EF) with supplemental limited internal fixation and 35 were treated with open reduction and internal fixation (ORIF) utilizing traditional small fragment plates and screws. Out of the 62 patients, a total of 46 patients were available for review. Charts and radiographs were reviewed and a Short Musculoskeletal Function Assessment (SMFA) questionnaire was administered by a trained interviewer. Seventy-four percent of both the ex-fix patients and ORIF patients were available for followup with a mean of 18 and 22 months, respectively. Results were compared using student's T-tests.
There were no differences between the cohorts with respect to mechanism of injury, presence of an open wound and age. Functional outcomes were similar between the two groups based on the American Orthopaedic Foot and Ankle Society (AOFAS) score and the "function" index of the SMFA. The overall complication and union rates were similar between the two groups.
Both ORIF and EF appear to be comparable for treatment of OTA type 43C (pilon) fractures with regard to final range of ankle motion, development of arthritis and hindfoot scores.
高能 Pilon 骨折的最佳治疗方法存在争议。传统的切开复位技术和微创技术（利用外固定架）已报道取得了良好的临床和功能结果。本研究的目的是批判性地评估高能胫骨平台骨折的临床、影像学和功能结果。
2000 年至 2006 年间，由一位外科医生对 63 例 43C 型 Pilon 骨折患者进行了手术治疗，回顾性分析。27 例患者采用铰链式桥接外固定架（EF）联合有限内固定治疗，35 例患者采用切开复位内固定（ORIF）联合传统小片段钢板和螺钉治疗。62 例患者中，共有 46 例患者可供评估。通过调查病历和 X 光片，以及由受过培训的访谈员进行短肢肌肉骨骼功能评估（SMFA）问卷调查，对患者进行评估。EF 组和 ORIF 组分别有 74%和 71%的患者可获得随访，平均随访时间分别为 18 个月和 22 个月。采用学生 T 检验比较两组结果。
两组患者在受伤机制、开放性伤口和年龄方面无差异。根据美国矫形足踝协会（AOFAS）评分和 SMFA 的“功能”指数，两组患者的功能结果相似。两组的总体并发症和愈合率相似。
在最终踝关节活动范围、关节炎和后足评分方面，ORIF 和 EF 似乎对于 OTA 43C（Pilon）骨折的治疗效果相当。
